~ MARCH 29, 2011 ~

JOY KNISKERN: This is Joy Kniskern with the Pass

It On Center. And today we'll be talking about Making the

Business Case for AT Reutilization.

First what I'd like to do is take a few moments to

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transcriptionist with us today, and so she will be taking

transcripts. And that's Kimberly Griffin.

Thank you, Kimberly.

And if you do have technical problems, you can call

Caroline Van Howe, who's with us today.

Hello, Caroline.

And she's at (415) 458-3597. Or you can e-mail

her -- actually, you can type a message in the public chat,

and she can respond to your questions that way as well.

Next slide.

Okay. And we're refreshing on our screen here. So

basically, if you want to look at the learning package for

today's webinar, you can click -- you can go to that

website, and you will see all the slides that we're working

with today, "Building the Business Case For AT Reuse,"

under "New to the knowledge base."

All right. Let's move on.

And for those of you who are interested in getting

CEUs or CRCs, we have the various links to get that

information. If you're asking for CEUs or CRCs, we ask

that you log back in and you put your full name and your

organization so we can provide that to you.

And today joining us we have Sonja Schaible, who is

our executive director with the FREE Foundation in

Virginia; and Barclay Shepard, who's the AT program

specialist with Virginia Assistive Technology System; and

then Sara Sack, who's been with us on previous webinars.

She's the Director of Assistive Technology for Kansans.

And Trish Redmon, who's a consultant with the Pass It On

Center. Thank you all for joining us today.

I wanted to make a few quick comments. And that

is, I just received information from the National

Information System on Assistive Technology. Those of you

who know Dine Golden know that she's been working with the

data system for all the AT programs.

And the information we received on data is that in

2006 we've known that devices that were refurbished and so

on was 5,602. Recent data for 2010 shows a huge jump to

35,844 devices that were reutilized. And that also

includes exchange programs and open loans.

And the total amount of savings that were reported

from all the state AT programs using this system was a

little bit under $18,000.

This is very, very significant. And I'm bringing

this up because today you're going to learn how to go

beyond those basic figures, which is very important if

you're wanting to sustain and grow your program, very, very

important. This basic information is a starting point.

But if you're operating a reutilization program and

you're looking at funding resources or you're looking at

ways to improve the efficiencies of your program, then the

questions we'll be answering today are, what kinds of data

are you going to need?

And through our different speakers today, you'll

hear from program examples, and you'll get, I think, some

very useful data and information that will help you.

So with that, I'm going to turn this away to Sonja.

I will review our learning objectives briefly.

We're going to be developing a business case study of your

program. It should be a sustainability priority. You're

going to be looking at how to identify some target

audiences and specific data to make the business case for

AT reuse. And then you'll be learning about financial data

to compute return on investment for AT reuse data.

You'll also get the beginnings of what you need to

know if you were to develop a business plan for your

program using the business plan guide that Trish Redmon has

developed for us. And we know of a couple of different

programs who've already used this guide to really develop a

solid business plan.

So with that, I'll turn it away to Sonja. Glad you

could join us today.

SONJA SCHAIBLE: Thank you, Joy, and all of you at

the Pass It On Center.

This is Sonja Schaible with the FREE Foundation and

I'm going to start off with making your case stand out

through outcomes data.

Next slide.

Why do I need outcome data? Basically outcome data

is important for a few reasons. It shows equipment donors

the therapeutic and financial impacts of gifted equipment.

It also shows grantors and contributors the therapeutic and

financial impacts of their funding.

You know, there's a lot of great programs out

there, a lot of nonprofits all fighting for the same

dollars right now with this economy. And by us being able

to stand out and show more objective evidence as to why and

how your program is impacting the community that these

grantors and contributors live in and serve in, then that's

going to help you to get the dollars maybe over another

great program that's also going for it.

Another thing that helps with having outcome data

is it just helps to continually test, monitor, and validate

your service model. It's a great way to make sure that

what you're doing is what you want to be doing. If the

numbers are low, then you know you need to make some

changes. So it's a great evaluation tool.

Next slide.

Where do I start? Well, first of all, I think

definitely information you want to remember is that it

doesn't happen overnight. It does take time to develop

your case statement.

The four areas that we have identified as necessary

is -- the first one is, identify the problem that your

organization addresses. Secondly, determine the

consequences if your organization wasn't providing these


So the problem is what's happening in the community

that's not good, and the consequences are what would happen

if your organization wasn't there to provide that service

to make those consequences be less or not at all.

Research costs of these determined consequences.

So you put a dollar value to these consequences. And then

next you're going to collect the data to determine the


So, you know, once you've determined the cost, then

you're going to have that to help you. But now you need to

know to what extent your data helps to apply those numbers

to your data to see the extent of that impact.

Next slide.

Identify the problem being addressed. So now we're

going to take each one of those sections and go a little

bit farther in explaining to you what they mean.

So how is your program helping the client and the

community you serve?

It's a good idea to just sit down with your board

members, your staff and just determine what exactly your

program is helping the client in the community you serve.

And what is your program helping to prevent in the

community from occurring. If your program wasn't there,

what would be happening?

For example, the FREE Foundation's problem is that

in Virginia almost one of every five adults does not have

health insurance. This means that 20 percent of the

state's adult population does not get needed health care

services, medicines and equipment.

Of course equipment is the important one for us.

Even some with insurance could not get all the equipment

they needed to fully recover. So once again, the problem

is that 20 percent of Virginians are not getting the

medical durable equipment that they need to fully recover.

Next slide.

So now we know the problem. So now let's determine

the consequences of that problem.

The consequences of this shortfall, this problem

are dramatic to individuals, families and the health care

system. Without the needed equipment, people could not

recover and return to a life of independence. So the

individual is definitely -- as a consequence, there's

definitely an impact to the individual because their

independence has been decreased as well as their quality of


That, of course, also impacts the family because

now that's the persons who are going to have to help take

care of that family member. And often their health

declined, and falls occurred upon return home without

necessary devices.

So what happens when you don't have the appropriate

piece of medical equipment? You try to make unsafe

transfers. You try to get from point A to point B unsafely

with walking or et cetera. And you fall because you're not

doing it safely, and you don't have the right equipment.

So the biggest consequence for us, besides just

their health decline, is the falls.

Next slide.

So if we take it a step farther and say, Well, what

happens when someone falls or if someone has some kind of

secondary medical condition because they're sedentary and

haven't been able to get around like they should? So

you've got to think of the costly results of these


For the FREE Foundation, what we had determined

was, once a person falls because they weren't able to move

safely in their home, that they ended up having to go to

the E.R.

They ended up having to go to the doctor because of

this fall or because of their condition. They may have to

stay in a hospital because they've broken a bone, and now

they're going to have to stay for a while to get that taken

care of.

They may not be able to return home and have to go

to a skilled-nursing facility or an assisted-living

facility because they're not independent. They can't stay

home alone. So if someone can't take care of them from

their own family, then they're going to have to go into one

of these long-term-care facilities.

Maybe lost wages of the individuals who cannot

return to work. So if the person who doesn't have the

equipment they need is the person who fell, they can't go

back to work. Or if it's the person who needed the

equipment in order to be able to get to work doesn't have

the equipment, they can't get to work.

Lost wages of family members forced to leave jobs

to become caregivers. So if someone doesn't have the

equipment they need to be independent, then if they're not

independent, they're dependent on someone, and it's usually

the family members that have to quit their job to stay home

now to take care of that person.

So it certainly has that ripple effect. It not

only affects the client that's being served but also the

whole family and the community at large.

Let's see. That's the next slide.

So once you've determined your consequences and

that there's a cost related, then you need to determine

what those costs are. So you're going to research. And

again, this is time consuming. Don't expect instant


Some websites that we have found helpful are the

U.S. Department of Health and Human Services, American

Hospital Association, U.S. Census Bureau. Also down below

you can see the National Center For Health Statistics and

the WHO Statistical Information System.

Also locally there are lots of times community

service organizations who do local census services. So

with us we have the Council of Community Services who does

statistics locally. They'll send out surveys. And we can

find out -- if we're looking for funding from local grants

here in our area, then they want to know really how we're

specifically targeting this community, and we can find out

statistics just for this community. So that's always

helpful as well.

Again, once you even get on the site, say you go to

the U.S. Department of Health and Human Services, you must

also remember that the numbers aren't going to pop out at

you. You still have to search even the sites that you know

you can get information from. So it is a time-consuming

step process, but it's worth it when you get the


Next slide.

So we, of course, had done our research. And these

are the costs that we had found using the FREE Foundation


The average cost of an E.R. visit was $1,896. The

average cost of a typical doctor's visit was $155. Average

daily cost of a hospital stay was $1,149. And further

research indicated that a typical stay is usually five

days. So that cost was $5,745.

Average annual cost of a skilled-nursing facility

is $74,095. Further research indicated that the average

stay for recovery is usually 50 days. So we took $74,095,

divided it by 365 days, and then took that number times 50

to get the $10,150.

The average annual cost to stay in an

assisted-living facility, $35,616. Did the same

calculation to get the 50 days, which is the average stay.

That made it $4,879.

The financial impact of a job loss to a family of

three at poverty level is $17,170. Again, we took this at

poverty level. We serve people up to 200 percent above

poverty level. So that really is the lowest, most

conservative figure there for the impact on a family. It

could definitely be higher.

We tend to go with more the conservative figures

and certainly let our funders know that that's the route

that we've gone.

Next slide.

So now that we have the costs of the consequences

that occur from the problem, then we try to go and collect

data to determine the actual impact that those costs have.

What we do at the FREE Foundation is we've

developed a questionnaire that captures the desired outcome


So you need to think what is it that I'm looking

for? What questions can I ask that are certainly going to

give me those answers that I need to find out?

Also you want to determine an appropriate time

lapse before calling or mailing the questionnaire. We

found that calling works much better than mailing. People

tend to move around, or they don't return questionnaires if

you send them in the mail. We haven't had good success

with that.

So we call on the phone. We give the gift

recipient 30 days after receiving their equipment before we

call them. So we feel that that's an ample amount of time

that they've used the equipment and learned the benefits of

it and can give us some good valid information from the use

of that piece of equipment.

Then again we probe the recipients to determine if

the equipment they received is solving the need that

brought them to our program. So that seems to certainly

work best for us.

Next slide.

So determine how equipment alleviates problems. So

the FREE questionnaire is tailored to determine how FREE's

program helps alleviate the problem.

Questions are designed to determine if the

recipients have become more independent; able to take care

of themselves well; had fewer falls; reduced the number of

hospital stays, E.R. visits, and doctor visits; been able

to continue living in their current residence without

having to move to a facility that provides a higher level

of care, which of course are your skilled-nursing

facilities or your assisted-living facilities or even into

a house with someone else, with a family member, which

would require a higher level of care.

So again, these are consequences that we're

checking out to see how we've helped to reduce those.

Next slide.

Our outcomes. We've been doing outcomes since

2004, I believe -- 2002. Excuse me. But for the last five

years these are what our outcomes have been.

And you can see for 2010 greater independence is 96

percent of those that we have given equipment to. We have

decreased falls by 88 percent as well as E.R. visits by

88 percent. We have decreased hospitalizations by 93

percent. And those that were able to stay home versus

having to move into a higher level of care was 100 percent.

So we're very proud of our outcomes this year.

And just quickly, if one of those numbers was very

low, say the decreased falls was -- I'm sorry -- I'm kind

of going back here -- was down to say 70 percent, we would

know then to look at that and realize that we need to

evaluate our program and do some research to find out why

that number was so low.

And that's how we can use this to help us with

evaluating our program and making it what we want it to be

at the standard that we want it to be at.

Next slide.

So then you want to put it all together. So we've

determined the problem. We've determined what those

consequences are because of the problem. Then we've put a

cost value, dollar value to those consequences. And then

we've collected data to see how much those consequences are

being prevented.

And now we're going to take that and apply the cost

to that impact, that data. So knowing the outcomes allows

us to project the final financial savings that result from

the equipment gifted.

You can now quantify the real dollar value of your

program's outcomes, and you can determine the appropriate

number of people served to make the resulting cost savings

present a valid picture.

We used a hundred people served. So we collected

all of our data, and we said, "We think that we can take

100 of the people that we served, and that would give us a

good average range of what would show us the whole -- that

would be a good picture of everyone that we serve."

Next slide.

So our cost savings analysis. We did determine

that, for every 100 persons served, the average is that 26

hospital stays were avoided. And we can take -- you know,

the average stay is five days, which was $1,149. Take that

times 26 to get the true impact of hospital stays avoided.

29 emergency room visits were avoided; same thing.

11 moves to skilled-nursing facilities were avoided.

Again, times the 50 days was the average length of stay

times 11. And then 11 moves to assisted-living facilities

were avoided. So same situation. You can take that times

the average stay of 50 days to get what the dollar impact

is for the savings that we've been able to help.

So our cost savings continued. Again, for every

hundred persons served, also 112 falls were avoided. And

one in four falls results in doctors visited. So we of

course divided 112 by four to get 28 and took that times

the average cost of a doctor's visit.

And 16 family members avoided quitting jobs to stay

at home and care for the recipients. Income per family of

three at poverty level is 17,170.

And again I've said here that, for purposes of

conservatism, FREE assumed only one-third of this cost,

which is $5,723, would be borne by the commonwealth of

Virginia. In reality, 100 percent of lost wages will

directly impact families.

So 16 times $5,723 is $91,573. And again, that's

very low. That's only a third of lost wages, that cost,

that impact.

Next slide.

So the conclusion. FREE has estimated the

financial impact of these results. Most data sources are

prior to 2007. But overall estimates are not adjusted

upward for inflation, therefore, underestimate current


So as you know, a lot has happened with the cost of

living. And the data is from 2007, so this number is very

low. It should be -- could be a lot higher. But the total

cost savings for each 100 recipients served is $465,586.

So next slide.

As you can see, that gives an actual dollar value,

and it certainly stands out and gives us ammunition to

definitely be able to prove that our program saves dollars

for the community as well as subjectively helping the

client that we serve with improved quality of life and

improving their independence.

Cost savings and outcomes data have helped the FREE

Foundation. Again, we have received consistent feedback,

positive feedback from grantors who value our ability to

show measurable results. This has really made us get some

funding that we may not have otherwise because we stood


Knowing their dollars will yield measurable

outcomes has made grantors more willing to invest in us.

People who give money want to see how that money is going

to be used and what the cost savings are. They know that,

like I said, all programs are doing good things, but

they're dollar people, and they like to see dollars.

Our ability to demonstrate quantitative outcome

data has been instrumental obviously in sustainability.

And I think that's the last of my slides.

Any questions? If there are any questions, you can

certainly ask even as the next presenter is going on.

Thank you again, and I'll be listening to the rest of the


JOY KNISKERN: Thank you so much, Sonja. We really

appreciate your information. That was really excellent.

And now what you're going to see from Barclay

Shepard is how the Virginia Assistive Technology System

used the data to secure sustainability funding. And the

FREE Foundation is one of their partners in reuse

throughout the state.

So, Barclay, take it away.

BARCLAY SHEPARD: All right. Thanks, Joy.

I want to talk about -- if we could flip to the

next slide, please.

I'm Barclay Shepard with Virginia Assistive

Technology System, as Joy said. And the first slide I just

wanted to show you real briefly just so you know what AT

reuse looks like in Virginia.

And this is our Virginia reuse network and the

location of the programs. And we have a formal and really

a virtual network.

And the formal network comprises of VATS or

Virginia Assistive Technology System, the FREE Foundation,

and the Department of Rehabilitative Services Woodrow

Wilson Rehabilitation Center. So those three programs.

And our informal network comprises of a whole host

of individuals, faith-based organizations, health care

organizations, much like in many of the other reuse

programs across the country.

But for the formal network, that is the AT Act

program. We are located in the Department of

Rehabilitative Services, which is our VR program. And VATS

administers the Virginia Reuse Network.

As Sonja was just speaking for the FREE Foundation,

the FREE Foundation is a nonprofit organization; they're

more than ten years old; and they're housed in eight

locations across the state. And in the graphic I showed of

Virginia, the stars are where the FREE Foundation has

services in the state.

And in Department of Rehabilitative Services,

Woodrow Wilson Rehabilitation Center has a spinal cord

injury unit, and they have a reuse program in that spinal

cord injury unit.

And really the formal network, we all collect

common data, and we share inventory, and we support one

another when individual programs seek funding.

And really VATS is using the data from all of the

partners to sustain the overall network. So each one of

these partners may get funding on their own for their own

program or for certain areas of the state, and we support


But we also -- what we're looking at doing and what

I'm going to be talking about today is using data to find

funding for the entire network, to support the network,

since that's our approach.

Next slide, please.

I put our mission statement up here. Not that we

wanted to spend a lot of time on the mission statement, but

I just wanted to kind of talk a little bit about that the

Virginia Reuse Network supports AT reuse programs and

services that are appropriate, effective, centralized,

sustainable, and are committed to standardized data

collection and best practices/quality indicators for

national AT reuse.

And really, when we started the Virginia Reuse

Network, we included data in our mission statement. And

really we included this slide because we feel that having

data in the mission statement is really highly relevant to

our conversation today in making a business case for AT

reuse. So that's the only real reason I put it in there,

to show you that data is important.

Next slide, please.

Okay. This slide is labeled "No Data...No

Money...No Mission!" And really, within that, this has

become our informal slogan.

I used to -- when I was in high school, I worked

for an accounting department for a Catholic health care

organization. And what we learned was that the nuns were

very tough businesswomen. And we often heard the slogan

"No money, no mission" when the nuns were making business

decisions or tough business decisions.

And really there's no difference. Health care

organizations like a hospital and reuse programs, they're

both businesses, and they both can have a strong charitable

side to them.

So we kind of incorporated -- and it's just

something we started -- the "no data" part. So instead of

just saying "No money, no mission," we informally say "No

data, no money, no mission." And really we say that to

emphasize the importance of data not just as a requirement

but also as a strategy so we can modify our services and

secure funding.

And really, when I'm talking about data, I'm

talking about statistics and outcomes. And really we use

both. Sonja talked about the outcomes a little bit. But

data -- basic demographic data, persons served, devices

gifted, all those things are very important equally as

important as really all the data is equally important.

But what I found is -- and when we're writing

grants or we're trying to secure funding is who we're not

serving or the underserved. So either we're not serving or

we're not serving them to full capacity or we could serve

them better.

Those are really the important persons to look at

if you're looking for funding. And really the reason for

that is it creates a great opportunity. You can say you're

serving this target population, children, or you're not

serving this target population.

But what we've found is that grantors really prefer

new services that are sustainable versus supplying money or

giving money to a continuation of what already exists.

So most grants that we're finding out there all ask

for either adding to an existing service or creating a new

service out there. And that's what they're willing to


With outcomes, Sonja talked a little bit about the

FREE outcome survey. And this is a customer feedback or

self-reporting exercise that they do that I think is really

great. And like Sonja said, it gives us cost savings,

therapeutic benefits. It gives us a little bit more

information than what the typical statistics or typical

data that we would collect would give us. And we use that.

And I'll kind of share that on the next slide in just a


And the other thing that we've done is really we've

compared ourselves -- how does our program, our state AT

program, how does that compare nationally?

So I mean if we look at 2008 data, we have a pretty

high number of individuals served, a significant amount of

devices distributed, and a significant cost savings when we

compare that to other AT Act programs.

And really we just use this as a strategy to show

that Virginia has a strong program. So when we go out

there and we're talking to people, we can say we have a

strong program in the state, and we want to expand that;

but also we have a strong program nationally. And we can

use that data to kind of make that point.

Next slide, please.

Okay. I talked about the FREE outcome survey that

Sonja was talking about earlier. And it would be too

difficult to put it on the slide. Everything would look so

small. We tried to scan it in.

And so what I did was I just kind of just pulled an

example of some of the FREE questions so you get a basic

idea of what that outcome survey would look like.

And it's really broken into two different sections.

You have yes/no and open-ended-type questions, and then you

have quantitative responses. And both of them are equally


Yes/no, open-ended questions could be, you know,

How is the equipment working for you? That's an open-ended

statement. Do you feel this equipment has increased your

independence when you've used it? Were you mobile or able

to walk before receiving this equipment? And then the

follow-up question would be, Are you more mobile or more

able to walk with the use of this equipment once you

received this equipment? And those are good questions to


And then the quantitative responses -- and some of

Sonja's cost analysis comes from this -- it's

self-reporting from the recipients. How many falls a week

did you have before receiving this equipment? How many

falls a week did you have after you received this

equipment? And that's where she gets some of that data.

And then we can go through. But each one of them

are kind of questions about emergency room visits, avoiding

hospital stays and things like that. And those are all

really important when you're trying to evaluate the impact

on the community.

And really we gather a lot of this information from

the survey, and we can report these outcomes. And once

again, this kind of helps shows the impact on the entire

community from self-reporting from individuals

participating in the program or individuals receiving

services from the program.

Okay. Next slide.

On this slide, what made me put this one up is

Carolyn Phillips with Pass It On Center would always say --

she kind of always says, "Make sure you tell your story."

Make sure you kind of put a face to what you're doing.

And we've really taken this to heart. So we really

use our data and our marketing and our grant applications

and any presentations we make really to tell our story

better. So really we use data as a strategy to tell our

story better.

And if you look at -- we really don't give

ourselves enough credit. And probably you don't either.

We tend to make very passive statements instead of more

stronger statements about what we do.

So I kind of have an "Acceptable" column and a

"Better" column. And really the acceptable is more passive

statements, and the stronger statements are on the

right-hand side.

So, for example, in our marketing and in our

presentations, we could say and it would be reasonable to

say "In FY 2010, the Virginia Reuse Network served 502


We found that it's better or has a stronger impact

if we say "Since 2006, Virginia's formal network of reuse

programs served 6,882 Virginians with disabilities, gifting

8,500 AT devices valued at $3.2 million." And this really

demonstrates the greater impact our programs have had

versus what we just did last year.

Another statement, "The Virginia Reuse Network" --

or the FREE Foundation, either one -- "is a good steward of

its money." And that's certainly a statement that we've

used in the past.

What we've tried to do is make that a little bit

more of a stronger statement. And we will say, "For every

$1 spent on FREE" -- I'm sorry -- "For every $1 spent by

FREE on its mission, $33.40 is returned to the community."

And really this is a nontraditional return on

investment using FREE's cost analysis and its savings to

the community.

So that's some data that we've come up with and

calculated. And we think it sends a stronger message, or

it's easier for somebody to grab that and say, "Wow,

they're doing something really great. Let's figure out how

they've been able to do that."

And then lastly, "The Virginia Reuse Network helps

individuals with disabilities to be more independent." And

that's a great thing, and we certainly support that.

But probably a better way to say that is "Recipient

outcome surveys show 80 to 100 percent decrease in falls,

E.R. visits, and hospitalizations."

And that was that table that Sonja was talking

about at the end regarding the outcome survey, the results

from individuals.

And really we feel that the data really helps us to

tell our story. And we use this as a strategy, like I

said, to modify our services and approach funding sources.

Next slide, please.

Okay. This is a pretty simple graphic. It's a

little table, and it's only got a couple of items in it.

But we think it really shows the value of reuse.

If the average cost of a walker, cane, or similar

device is $100, our reuse ratio -- it's pretty simple to

explain. We could buy one walker or one cane for the

amount that we could gift two of them.

The same thing with wheelchairs. We could buy one

wheelchair, or we could gift four. We could buy one power

chair, or we could gift ten.

And the FREE Foundation came up with this reuse

leverage table. And I thought it was really good because,

inherently there's a cost to reuse, but it shows that reuse

is an efficient and effective model for getting people the

rehab equipment that they need. So that's why we use that

one. And it's pretty simple, and people kind of seem to

get that. Easy to follow.

Next slide, please.

Okay. How does VATS use the data to secure funding

for the network. And like I said, we're talking about the

entire Virginia Reuse Network. And really this is an

overly simplified looking graphic. It's not really meant

to be that impressive.

It's really just a philosophy to help guide us in

terms of our sustainability and what we need to be looking

at in terms of sustainability. And it's called the

"Five-Legged Stool."

And the stool could be a 20-legged stool.

Hopefully it's more than a one- or two-legged stool. And

that's the idea. But we kind of look in several different

areas right now that we're looking for funding for our


And we're really looking at long-term grants;

short-term grants; funding from our state AT program,

putting aside some money for reuse within our ATF dollars;

Virginia Medicaid, and what I'm really talking about is

collaborating with the Department of Medical Assistance

Services or Virginia Medicaid; and then a legislative

approach, approaching the Virginia General Assembly for


And we've used data in all of these. Some of them

we've been more successful in than others. And I can kind

of go through that with the next slides.

Next slide, please.

The Commonwealth Neurotrauma Trust Fund Board, or

CNI. The Virginia General Assembly established this

Commonwealth Neurotrauma Initiative Trust Fund Board to

support research, education, and treatment relating to

traumatic spinal cord and traumatic brain injury.

And the really interesting thing is that the Code

of Virginia established a funding mechanism for this. And

the Department of Motor Vehicles collects an extra $30

additional reinstatement fee for an operator's license.

So basically you have bad drivers' fees. So if

someone has their driver's license suspended for a host of

reasons, $5 will go towards administrative fees, $10 will

go towards research, and then $10 will go towards

community-based programs.

And we were fortunate enough that the Commonwealth

Neurotrauma Initiative Trust Fund Board put out an RFP.

And this RFP was specifically for community-based programs

to be able to improve services for persons with spinal cord

injury and traumatic brain injury.

And when we were applying for this, at first we

said, "Well, you know, it might fit." And with any grant

you're going to look at it and go, "Hmm, let's see if this

works or this doesn't work for us."

And we looked at it, and we knew we were serving

persons with some complex cases because of the medical

model that we have with the FREE Foundation and some other


But we kind of really had to look at our data to

see how we can make a case for this. And really, when we

looked at our data, we really saw that we were serving

mostly persons who were 55 and older. And that might be

very similar to a lot of the other AT reuse programs across

the country.

But we were serving some. It's just we had low

numbers of what we thought of persons with spinal cord

injury and traumatic brain injury, maybe even lower than

what we thought. And it just seemed to, in our brains,

create an opportunity to build the capacity.

So although our data showed that we were serving

low numbers, this was a great opportunity for us to say,

"Wow, you know what? If we do certain things, we can build

capacity to better serve these individuals."

And also we showed that we were serving large

numbers of individuals in our programs. And because we had

a lot of equipment that needed to be processed, we really

needed to automate this process, but not only automate it

but to upgrade the process from a cleaning process to a

true sanitization process.

So we responded to the RFP. And in our proposal we

added Woodrow Wilson Rehabilitation Center because they

have a spinal cord injury unit, and they're part of the

state's VR program. So by adding them, we added in some

extra expertise for spinal cord injury.

So using all of this together, we were able to put

in a proposal. In the end result we ended up getting

$416,000 over three years. And I just estimated here about

$300,000 for operations, which is great, and about $100,000

for five Hub Scrubs or automated sanitizations units that

we've been able to put across the state.

So we're really excited about this. And this is

one way that we used our data to show that, through

additional funding, we could expand these services to

better serve a target group that we really weren't

targeting at the time, but now we are.

And we've made some great connections with the

Spinal Cord Injury Association of Virginia and the

Traumatic Brain Injury Group in Virginia. And so we've

actually made some great connections through them through

obtaining this grant.

Next slide.

The American Recovery and Reinvestment Act funds.

ARRA funds became available last year, and we immediately

began looking at how we could secure some funding through

our VR, vocation rehabilitation, program for reuse. And we

weren't sure how we were going to do this, to be quite

honest with you.

We did look at the number of vocational

rehabilitation participants that we were serving in our

reuse programs. And we found those numbers to be very low.

It might have been 1 or 2 or 3, and maybe they weren't


The other part of it was we really weren't tracking

VR participants. It wasn't part of our data collection


And we also saw that there was a great opportunity

to help vocationally oriented individuals have access to

back-up durable medical equipment.

And we looked at this as being -- originally as can

the counselor, instead of purchasing AT for an individual,

could they look at this as a comparable benefit?

And we had a lot of issues with that. And so we

decided to kind of drop that part of it and really look at

just what would be considered true back-up...

JOY KNISKERN: Hello, Barclay. We've lost sound.

Hope you can hear us. And maybe you need to depress your

mic again.

BARCLAY SHEPARD: Yeah. I think what happened is

my screen saver went off, and my mic got depressed.

So the point -- and I'm not sure where you lost me,

but basically the point I was making was we were serving

low numbers in the VR program, and we saw an opportunity to

help persons get back-up durable medical equipment.

Everybody needs a primary piece of equipment, but

you can't go to your job or receive your education if you

don't have a back-up piece of DME. And we really felt like

this was a great opportunity to partner with the VR

program, our reuse program, and our reuse partners with the

VR program.

And the other issue that we found just through our

research, that the VR programs or VR field offices across

the state, families would call them and say, "Hey, we had

this piece of equipment. We no longer need it. What do we

need to do with it?"

And these pieces of equipment were just getting

stored in VR offices, and there was no system to get

this -- there was no connection to the reuse program or no

system to get this good equipment back into the hands of

people that could use it. So it was kind of a win-win all

the way around.

It was also another opportunity to connect our VR

offices, our employment service organizations with our

reuse partners.

So the long story short is we did get some monies

through ARRA funding through our VR program, about $20,000

annually. It wasn't a lot of money, but it was good

because it got our foot in the door with the VR program in

terms of receiving some funding through them.

In our preliminary results in the first eight

months, we saw 22 VR participants served by the reuse

programs. The cost savings was about $16,500. And that's

just the value of the back-up equipment that these

individuals were receiving. And we did get increased

donations from VR participants and field offices.

And the other part that I didn't put on here was we

just really connected our reuse partners across the state

with our VR field offices, with our employment service

organizations. So there were a lot of connections that

were made past that.

But anyway, okay. I think that's enough on that


Okay. Other strategies -- and we're almost done

here. But other strategies that we have that we've used

data to sustain the network.

We've certainly looked at -- with Virginia

Medicaid, we actually invited two members of the Department

of Medical Assistance Services to be a part of our AT

advisory council. And we share with them data constantly:

what we're doing, how we're expanding programs, what we're

seeing in our reuse programs. So we have them a part of

our advisory council, which has been a really good thing.

We developed a durable medical equipment pilot

program, which is really a collaboration among the Virginia

Reuse Network partners, durable medical equipment vendors,

and Virginia Medicaid.

And the purpose of this program -- it's not a

funding thing where Medicaid is -- Virginia Medicaid is

giving us money; however, it's a foot in the door, and it's

us all collaborating together where the durable medical

equipment vendors are educating Medicaid recipients about

the benefits of reuse, who it might benefit, and really how

to increase our inventory of gently used equipment with the

application of the 1-800 stickers on it.

So we've gotten some great collaboration out of

that, and we're still collecting data on that.

The last -- well, there's actually this slide and

then one more. But the last thing I was going to talk

about was the Virginia General Assembly and the governor's

budget fact sheets.

And really what we found is that it's difficult. I

mean it's difficult to use a general assembly approach to

get money. And I know it has been done in the past.

But what our idea is and what we need to do on an

annual basis is educate our legislators and educate the

governor about what we're doing and how we are impacting

the community.

Using some of that cost analysis that Sonja was

talking about and I was talking about, the outcomes data.

We include a lot of that information on our facts sheet.

It's a one-page fact sheet. On the front is basic

facts, and the next slide will show it in a minute. And on

the back we have a proposed budget.

And really the thing that we've gotten out of the

legislative approach is we've learned that you don't need

to just go after all the legislators. You really need to

go after the legislators that are on particular committees,

the money committees.

And there might be six, eight, or ten people on

those money committees, the house appropriations or Senate

finance. And those are really the individuals that you

need as patrons on your legislation that you're trying to

get passed or on your budget amendment that you're trying

to get passed.

And really, if you can get some of those key

individuals on those committees, you're working a lot

smarter and not harder. And we've definitely learned a


The other thing is you've got to get started on

that stuff early. Like if you want to get on the

governor's budget, we've determined you really need to

start about in June or July having meetings with the

governor because the governor's budget in Virginia is done

by about mid-December.

We started the approach this year I think in

October or November or something, and it was just too late.

But that's just something we learn every single year as we

do this.

But just producing these fact sheets. And I think

constantly going back and not giving up after the first

year. Keep going back and going back. And it might take

three, four, five, six years. But we're going to keep

doing it; we're going to get smarter at it; and eventually

we're going to get in there, especially when the state gets

a little bit better economy.

But I think it's always important just to keep

using that data and keep those individuals informed on what

you're doing and what your reuse programs are and how

efficient and effective our programs are or your programs

are in helping people.

And the last slide -- and this is going to be our

fact sheet -- oh, I see. It says "The fact sheets are

included in the webinar package."

So anyway, the fact sheets are going to be included

in the webinar package, and you can download it and take a


Any questions for me? Let me take my mic off real


JOY KNISKERN: Thank you, Barclay. We really

appreciate it. That's excellent, excellent information

from both you and Sonja and the first two presentations.

And we are going to move forward and look at return

on investment: what it is, how you can use it. Sara Sack

is sharing this information with us today.

Thank you, Sara.

SARA SACK: Good afternoon. And if we can advance

to the next slide, I'll take you through the road map of my

assignment for this afternoon.

And we will be discussing the terms that you use to

talk about value and how we really come to those terms; the

evolution of value, how we kind of arrived at where we are

now; how to calculate return on investment, simple return

on investment.

And then I'll share examples of using return on

investment in our practice for guiding our program

decisions. And then we will talk about using complex

return of investment to build a business case.

And as Barclay and Sonja were talking about, how to

use that to share with other potential funders and how to

make that more solid in our efforts.

So if we could move to the next slide.

I think we're all pretty comfortable now that -- we

know that it wasn't that long ago that we were talking

about activities, numbers of activities, and how that's

changed. And now we're really looking at the benefit or

the value of what we do.

And people generally talk about the value of

investment in terms of money, people, and time. Monetary,

the money side of it, is the most commonly used term of

value. But we look at return of investment in other

broader areas. And that was just what Sonja and Barclay

were doing.

The Global Reporting Initiative, it's a federal

initiative and an international initiative that was

established in 1997 where they're really looking at value

across three different areas: the environmental value, the

economic value, and the societal value.

And I think what we're doing naturally is talking

about our program in these three key areas. I think it

might be wise for us to be maybe more aware that that's

what we're doing, and maybe we can approach it and

strengthen our efforts in those areas.

So if we move on, what exactly are we talking about

in terms of -- in these financial, these value-laden terms

because we want to be comfortable with the words that we

use when we try and explain what we do to these potential

funders and benefactors.

The terms you'll hear are things like: The cost

benefit of your program. What is a simple return of

investment of your program? What's the business case for

your program?

So what are these terms? Well, they're similar,

but they're slightly different.

When individuals are talking about cost benefit,

most generally it's a list, a general list. Once in a

while you'll see a benefits-to-cost ratio. And I'll talk

about that in just a minute in a little more detail so you

kind of are more comfortable, when someone uses that, what

exactly that they mean and what they don't mean.

And then the term that we're using and we're

talking more and more about is return of investment. And

you have two basic types. You have a simple return on an

investment where you're really just comparing the efficacy

and efficiency of different investments.

And then the more complex version, and they do call

it complex return of investment or a business case. And

that is really where you're stating your definitions and

your assumptions. And as you go and do this, you're

actually modifying your statements and your values

according to the picture that you're painting for a

specific audience.

For example, in Kansas, if I know I'm going in

front of a certain group of bankers, I know they're very

conservative. So I would modify perhaps the value of the

equipment. I might take a more restricted value.

In Kansas we already take a conservative value of

80 percent of MRSP for our durable medical equipment. In

going before some conservative bankers, I may devalue that

to say 50 percent. In doing that, in stating that, I'm

making a more complex return-on-investment analysis and a

more business case approach.

So if we can move to the next slide.

So when you go -- if you Google "return on

investment" or listen to some YouTube videos, you'll hear

different people talking about it.

One person you'll hear a lot is Jack Phillips. And

if you go to the library and look at the books on return of

investment, he's published extensively on this topic.

And one of the key points that Mr. Phillips makes

is that you really need to state everything before you

begin and that the credibility of your organization of

these facts is really critical to your eventual success and

in sharing your information.

And so just real quickly, he talks about balanced

categories of data; he talks about using a conservative set

of standards.

Everything we're going to be doing today and we

have done. We've heard from Sonja and Barclay today is

reflected here.

And then he talks at the last about using a

procedure or procedures that are accepted by other funding

entities and agencies. And again, that's what we're doing,

and that's what we're trying to strengthen as we do so our

arguments are really well received and understood by folks

that maybe have stronger financial backgrounds than some of


So if we move to the next slide.

If you're starting in this arena and figuring out

your return of investment for your program, it's fine to

start with -- I mean the word is simple return of

investment, but that's just fine.

So how do you calculate that? Well, quickly, you

just take your gains or the benefits of your program, and

you subtract your investment, and then you divide by the

cost of operating that program.

Now, I've got a note on this slide that lately I've

been seeing reports where groups are just taking the

benefits and not subtracting what it costs to run the

program and then just dividing by the cost of the program

and saying that that's a cost-benefit ratio.

Well, yes, it is a cost-benefit ratio. But when

you talk to financial professionals, they're really saying

that this is not an appropriate use and that you really

need to always subtract the cost.

So just a caution, if you look at materials to see

how the formula has been calculated, that you really do

want to acknowledge the costs of operating a program and

take those out.

So quickly and easily, if you had an investment of

a hundred dollars in the stock market and you were one of

the lucky ones and now you've earned $20, so when you cash

it in you have $120.

So using this formula, you'd say, "Okay. I now

have $120. I started with a hundred. That was my

investment. So I take that off. And then I divide by the

cost of my investment," by your hundred dollars. So you

have a return of 20 percent.

So the way you would talk about this with a

financial audience is, for each dollar invested, 20 cents

earned in return after costs were recovered. And that I

think is the language we want to get comfortable with

using; that you've acknowledged the cost of operating your

program, and this return is after those costs have been

recovered. I think that's a way that we want to start


If we can have the next slide, please.

So I'll move through this kind of quickly. You'll

have, obviously, this material in the archives. So if this

is new to you and you want to start figuring your return of

investment, you'll have it to go back and refer to. I know

we want to be sure and have time for Trish and her work


But before you start your calculations, it's like

everything. You want to lay out the rules and get started

and not make adjustments to make them fit at the end that

you'd like to have them.

So you list the costs of your program. What are

the operational costs including your staff time? What are

the costs of your volunteers? And include that.

Like Sonja had done in her presentation, I've

listed several resources for you that will take you right

to the facts and figures for your state. And if you go to

this site, it would tell you volunteer time in the United

States for 2009 was calculated at $20.85, but for Kansas it

was $17.79.

And if we move to the next slide, it will just give

you that website, and we'll again show you the map of the

United States.

And then if you were able to see there in the

bottom, you can calculate the costs. And if the web page

actually went further down, it would list state by state

the costs or values for your area.

So I thought that was very helpful. And that is a

well recognized site used by nonprofits and others.

The next slide.

And before you're starting your calculation, of

course, you'll want to think about the benefits. And

that's of course what Sonja and Barclay have been talking

about. And we want to go back and remember that global

initiative and think, "Okay. What case are we making?"

And so you will have a number of different cases.

Are we making an economic case? Are we making a societal

case? Are we making an environmental case?

And we've just listed here a number of return on

investment business cases that you may want to make for

your program depending on the audiences that you're going

to approach.

And this comes from a presentation that Joy and I

did down in Orlando.

And we had just listed: access to needed

equipment; increased community living; preventing

institutionalizations, which we have done in our state;

increased independence; less personal assistance; reduction

of work absence by having back-up and secondary equipment

like Barclay was talking about; prevention of falls and so

forth; reduction in number of emergency room visits;

calculation to determine the waste kept out of landfills --

and I'll show you one of those in just a minute; the value

of increased time producing homework with refurbished

laptops, and that was a return of investment that Joy and

her folks in Georgia have done.

The next slide, please.

So we also want to think of any additional benefits

that you want to acknowledge in your formula. Increase

network partners. Those have been very valuable for us.

We could easily do a return of investment for having that

increased network out there and our ability to respond in

cases of emergencies if the audience that we were going to

approach was, you know, a disaster response team.

So then, when you figure your return of

investment -- and I'll show you some of our charts here in

just a second -- you want to state right on there your

definitions and your focus.

And then finally you want to think about what would

make your happy; what's a good return of investment. I was

at a hearing at the Kansas legislature. And a legislator

had announced that he would be quite happy with a $2 return

on an investment. So I thought, "Well, okay. We can make

him quite happy." So that was nice to know and nice to

hear just kind of what they thought a good metric was.

So your next slide just shows we use figuring just

simple return of investment for our access sites and for

our program.

And this is an old slide. This was our 2008, 2009

data. And I'm just showing you because it was already

creating, and this is just simple return on investment.

And it just lists the costs that we had there. It lists --

at that time we were saying "assets," but the benefits, the

value of the program, the number of pieces of equipment,

the value of that.

So at that point, our return on investments after

costs were recovered was $2.62 in the early days of our


So next slide.

We use program data. We will look at -- we have

five access sites across our state and additional affiliate

sites, so really six sites that bring in and work on the

distribution of equipment. And we look at each of these on

a regular basis and what types of equipment they're

bringing in and what's their calculation for that period of

time, how much did it cost to run their program.

So this just shows you how we look at that -- those

numbers across time by devices, what types of devices.

Next slide, please.

And this slide will just tell you then for the next

quarter. And the decision made on that last quarter was

that they had a lot of lower-cost items. And while they

had a lot, it was a very rural site. That was great. But

our focus is on lightly used, high-cost items.

So even though our ROI would be going down to

adhere to our program standards, we needed to increase the

focus on our more expensive equipment. And it just shows

you that was the decision we made. That was the

instructions. We had changed on our broadcasts and our

radio alerts and changed that information.

And then the next slide.

I'm just going to kind of hurry through some of

these. That just shows that, yes, when we did that for a

period of time, we did drop in our ROI, but it adhered

closer to our program standards. And we thought long term

it was a good decision to make. And that was just where we

showed you that information and how we're displaying that.

The next slide shows you return of investment for

collection drives. We hold durable medical equipment

collection drives across the state. And so I've just

shared some of our graphs on doing that and looking at

the --

I hear a message "Don't rush." And I see -- I'll

slow down for half a second. I see Joy's message on a URL

for the volunteer site. Yes, it's on there. I'll go back

in just a minute and repeat it to you. But it's included

in the link here.

So what we have on this slide -- I was talking

about the durable medical equipment collection drives --

this was a simple return on investment where we just said,

"Okay. What did it really cost us to run these collection


And it cost $5,060 including all the personnel

time. And so that was really a cheap, cheap series of

collection drives. And we brought in quite a bit of

equipment. And when you valued the equipment, it gave you

a return of investment for the drive of $28.97. So it

looked like a good return of investment.

Okay. And the next slide.

We then started looking at that and did a more

complex return on investment. And we said, "Well, you

know, some of our assumptions in here is that our program,

as I said, really focuses on lightly used, high-cost


And so we adjusted the figures and said, "Okay. We

really felt like the value of this equipment was too high.

And this was used a little bit heavier, so we adjusted our

value to 40 percent of the manufacturer's suggested retail

price." And that brought that return of investment down

from your $26 figure to $13.99.

And then we went at the next slide a step further,

as we're really analyzing what we were doing, and said that

we wanted to look more carefully at what we got.

And in doing this, this is kind of like what they

will tell you if you're looking at the training or some

other aspect of your program that's a little harder to

value, that you need to make your statements and then say

what it is worth to your program.

Like in the earlier example, developing network

partners. It may be worth a lot to our program. Or it may

cut down on other public awareness costs. Or it may save

us considerable money for not having the costs of another

site. So you state all of those things.

Well, our assumption here was that we wanted to

focus on the lightly used, high-cost; and we wanted to

increase the public's awareness of the program. So that

was a benefit from the program as well as increasing our

durable medical equipment provider network.

So if you move on then to the next slide.

And this shows just the beginning analysis that we

made on that where we acknowledged only a portion of the

equipment that was brought in. So only the higher-cost

items were calculated. Everything else was still accepted

at the collection drive, but the values were only given for

those specific items.

So then your return on investment went from that

original $26 for the very same series of collection drives

to $8.39. But we felt that that was a more honest figure

for what we were trying to do. But that's just an example

of how we use the data.

Then we're moving on. I'm showing you here that we

applied for an award back in 2007. And people around here

are snickering and laughing because it was pretty funny,

but it was the Department of Health and Environment, and it

was a pollution prevention award.

And we actually won one of the five awards or

whatever for the state, and we got a lot of publicity. It

was probably one of the smartest things we did because it

got you at the state capitol in a good light.

But this is the way we did it. It was kind of like

back to what Barclay and Sonja were saying. We approached

a durable medical equipment provider, and he helped us with

estimated weights of the items. And then we calculated how

many items that we had kept out of the landfill. And this

is just the chart on how we did it.

And then the next slide shows you the additional

values and details. So if you want to try an environmental

return on investment, here are some of the things you might

think about.

You could use like the previous information and

then combine it with the facts and figures for your state.

Landfill tipping costs were between $13 and $20 per ton

that year. The costs getting to the landfill were not

included. So that's even more money.

We talked about environmental hazards, but we

didn't put a dollar value on it. We just talked about all

these metals leaching into the ground and so forth that we

had prevented.

We talked with a local manufacturer who reported

that he spent $194,000 to landfill 5,000 tons. So that

gave us a more accurate cost, local cost per tonnage.

And so that we concluded in 2007 that our program,

the Kansas Equipment Reutilization Program, saved at least

$1,373 in potential landfill costs by keeping this tonnage

out of the landfill.

So you might find that interesting or not, but it

might help you if you want to try and make that argument in

your state.

So then I thought, "Okay. You probably want to

know how we're doing now and what our return on investment

looks like and what our considerations are."

So I thought I'd give you and we could just look at

2009, 2010 data. And using that high-cost, lightly used

equipment, we reassigned 698 devices that were valued at

$940,000 -- well, $940,004.

And the value -- I've got the asterisk there. It

doesn't -- and then you see later in the chart that we are

valuing that on 80 percent MSRP.

And there is the cost of our program, $271,487. So

if you're doing the math, you would take the 940,000,

subtract the 271, and then divide by the 271. And that

would give you a $2.46 return on investment after costs are


And then the way you would state that is that is a

246 percent return of investment. And so that would be how

your financial professionals would be wanting to hear it.

So then if we move to the next slide.

I thought, "Okay. Let's take that and apply what

we've learned today and make a more complex business case

and see how easily we could do that."

We could cite the nice data we have from the

Virginia study, which you just heard said that 11

assisted-living placements were avoided per 136. I didn't

quite know Sonja's breakdown. I had her earlier figures.

But that was, according to my calculations, roughly 8

percent of the population.

So I think again, "Knowing my audience -- very,

very conservative -- we would cite the Virginia study, say

that in Kansas, if we were keeping 1 percent of Kansans, or

in this case approximately seven people this last year, out

of assisted living, what would that mean?"

And I've given you here one source for

long-term-care placement costs. And again, this site will

take you to the current costs for your state. And it gives

nursing-home costs, assisted-living-center costs, the

various costs. And they reported that the costs in Kansas

were $24,999 a year for assisted-living placement.

So if we go to the next slide, you would take that

almost $25,000 times your seven people. So we had avoided

$174,993 in costs.

So then your formula is just your benefits -- so

you get to add that to your benefit line and then do your

math. And so when you follow that same formula, then your

return on investment, when you calculate that seven people

have not entered an assisted living, which is very, very,

very conservative, that gives you your $3.11 earned in

return after your costs are covered or your ROI goes to

301 percent.

So that's just currently how we're using the data.

We just had a visit here on-site last Thursday from our

governor, and we were able to talk with him about just

briefly this program and its return on investment. And he

was like, "Oh, that sounds like a really strong program."

So that's kind of the report from Kansas.

So at this point I'll turn it over to Trish, and

we'll move on.

JOY KNISKERN: And Trish is a consultant with the

Pass It On Center -- this is Joy speaking -- and has worked

with us, as mentioned before, on developing a business plan

that has actually been used by a couple of states.

And it's a way to take all this data that you've

learned about -- or if you're even starting a new program,

you can do some extrapolations of the population you would

intend to serve.

And, Trish, if you've got a mic, I'm going to turn

it over to you.

TRISH REDMON: Thank you, Joy.

We've heard three really good presentations today

about using data to make a business case. And I'm just

going to go briefly through a few slides because our

outlines for how to write these plans are in the knowledge

base. I've attached them to today's webinar package.

So if you go to the knowledge base, the first thing

you'll see listed under "New" will be an item about the

webinar, and it will have the guide attached.

Just quickly, we talked about developing business

plans. And the first step I think is to go back and review

the indicators of quality of AT reuse to frame


Whether you're a new program or an existing

program, that gives you an idea of what you're doing. If

you're new, of course you have to address the issues of

organization, structure and legalities.

But whether you're new or an old program, you first

need to develop a strategic plan before you write a

business plan. And you'll see a brief guide to the

differences and what you need in each one in those outlines

that I've attached. And then you're going to want to

tailor the plan for its proposed use.

We talked about how you would use these plans to

focus your new program or your existing program, how you

use it to support applications for funding, and how you

make the case to nonfinancial supporters and advocates.

The first thing is a strategic plan. And without

going into it at length, this is when you scope what it is

that you do with your program and explain to someone else

what you're doing; or perhaps you explain to yourself what

your focus is for the future.

And it first and foremost articulates your mission

and vision. And I'd like to tell all of you that Sonja's

FREE Foundation does something that's just outstanding. If

you look at her website, every single page has the mission

displayed. It's very creatively done. I recommend you

look at it.

We looked at that last year when we did a webinar

on effective websites. And I was just struck by how great

it is that they found a design to do that.

You really want to analyze your prospects using

SWOT analysis that's frequently used in business your

internal strengths and weaknesses and the external

opportunities and threats that present for you.

And then you want to translate your mission into

SMART goals. And you all know about SMART goals. And if

you're starting something new, whether it's a new program

or a new improvement plan, you want a timeline for


So once you do the strategic plan -- which is not a

big document. This is a narrowly focused document that you

develop with your board, your advisory council, your key

individuals -- then you're going to add the business plan

components: demographics about populations, statistics.

And you can take a look at the outline, and you're going to

need to do some financial analysis.

An example. We saw some statistics. Sonja used

some of those. This is one from the business plan from DME

Dallas that was one of the people who used our outline.

And it was similar to what Sonja showed you.

In Dallas County, 33.2 percent of the residents

under the age of 65 have no medical coverage. Over

40 percent of the people have incomes below 200 percent of

the federal poverty level. Well, that's a start on

defining the population you're going to serve.

And then they applying something else. And you can

do perspective analysis. They don't know, but applying

something researched in California, they said 5 percent of

the population will use DME each year.

According to this standard, we have 25,000 to

50,000 uninsured or low-income people in Dallas County who

need DME each year and don't get it.

So the essential components of your plan. And I'm

going to go through this quickly and not read all this to

you because you'll find questions in every section of the

plan outline for you. So if you just download that, it

will walk you through all these things.

You'll need to determine what your costs are. And

you've seen that. You'll need to do some accounting


And then, as Sonja and Barclay and Sara have all

said, you need to tell the story. After you've collected

all this financial data and collected outcomes data or

applied other people's outcomes data to get perspective or

potential savings or payback or return on investment, then

you have a story to tell.

And when you write this plan, you'll do a generic

plan, and then you'll customize this plan for the specific

audiences you have.

To borrow money, if you contemplate doing that, you

focus on how you assure someone of orderly repayment.

If you want support from foundations or

corporations, you need to emphasize the return on

investment we've talked about today; the societal benefits

that we've been able to compute; and the capacity for

growth that Barclay touched on -- who else can we serve;

and your plans for sustaining your program.

So you can use what you learned today about the

impact of outcomes data to make the case for investment in

your program.

And for individual donors, never underestimate how

important it is to explain in simple terms. As we saw, a

manual wheelchair can save this many dollars in hospital

stays, doctors visits, lost income. We've all seen those

ads on TV how few dollars it takes to feed a child for a

month. Those things really touch people in real ways that

they can understand.

The guides for writing the business and strategic

plans are on the Pass It On Center knowledge base,

passitoncenter -- that should be ".org." My mistake. I

left out the ".org."

It's You'll see

the guides. And I'll add PDFs of our slides there


We would like to -- before we leave -- and it's

been wonderful for me. And we thank you all for attending.

We want to encourage you to please put your program

on the map. The Pass It On Center website has a locations

database. We would like you to take a look. If you're not

there, please create a profile and enter your information.

If you are there, please update it.

And we'd like to ask you to evaluate our

performance today. And if you would go to this web

address, Survey Monkey, you'll find a survey to do that


And do we have any questions?

JOY KNISKERN: Thank you, Trish. That was


And as Trish said, we really hope that you will

take the time to go ahead and fill out that survey and let

us know how we're doing.

And please, please, please do let us know if this

was helpful to you and if there are other topics around

this area that you feel we need to address or anything else

that's reuse.

If there are a few questions, we can take them now

and let you go on about your way the rest of the afternoon.

All right. Thank you all so much for joining us

today. We appreciate your participation. I think this was

a knowledge-packed information session with lots of good

information that we can take back and use.

And I see a lot of people are saying, "Thanks."

We appreciate you. And thanks for joining us


And thanks also to Sonja and Barclay and Sara and

Trish. Appreciate the work that you did putting this

together for us. Thank you.