Job placement and development activities are important predictors of Vocational Rehabilitation (VR) employment outcome, and the bulk of these services are provided through purchasing agreements with external vendors. When these services are not available for purchase, VR counselors provide them. This can cause significant delay for rural consumers because many counselors are unable to provide timely services due to their large service areas.
One explanation for provider scarcity is the VR system’s movement away from fee-for-service (FFS) towards results-based funding (RBF) for purchasing job placement and development services. FFS arrangements generally require pre-authorization from the VR agency to pay for a specified number of consumer contact hours. RBF payments are contingent on achieving specified milestones linked to consumer outcomes. RBF has some noted advantages, including greater incentive to secure consumer employment outcomes; faster service delivery; reduced provider paperwork requirements; and greater flexibility in how providers deliver services. Studies have highlighted improved outcomes using RBF including higher rates of person centered planning and employment retention rates for consumers.
However, the system has limitations. For instance, because RBF payments are contingent on meeting specific milestones, there is an inherent disincentive to serve cases who might be harder to place. RBF also shifts risk away from the payer of services towards the provider because there is no payment unless a milestone is achieved. There is a need for adequate compensation to overcome disincentive and risk to entice providers to serve consumers in most need.
RBF payment mechanisms also have not adequately accommodated geographic “risk” or disincentives linked to serving consumers in or near towns with small economies. Qualitative research conducted by RTC:Rural showed that RBF resulted in fewer providers in rural locations because consumers were harder to reach, experienced transportation barriers, and had fewer employment options—all factors that delay case progression and make it more difficult to achieve required milestones.
The Rural Contracted Services project explores state VR agency access to job development services provided by vendors in rural communities.
- Study 1 uses qualitative interviews with VR informants to examine current VR agency purchasing practices for job placement and development services, current provider availability within each state and region, and agency strategies for delivering services when providers are not present.
- Study 2 is informed by study one to examine how different payment methods affect competitive employment outcomes using RSA 911 data.
- Study 3 examines vendor decision-making regarding service delivery to rural areas, including the advantages and disadvantages of different payment arrangements such as fee-for-service or milestone payments to overcome geographic risk. We will conduct qualitative interviews with both small and large vendors operating under a variety of payment arrangements.
Results from these three studies will serve as a basis for developing VR practice recommendations. The recommendations will outline effective third-party payment arrangements that promote access for rural consumers. These findings are important because third party providers often provide the bulk of job placement and development services. When these services are not available for purchase, VR counselors provide them. For rural consumers, this can significantly delay case progression because many counselors visit out-locations infrequently and are unable to provide timely services (Rigles, Ipsen, Arnold, & Seekins, 2011). Additionally, VR offices indicate that lack of access to community rehabilitation programs “impedes positive consumer outcomes” (U.S. Department of Education, 2005, p. 35).
- Project dates: 2013-2018
- Funded by: National Institute on Disability and Rehabilitation Research Grant No. H133B130028
- Principal staff: Catherine Ipsen, Ph.D., Becca Goe, M.A., Mary Olson, MSW
- Related projects: