The introduction of consumer-led models of service delivery are fundamentally changing and challenging the role of governments and service providers.
The shift toward commissioning and contestability in human services is happening just as another trend – the move from a traditional service-led environment to a new consumer-led era – is picking up speed.
The introduction of consumer-led models of service delivery – where consumers are empowered to exercise choice and control over their lives and the services they use – are fundamentally changing and challenging the role of governments and service providers. It involves a shift in the power balance between the consumer and the professional, recognising that the consumers lived experience might provide useful insights into what supports might be effective.
While this model can bring many benefits, including faster innovation, higher consumer satisfaction, improved outcomes, and up to 20 percent cost savings1, the change is not easy. In fact, in the private sector, where this trend has been ongoing for some years, leaders still cite the challenge of remaining relevant and customer-centric as their top concern2.
In human services, a consumer-led model is a fundamental change for all stakeholders. Governments are focused on managing the transition with care to ensure that outcomes improve, rather than deteriorate, and it produces some financial benefit.
The traditional service-led model of human services delivery – the ‘medical’ model – often positions individuals as ‘problems’ or ‘challenges’. Service delivery is more ‘one size fits all’, typically focusing on pre-defined off-the-shelf services or support.
In a consumer-led model, services are tailored towards the individual’s specific needs and desired outcomes, forcing the service provider to tackle the barriers to better care being faced by the consumer. The service provider must listen to the individual to better understand their needs, and then respond in a more integrated way.
The question shifts from ‘which one of these services do you need?’ to ‘what does a good day look like for you?’
Not only does this represent a significant transition for the individual, from being a passive recipient of services to becoming an informed, active consumer, it is also a fundamental challenge for government in terms of creating and facilitating a supportive environment.
The key challenges that governments and service providers must address while transitioning to this new delivery model can be distilled into four main issues:
1. Providing the incentive to exercise choice
There needs to be an incentive for consumers to exercise their new-found choice and control. Otherwise, why bother? Allowing people to personally benefit from their decisions creates an incentive for them to exercise an informed choice.
Many current models use the language of ‘choice and control’, but in reality it is the service provider – often the government – that retains most control, given their regulation of how the market works. In some cases, consumers may be given a personal budget to spend, but they can only spend it on strictly prescribed items or services, as defined by government. Likewise, only those providers approved by government can supply services in the first place.
For more progressive models to work, this needs to change. Governments will have to genuinely relinquish control to consumers. They need to empower people to consider the range of options available to them, and resist the urge to control 100 percent of the risks.
2. Accepting a higher level of risk
The flipside of providing an incentive for people to exercise choice is that they must be trusted to make that choice appropriately – and this means governments need to accept a higher level of risk than they are used to. It doesn’t necessarily mean giving people carte blanche to spend their allotted budget on whatever they want, but listening to the individual and trusting them to know how best to spend their budget, even if it is not on services or solutions a traditional human services delivery model would have provided.
The National Disability Insurance Scheme (NDIS) in Australia, for example, received some early criticism for the level of control retained by government. More recently, however, it is starting to consider how it can give people more control over the services they buy, and moving towards the acceptance of a higher level of risk in the process.
3. Providing choice in the market
In the absence of competition (e.g. in regional or lowly populated areas) there is little point in creating a new service delivery model that drives the concept of choice and control. Service providers accustomed to a traditional service delivery model will often have a tendency to provide the same services they have always have.
Likewise, people will tend to only ask for the services they have always received. Governments must therefore be prepared to disrupt the market by introducing an ‘irritant’ to facilitate a change in consumer behaviour. In the UK, for example, support planner programs (such as MySupportBroker.com and London Brokerage Network) have introduced new services through consumer-centred assessments targeting outcomes, as opposed to items of equipment that were needed. Such approaches have enabled consumers to think in a different way about what they wanted and has forced providers to be more responsive and innovative.
Providing choice, in turn, drives service providers to be more innovative in the services they deliver and the value they add.
4. Creating a system that people can easily navigate
Service delivery models need to be designed in such a way that enables people, in a practical sense, to make those choices and exercise control. They need to be able to navigate the system and choose how to spend their budgets.
In a simple, highly regulated market, if someone needs homecare and there is only one provider it is easy to get the required services. With the introduction of choice, however, it becomes more complex. Consumers need timely, accurate and consistent information on which to base their choices.
One way for authorities to address this issue is through ‘brokerage’. That is, specialist and knowledgeable intermediaries that, based on the consumer’s desired outcomes, can inform them about, and guide them towards, the range of options available to provide the care they seek.
Online ‘e-marketplaces’ are one way of achieving this. Online portals, such as the Staffordshire Marketplace in the UK and Better Caring in Australia, enable providers to promote their offering, and consumers can directly access the care services they need.
But particularly for human care services, e-markets alone are rarely an adequate solution. Much of the evidence suggests that consumers, as well as family members and caregivers, prefer to talk to a human being. If someone is choosing care services to improve the quality of life for their child, for example, clicking twice on a website and then ‘checking out’ is unlikely to satisfy their very human need for guidance and reassurance.
This does not mean that the whole process must be one-to-one but, initially at least, people benefit from personal advice and guidance to point them in the right direction. Such guidance may be particularly important for individuals with complex needs. Peer Brokerage services and Cultural Brokerage programs that provide peer system support and planning are models used in the United States to this effect.
The capacity of Artificial Intelligence to make complex decisions, and learn, presents great potential in supporting consumers to navigate complex service systems and exercise choice. For example, Enfield Council in the UK is trialling an AI tool named Amelia to support customer navigation of council services. In Australia, the National Disability Insurance Agency is partnering with IBM Watson to incorporate cognitive computing into its technology platform to support program participants3.
Other guidance includes a ‘Trip Advisor’ approach, with sites emerging that provide real-life feedback, reviews and ratings to help other consumers find the best care for their needs. Examples include Care Navigator in Australia, which allows people to search for NDIS services and provide reviews. Similarly, in the aged care sector, Aged Care Report Card allows people to rate services against categories, such as food or staffing levels.
A truly vibrant, innovative market driven by active consumers making informed decisions can lead to better outcomes. To achieve this, governments are enabling the right incentives and choice for consumers, while adapting their views of risk.
Everyone has someone they care for. Whether it is a child, parent or spouse, people want to make sure their loved ones are well looked after. But more than anything, they want them to be as happy as they can be. This means much more than just organising good care – it means listening and working together to find the right mix of support for that individual. That’s a much harder objective to achieve, but the benefits are worth it.
Liz Forsyth is a key adviser to government as well as the private and not-for-profit sectors. Liz’s practice specialises in strategy, policy development, program design and reform, service improvement, resource allocation and funding methodologies and evaluation.
She has lead major projects related to establishing the Australian National Disability Insurance Scheme, developing new integrated service delivery models for reducing violence against women and children, developing a model regulatory framework to support deregulation in social services at a national level.