A Menu Based Approach to Pricing – a Test on Day … menu based appr… · Web viewThe exercise may help to prompt thought about more possibilities. The pricing of a menu based

In Control Conversion of in-house services project

A Menu Based Approach to Pricing – a Test on Day Services

Introduction

In larger extra care schemes for older people there have been some experiments in offering residents the chance to individually tailor services by choosing from a costed ‘menu’. Appendix 1 gives an example.

The idea considered here is whether a similar approach to the pricing and marketing of other in house, support and social care services might also have some merit?

In discussion with local authorities taking part in the conversion of in-house services project,, it was felt that a useful area to at least initially explore this idea was day services.

Modernising day services puts “a strong emphasis on individual needs, flexibility and the active involvement of service users1”. This would seem to be exactly what some of the experiments with extra care services achieve:

Individuals select what services they want so the service is developed by the person – active, direct involvement to meet personal needs as determined by the individual

It can be very flexible varying on a daily, weekly or monthly basis according to needs and preferences

As far as pricing is concerned, this is transparent for users. The basis of charging does vary according to the nature of the activity so it allows for a more sophisticated pricing structure than for example, simply one set hourly rate for support. The pricing however remains simple. It also allows prices to reflect different cost levels associated with each activity.

Test on day services in Leeds

In extending day services beyond dependence on traditional building based day centres, a wider range of individual or small group activities are envisaged. For people with learning disabilities and mental health problems there is also a focus on employment and work opportunities as well as education.

Leeds City Council currently runs 33 traditional day centres which are used by a variety of groups, in particular:

Older people People with learning disabilities People with mental health problems

1 A Life in the Day, Campaigns Team, Mencap, February 2002.

- 1 -


People with physical or sensory impairments

It was agreed that as the authority is in the process of modernising services moving to more community based activities and it is anticipated eventually closing these day centres, it would be most useful to focus on these newer forms of modern day service that do not depend on presence in a designated centre.

Traditional charges

Under different names, including resources centres, activity centres, adult learning centres, social activity centres, day services involve building based activities, in a segregated environment. For carer’s day centres have offered (relatively cheap) respite care. For those who use day centres they are a place where various activities take place. They may fulfil a social, rehabilitation, education or work function. The centres vary in scale, focus and scope.

The traditional pricing structure in relation to older people’s centres has however typically been:

A modest charge for 5 – 6 hours presence. This may be free, £1.50, £3.50 or some other figure up to around £10

Cost of meals, £1 – £2.50 Cost of transport, £1 - £2.50 Charges, where levied, will normally be subject to financial assessment of

ability to pay under FACS. Users placed in permanent care for example, are very unlikely to have sufficient resources to make a contribution under non-residential charges

Charges historically do not necessarily bear much relation to actual cost. In many local authorities, transport costs account for a substantial amount (up to 25%) of the day services budget. A common criticism of the larger day centre model is the time spent (and cost to the authority) of travelling to and from the day centre and possibly to and from an activity originating at a day centre.

Community based provision

Local authorities have developed day services based on accessing ordinary facilities in the locality. Typically these are things like shopping, going to a gym or leisure centre, swimming, the library, attending some form of education or occasionally, for some groups other than older people, employment.

There are also examples of people, usually in small groups of 2 or 3, going to someone’s house (often a volunteer) for the day or part of a day.

Community based services are indicative of the ‘direction of travel’, however criticisms include:

Cost of using community facilities

- 2 -


Where cost is not an issue, the activity, if repeated to excess may not be very ‘meaningful’ e.g. going round the shops, when the individual concerned cannot afford to buy anything

May not operate every day May not offer effective respite

As the Mencap report on day opportunities noted (op cit):

“The premature closure of day centres before viable alternatives are in place is mirrored by concerns that some local authorities are increasingly trying to offer services ‘on the cheap’. Typical practices are, in fact, mass group outings and people spending hours each week on college courses with no perceptible aim”.

Modern day services

The principles of modern day services are broadly agreed. They derive from national policy leads such as ‘Valuing People’ (DH, 2001), ‘Independence, well-being and choice’ (DH, 2001) and ‘From segregation to inclusion: commissioning guidance on day services for people with mental health problems’ (DH, 2006) and are:

Focus on the individual with some real choice; tailored support where necessary

A wider range of activities which are meaningful A focus on inclusive activities based in the community A full service covering at least five days of the week; ideally evening and

weekends as well A service that meets the needs of both the individual and, where relevant,

carers Accessible services that should meet the needs of diverse groups Be based on partnership between Adult Social Care and local agencies

To varying degrees, to some extent influenced by the particular user group, there is also emphasis on:

User involvement and user led services Recovery, rehabilitation or health Reducing social isolation Personal or skills development

In concrete terms the type of service to be offered to individuals typically looks like that summarised in the box below taken from a service specification.

- 3 -


The contractor will offer: Individually designed and structured activities – education, sport and fitness,

leisure, art, design, crafts and supported volunteering etc – which support people to connect with mainstream community activities

Up to date advice and information, on education, sports, leisure and the arts activities with the local community

In partnership with educational institutes, access and support into further education courses in-house and externally, on a one to one or group basis

Support to access and sustain supported volunteering A place to meet people, incorporating social aspects, promoting confidence

building, in a relaxed friendly environment The opportunity to acquire recognised qualifications in administration,

Information Technology and E-commerce Particular activities and opportunities for currently under-represented groups e.g.

women, people from black and minority ethnic communities The opportunity to socialise with the support of a peer group The opportunity to access paid work when ready, through the supported

employment services Regular individual reviews to ensure individual needs and aspirations are being

metMental Health Work and Day Services, Community specification, The Eastern Surrey Partnership, 2006

Principles of extra care approach

The example cited of extra care (Appendix 1) illustrates the menu approach:

A list – the ‘menu’ of personal support and related housing services that a resident might want - is created

The options are grouped in a way that reflects the nature of the service Each group then is priced – most charged by time but not necessarily or

solely.

There is an on-going debate about how to fit Personal Budgets into extra care where a basic building block of services has been a degree of common, shared services; buildings, facilities, support and care. The best schemes are argued to be those that integrate housing, care and support so from the individual residents perspective it is one ‘seamless’ and flexible service. A key contribution to this debate noted:

“Cost transparency

Previous research evaluating the costs and benefits of extra care has been unable to disaggregate costs of all the complex funding systems and unit costs to the level of the individual, beyond basic data on rents and service charge. How can costs be made more transparent at an individual level? What will the impact be on individualised contracts and accounting for services? ”2

The ‘menu’ approach delivers a degree of transparency for the resident. It seems likely that further refinement in extra care will be to set:

2 Building Choices; Personal budgets and older people’s housing, Housing 21, 2007.

- 4 -


A core charge which recovers costs of facilities and services which are necessarily shared and where it is clearly economic or effective for this to continue

Individual charges as per the menu – but extended beyond the example in the Appendix

Individual Budget Pilots – Lessons

An analysis of the costs of the support plus of 285 people in the Individual Budget (IB) pilot gives an initial picture of how money maybe spent in the future3. This includes spending on day opportunities.

The packages of support varied greatly from only £72 to £165,000 resulting in some difficulty in describing the typical or ‘average’ position. Thus the mean IB was £11,760 (total cost divided by number of packages) but the median – the package for the middle person in the list - was only £6580.

Taking the ‘mean’ as our measurement of the norm costs this varied significantly between groups as would be expected:

Table 1 Average cost of IB

Mean Costs (£s)People with learning disabilities 18,610People with physical disabilities 11,150People with mental health problems 5,530Older people 7,860

About 6 in every 10 people used their IB to buy traditional services although they spent proportionately less of their funds on them; 44%. So the majority of the money was not spent on the usual mainstream services but something different.

In terms of day opportunities ‘menu’ and how people used their IB in the pilot the list included:

Employment and occupation Going out: meals/ pub/ day trips/ cinema etc. Classes/ arts and crafts Gym membership/ swimming Computer maintenance/ internet access/ games Admission fees for service user and PA

Courses and computer equipment Photography course Computer/ laptop IT course Hygiene training

3 Unit costs of health and social care, Lesley Curtis (ed), PSSRU, 2008

- 5 -


Driving lessons

Hobby Hobby related e.g. art materials, music keyboard, bikes, camera, football tickets,

snooker cue

Day services – the Leeds context

Leeds City Council operates a significant level of traditional in-house day service provision, predominantly day centres, for a range of groups. The scale of the current operation, in terms of buildings based day services is summarised below.

Older people – 20 day services including 4 centres that specialise in provision for people with dementia and 2 that offer some specialist provision for people with dementia.

People with learning disabilities – 8 day services. People with mental health problems – 3 day services. People with physical or sensory impairments – 2 day services.

Leeds has undertaken work to identify and set prices for its in-house day services. This has been based on identifying the current unit prices for each day service (based on 2009/10 expenditure divided by 2008/09 activity, excluding transport costs, meal costs and any recharges). The calculated unit costs are expressed as a price per day. The unit costs vary considerably between different services because of variations in staffing levels and client attendance. The unit cost (price per day) variations are summarised below.

Older people (mainstream day centres) - £29 - £51 Older people (dementia day centres) - £49 - £72 People with learning disabilities – £31 - £56 People with mental health problems – £24 - £26 People with physical or sensory impairments – £63 - £70

In order to be in a position for individuals who take up a personal budget to be able to ‘purchase’ a Leeds CC in-house day service, a set of prices has been agreed for each category of current buildings-based day services. Leeds has considered using three methods of identifying prices for day services; a daily price using the Sheffield pricing model (analysed as part of this work for iN Control Partnerships), data from the PSSRU and the existing method of dividing the budget for a service by the activity to produce a price per day. The existing pricing method has been used as an interim approach to setting prices for current day services with the proviso that these prices can be changed in response to feedback from clients and in the light of this work for iN Control Partnerships.

At the current time the following prices per day will apply for in-house day services:

Older people (mainstream) - £43.19 Older people (dementia) - £51 People with learning disabilities – £43.45

- 6 -


People with mental health problems – £28.24 People with physical or sensory impairments – £66.53

Although these prices have been agreed by Leeds CC Departmental Management Team Transformation Board, it is in full knowledge of the limitations of this approach and that this is, in effect, pricing services as they currently operate rather than an approach to pricing a different ‘menu-based’ approach to the delivery of day services and supports.

To this end Leeds sees the need to invest in the development of a new infrastructure for day opportunities. For example, in May (2009) it held a market engagement exercise with a variety of ‘third sector’ agencies that provide services for people with learning disabilities intended to increase the range of activities on offer and possibly extend the range of organisations involved. It is supporting this work with £0.8m of revenue funding and £2.1m of capital funding over 3 years. The intention is that third sector organisations will bid for this funding, as single organisations or in consortia, to develop and run new and innovate types of ‘day services’ that extend opportunities for people with learning disabilities.

One intention of this capacity building work is to encourage third sector organisations to develop an attractive range of day opportunities which in the future people with learning disabilities may choose to purchase from their personal budget allocations. It may also have the effect of generating a ‘menu’ of options that may either compete with or complement existing in-house day service provision.

In the longer term, Leeds also plans to open three new, large activity and leisure centres that can incorporate day service type work.

Towards a menu-based approach in Leeds

In order to test out the principles and ideas behind developing a ‘menu based’ approach to day services we undertook a brief series of meetings and conversations with day centre staff/managers (of older people’s services), staff involved in early implementation of personal budgets, Leeds Centre for Independent Living, adult/family placement staff, and social care finance staff, as well as attending the market engagement event for developing day opportunities for people with learning disabilities. The purpose of these meetings was to test out the ideas and principles of a ‘menu based’ approach to developing in-house day services but also the more difficult issue of how to implement this approach in practice.

There is widespread support for the ideas set out earlier for both modern day services and developing a ‘menu based’ approach that offers a choice of possible activities to individuals with a personal budget which are not necessarily based on using traditional buildings-based day services. However there were also views expressed that there is a continuing role for some buildings-based services, either as a ‘base’ for a wider range of activities, many of them outside the day centre with ‘outreach’ support, and for retaining specialised day centres for people with complex needs such as dementia.

- 7 -


Given that the policy of modernising day services is not a new one, it is not unexpected that there is support and acceptance for changing the way that in-house day services operate to make them relevant, attractive and 'purchasable' by individuals with a personal budget. The issue then is the process for making a change from a traditional day centre model to a menu-based approach to day opportunities. Set out below are the possible steps to move from the traditional buildings based model of day services with a set of unit prices, to a ‘menu based’ approach to the service offer and pricing. This is set out in four stages:

Generating a menu – Its application to modern day services Refining the menu for different in house day services Link to the self assessment and resource allocation systems Establish the costs and pricing of the menu

Generating a Menu - Application to modern day services

Taking the approach from extra care housing, a possible grouping and list of activities making up the menu and that could be the starting point for day services is set out below. This has been generated through:

Mangers of and staff in day services and also in the early implementer team Review of a sample of recent literature on modernising day services Individual Budget Pilots

It is not intended to be a definitive guide only an illustrative start.

ActivitiesHealth services e.g.PodiatryChiropody Dentistry Optician

PhysiotherapyPsychotherapySpeech TherapyRe-ablement

Participation in sport and games e.g.SwimmingTeam games – football etcTennisBadmintonSnooker/ billiardsFishingMartial artsYogaBoard games and cards

ArcheryWalking/ ramblingBowlsClimbingCanoeingKeep fitMusic and movementDarts and pub gamesSailing

Social and leisure activities e.g.Outings/ visits – gardens, parks, stately homes, seasideTheatre/ cinema visitsCooking

Eating out/ going to café or pubCreative writing/ poetryGardening

- 8 -


ActivitiesComputer usage/ ITDancingMusicDramaReminiscenceDriving

Flower arrangingWatching sportArts and craftsShoppingLibraryTalksPhotography

Complementary medicine/ self care e.g.AromatherapyManicure

HairdressingSocial skills

Advice and information e.g.BenefitsManaging moneyservices

ActivitiesEducationEmployment

“At Home” day service

This analysis does not extend into employment or college education, but there is a link in that colleges might for some individuals/ groups play a bigger role in gaining employment while employment might become more diverse with, for example, new social enterprises being established. Both places of work and education can potentially provide space for formal or informal social activities such as a café.

We have used the term ‘outreach support’ to describe the role of helping individuals (or small groups) access or undertake an activity. There are a range of possible new roles like employment officer, community managers, lead person for travel training etc4.

A pricing decision (covered below) is whether to:

Incorporate these costs in the unit cost of the ‘outreach support’ or Fund them centrally at no cost Find a way of directly charging as an identified service

Refining the menu based offer for different in house day services

Once a broad menu of activities has been developed the next stage is to refine or ‘package’ this into a series of options that are relevant to specific individuals or groups of individuals who will receive personal budgets. This is likely to involve market research with targeted current clients of in-house day services and some potential customers to refine the menu based approach so that a menu-based offer of ‘day opportunities’ is developed:

4 See for example “The strategic context for the modernisation of day services for people with learning disabilities and physical disabilities in Sandwell”, Sandwell MBC, 2008

- 9 -


That is relevant to people with different needs and requirements, e.g. the menu may need to differ between the offer to older people and people with learning disabilities.

That differentiates between the activities that are offered within existing day centre buildings and those that are offered outside of traditional day centres

For example, the work that Leeds is doing in relation to modernising day services for people with learning disabilities through engagement with the third sector and investing additional revenue and capital funding over the next three years, is based on an initial three ‘tier’ model of day supports and opportunities (referred to as signposting/enablement/on-going support) which in effect reflects a menu based approach to developing day services.

Another local authority that has been implementing SDS since the first In Control pilot sites, West Sussex, has used this type of approach to develop a day service offer for in-house services based on three options or ‘bands’. Their model is a ‘partial’ menu in that the offer in the form of bandings is based on the level of staff hours that will be provided to support individuals to access a range of buildings based and community based activities.

Link to the self assessment and resource allocation systems

The self assessment questionnaire (SAQ) and resource allocation system (RAS) determine the level of personal budget allocations made to individuals and therefore their ‘purchasing power’ when deciding how to spend their budget. Any provider of services, including an in-house provider, needs to understand how the SAQ and RAS that have been adopted will be likely to allocate funding to individuals and at what level.

In practice this means that there is little point in developing a menu of activities that might be attractive but will be too costly to provide compared with the typical level of personal budget allocation for a particular group of people. For example, through a desk top exercise undertaken by Leeds CC to assess the overall financial impact of implementing SDS for a sample of current social care clients, the average RAS was £14,729.

The purpose of doing this is to better understand the likely potential funding that is available through individuals taking up personal budgets. The evidence for how individual’s will spend their personal budget allocations in practice comes in part from the evaluations of the individual budget pilots but will also come from the Early Implementer Team working directly with individuals in Leeds receiving personal budgets.

It is suggested that this type of reality check against the adopted SAQ and RAS is undertaken whilst also refining a potential menu of activities with a sample of current and future clients.

Establish the costs and pricing of the menu

- 10 -


Once a menu of activities has been refined for different in-house day services, the proposed menu needs to be costed, i.e. the actual costs of delivery need to be established. This will require refining the current unit costing approach to identify the actual cost of delivery, including overheads as well as the direct cost of provision.

For a menu-based model a more relevant approach is to build up cost from activities/work done:

Direct + indirect cost (identified overhead allocation) = Cost of defined service;divided by chargeable unit (activity/ies) = Unit cost

An issue to resolve is how to cost the different components of a proposed menu of activities. Depending on the nature of the menu based activities being offered the costing options could include:

Define a core set of activities as part of the menu to be covered by the unit cost. Additional activities are then part of a fixed ‘banded’ menu of options with each having an associated cost.

Define a core set of activities as part of the menu to be covered by the unit cost. Additional activities (such as those listed within the sport, social and leisure activities menus above) to be costed on the basis of the direct cost of activity/equipment (shared where relevant) and outreach support to attend at £xx per hour (shared between group where relevant/ mutually acceptable)

A fully itemised menu of activities costed on the basis of the direct cost of activity/equipment (shared where relevant) and outreach support to attend at £xx per hour (shared between group where relevant/ mutually acceptable).

The issue of cost not being the same as price has been considered as part of the work to develop a congregate services costing tool so is not repeated here. However, the steps proposed above, of refining a menu based approach based on market research and reality checking against the adopted SAQ and RAS, are intended to identify a menu of activities that is sufficiently attractive to be purchased by individuals with personal budgets. An essential step for achieving this in reality is that the actual full costs of delivery can be met by the prices charged (or that a decision is taken to subsidise some of the indirect costs of delivery).

Conversely this approach may identify that it is not commercially viable to remodel in-house day services to provide a menu of activities that are sufficiently attractive to individuals with personal budgets at prices that can cover the full costs of delivery.

The outcome of this approach should be:

A menu of potential activities and day opportunities that is targeted, where necessary, at specific individuals/groups of individuals.

A set of clear prices that are attached to the menu, or elements of the menu, that reflect the ability and willingness to pay on the part of potential customers and reflect the costs of delivery.

- 11 -


This approach to developing day services in the context of personal budgets presents further issues for an in-house service provider to consider, which are beyond the scope of this work, for example establishing an overall business strategy for in-house day services including a marketing plan.

Pricing and Costing Issues - Non-Activity Costs

This exercise based on modern day services has found there may be a range of additional indirect costs that a local authority may have to consider. These may in turn be:

Met by the local authority in part or whole as a subsidy to the day service Considered as part of the authorities overall work, another service or statutory

function and not allocated to day services specifically but elsewhere. This may in turn possibly increase costs of another activity or function.

Recovered in the pricing presumably by adding the calculated margin to the outreach worker rate

The kinds of indirect costs identified include:

Personal planning Consultation with carers and individuals and then feeding back to those

consulted on results Teaching or developing skills to go out and access services outside a day centre

including travelling “Some of us want assistance to teach us skills we need to go out, some of us may need individual assistance all the time…”

Risk assessment in using day services and a rescue plan plus resources to implement “We need to plan activities we do and to have a plan for what to do if something goes wrong”

Offer services at weekends and evenings – with implications for staffing levels and pay rates – “…sometimes it is too early to finish at 10 pm if we are out enjoying ourselves”

Offering services 365 days a year “Less long closures as people find these really disruptive”

Improved communication using a variety of media to individuals and carers Independent advocacy “It would be helpful for an independent advocate to be

based in each day service” Investment in joint working process A lead worker(s) to steer modernisation in key opportunities and subsequently

develop activities and the market Process and infrastructure to review, audit, continually improve day

opportunities

Note: Quotes extracted from modernisation of day service reviews by local authorities such as

The list is indicative and not exhaustive.

- 12 -


Does the menu approach have merit?

The approach of identifying, grouping and then trying to price different categories of day service is in essence obvious, simple and straightforward. It reflects the desire to extend opportunities for older and disabled people and make more use of ‘ordinary’ facilities. The exercise may help to prompt thought about more possibilities.

The pricing of a menu based approach needs careful consideration. First, the different groups who may use day services may not generally need the same kind of ‘outreach support’. An older person may be perfectly capable of participating in a wide range of activities with no support at all in a way many people with learning disabilities could not. Second, there are substantial individual differences to cater for in the level and nature of help needed to participate in an activity. Third, how the support required by the person is delivered can also be very varied. It would be a mistake to assume even those who need some support need the paid ‘outreach support’ staff. An example of different ways of assisting people to travel to day opportunities illustrates this.

It is likely that confining an individual’s activity to those supported by congregate travel arrangements will be limiting.

The following examples of how some people have addressed making travel arrangements individualised may be useful:

Investing time in ‘travel training’ to enable people to independently use public transport

Developing individual travel plans with photographs of landmarks on the route and where to get off

Identify possible ‘travel buddies’, another passenger who gets on at the same stop as the individual and who could offer a gentle reminder when it is time to get off

Exploring opportunities for car sharing with co-workers, co-learners, etc. Negotiating travel expenses, for taxis, as part of someone’s employment or

volunteering package Is the activity available more locally to the person’s home?

Source: Day services modernisation toolkit, Part 2, B. Love et al, NDT, 2003

The idea of a costed menu, albeit in the example still largely hours x delivery rate, can begin to break away from thinking in ‘hours’ to thinking instead of ‘cost’ to the individual; particularly if some of the alternatives ways of procuring a service are incorporated. The need to think of real cost was identified in the evaluation of the IB Pilot Programme5.

“I kept saying ‘Stop looking at it in hours ‘cos it don’t mean nowt to me, I want money, I want to see what there is to spend’” (Carer of a person with a learning disability).

5 Evaluation of the IB pilot programme, C Glendunny et al. Social Policy Research Unit, University of York, 2008

- 13 -


The evaluation observed in many cases, care co-ordinators suggested which care agency a service user should use, typically the agency that the user was currently with, nevertheless some users took it upon themselves to ring around different agencies and ask for prices:

“I had said to (support planner) ‘Well, God, that’s not very much left to have a gardener’ and she said ‘Well, that’s how it’s been worked out’. But of course then I realised and appreciated that… the company I’d been put into, the agency, was about the dearest there is in (council district)… so I thought, right, well I can do this cheaper myself so… I went to a smaller, cheaper and far superior agency”(Older person).

- 14 -


Appendix 1 – Summary of Core Costs

Summary of the core cost of living at Denham Garden Village

Service What you receive Frequency Price

Domestic help and support

Cleaning Laundry/ironing Shopping Collecting prescriptions Preparing light meals Home valet service

(spring cleaning) Oven cleaning Help with reading/writing

letters Paying bills Facilitating contact with

family and friends Escort to and from social

events, appointments etc

As required £10 per hour

Personal care Assistance with mobility Help to get in and out of

bed Help with toileting,

washing and bathing Food preparation and help

with eating and drinking Assistance with

medication Assistance with personal

hygiene

As required £10 per hour

Handy person The handy person service is available to help with jobs around the house, for example hanging pictures, decoration or facilitating other individual works

As required £15 plus VAT per hour

Service Charge 24 hour emergency support

Dedicated customer services team

Enjoyment of well kept grounds and communal facilities

Laundry facilities Window cleaning CCTV security

Budgeted annually in consultation with residents

Approximately £85 per calendar month

- 15 -


Monitored emergency, burglar and smoke alarm

Buildings insurance Access to satellite TV Use of health and fitness

centre Village “golf buggy”

transportation

Repairs and maintenance fund

Cyclical works (e.g. external re-decorations), reactive repairs and technical inspections (e.g. gas boiler servicing)

Budgeted annually in consultation with residents

Approximately £28 per calendar month

Sinking fund Major property related repairs, replacements, renewals and improvements. Includes all works to roofs, windows, buildings structure, gas boiler etc

Deferred cost payable on re-sale or re-let

Calculated as 0.25% of purchase price plus Retail Price Index (inflation) for each year of occupation

Ground rent Annual invoice £150 per annum

With thanks to Anchor Trust – edited extract from published purchasers information pack.

- 16 -

Documents

A Menu Based Approach to Pricing – a Test on Day … menu based appr… · Web viewThe exercise may help to prompt thought about more possibilities. The pricing of a menu based