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@APHSA1
Building a Better Service Delivery System: Breaking
Down Silos
June 9, 2015
@APHSA1Speakers
Libby BaconPrincipal, Deloitte
Mary Ann Cooney, RN, MSN, MPHAssociate Commissioner, Human
Services Strategy, NH Department of Health and Human Services
Amy S. Lapierre, LICSWAdministrator for System Integration for the Rhode Island Executive Office of
Health and Human Services Medicaid program
Lindsay HoughPrincipal, Deloitte
@APHSA1
HOW AGENCIES ARE ADDRESSING PEOPLE, PROCESS & POLICY CHALLENGES IN HHS INTEGRATION
LINDSAY HOUGH
@APHSA1APHSA National Collaborative
@APHSA1
Difficulty Delivering Client-Centric Health & Human Services
Solutions• Review core business services to
remove duplication and streamline across programs
• Safeguard information through security protocols that allow information sharing
Services Technology Workforce
• Siloed processes across programs create redundant business processes and overlap in citizen interaction
• Case management occurs in isolation, preventing a holistic view of the individual or household
• Expects workers to know the client needs or wants outside of their program expertise which results in minimal or redundant services
• Many states have adopted a single self-service portal for applications, but have not progressed to integrated case management
• Data Exchange occurs on as-needed basis between agencies
• Agencies lack a consolidated source of data for cross-program analytics
• Systems are designed with one agency/program in mind, then heavily modified for others
• Workers focus on delivery of a single service so they lack the full picture of an individual’s needs
• Workers may refer individuals to other programs, but don’t have visibility once referral occurs
• Increasing collaboration to maintain case information creates redundancies and inconsistencies
• Culture of the system leads to single program management, as opposed to holistic view
• An enterprise framework supports the reuse of technology
• Robust data analytics allows information to be shared across programs/agencies
• Strong workforce performance support systems allow workers/ staff to manage the outcomes through multiple programs and/or services, without years of training
• A shift in culture provides the opportunity to focus on outcomes and effective program management
@APHSA1
Understanding Your Assets: Moving to an Outcome-Centric Delivery System
Needs Assessment
Issue/Incident Management
Goal & Service Plan Development
Outcomes Monitoring
No Wrong / Single Door
Service & Provider Coordination
Contact Log/ Case Notes
Intake Management &
Eligibility
Case & Demographic Data
Management
Referrals / Authorizations
Quality Management
Outcome(s)
Programs / Services
Align
Integrated Service Delivery Rules Engine and Predictive Analysis
@APHSA1
SNAP, MA338K
SNAP, MA, LIHEAP351K
MA, LIHEAP86K
LIHEAP Only300K
MA Only375K
SNAP Only154K
MA, SSI, SNAP 99K
TANF, SNAP, MA 69K
TANF, SNAP, LIHEAP
56K
MA, SSI, SNAP, LIHEAP
110K
MA, SSI69K
MA, SNAP, CC 42K
SNAP, MA, CC, LIHEAP 40K
MA, CC18K
CC Only74K
MA, HCBS29K
HCBS40K
MA, CW29K
CW38K
* Data is approximations to show overlap
SNAP, LIHEAP132K
TANF, SNAP, MA, CC
23K
TANF, SNAP, MA, LIHEAP 56K
MA, SSI, HCBS21K
LIHEAP, CHIP20K
CHIP Only129K
MA, LTC48K
MA, SSI,LIHEAP 18K
MA, SNAP, GA 36K
Program Total Enrollment
Total Medicaid 2,073,181
•Medicaid only 1,397,702
•SSI 365,976
•TANF 198,468
•GA 59,462
•LTC 51,570
SNAP 1,664,482
LIHEAP 1,278,006
Child Care 289,830
HCBS Waiver 197,695
CHIP 190,324
Child Welfare 160,626
LIHEAP, CHIP, SNAP 14K
TANF, SNAP, MA, CC, LIHEAP 15K
Understanding your Service Delivery Footprint: Program Overlaps
@APHSA1
Additional Service Opportunities
Understanding your Customer Experience
About Michelle
• I’m a single mother of three and have limited income. I have an infant, a 4 year-old, and a 14 year-old. I do not have reliable access to the internet and I have very few transportation options. I rent a home that was built in the 1950’s, I work a part time job with inconsistent hours, and I rely on family and friends for childcare. My teenager has been missing school lately and has had tow recent encounters with law enforcement
• I recently traveled to the HAB to get immunizations for my infant and boosters for my young child
I’m Michelle
Families /Children
Immunizations
Screening & Referrals
WIC
SNAP
Head Start
Lead Screening
Diversion / Prevention
PCMS
@APHSA1
New Hampshire Department of Health and Human Services Organization ReDesign
American Public Human Services Association
June 9, 2015
@APHSA1
Factors Impacting DHHS
Center of Perpetual Storm
DHHS
Client Profile and Needs
State Economy
Litigation
Federal Government
Uninsured
Technology
Global Economy
Demographics
DHHS Workforce Over Time
ADMINISTRATION
BEHAVIORAL HEALTH
CHILD SUPPORT
SERVICES
CHILDREN, YOUTH &
FAMILIES
COMMUNITY BASED
SERVICES
DEVELOPMENTAL
SERVICES
ELDERLY & ADULT
SERVICES
FAMILY ASSISTANCE
GLENCLIFFINTEGRITY
JUVENILE JUSTICE
MEDICAID BUSINESS &
POLICY
NHH
OFFICE INFORMATION
SERVICES
OFFICE OF THE COMMISSIONER
PROGRAM SUPPORT
PUBLIC HEALTH
SERVICES
M'AIDALLOCATEDSTAFF
FULL STAFF
0
100
200
300
# of Staff
0
200
400
600
# of Staff
149.0
336.0
105.0
364.0
167.0
252.0
588.0
105.0 120.0
237.0
30.0 23.0 38.0 57.0 54.0 40.017.0
Current Staff Allocations
Fiscal Year Authorized Staff Filled Positions Vacancies
2008 3,344 3,095 249
2011 2,995 2,764 231
2014 2,895 2,628 267
2015 2,981 2,628 353
Reductions from 2008 to Present
@APHSA1
Organization ReDesign to Support Strategic Initiatives
• Medicaid Care Management (MCM)
• Substance Use Disorder (SUD) Benefit
• Section 1115 Demonstration Waiver
• State Health Improvement Plan (SHIP)
• State Innovation Model (SIM) Model Design Round Two
• Medicaid Expansion: New Hampshire Health Protection Program
• Community Mental Health Agreement (CMHA)
• 10 Year Mental Health Plan
DHHS Strategic Initiatives
Medicaid Transformation
PopulationHealth
Mental HealthSystemReform
ExpandedHealth
Coverage
• District Office Modernization• Human Services Integration
Current State DHHS Business Model
Service Areas
Lead
ersh
ip, V
isio
n,
& S
trat
egic
Man
agem
ent
Enablers Information Management
SupportServices Finance Legal & Regulatory
MISSIO
N: To join com
munities and fam
ilies in providing opportunities for citizens to achieve health and independence
PolicyDevelopment
Alignment of programs is driven by funding streams
Resource Prioritization Client Services Delivery
Coordination Compliance
Resource Prioritization Client Services Delivery
Coordination Compliance
Resource Prioritization Client Services Delivery
Coordination Compliance
Resource Prioritization Client Services Delivery
Coordination Compliance
Office of Human Services
Division of Public Health
Division of Community Based Care Services
Office of Medicaid Business & Policy
@APHSA1DHHS ReDesign Goals
“Building an organization that improves the health and independence of the people we serve, by emphasizing a proactive and holistic approach to addressing their
needs”
Enable a team based environment that organizes DHHS
around the complex needs of those we
serve
Promote a DHHS organizational
culture that encourages working
across traditional boundaries
Streamline and rationalize the
delivery of services and support
functions across DHHS
Whole Person Centered
http://www.dhhs.nh.gov/media/av/redesign.htm
@APHSA1
Future State Vision for a Whole Person Approach
A client enters the DHHS system with a specific, primary request, or the “need”
DISTRICT OFFICE
We connect the client with relevant partners necessary to ensure all goals are met
We coordinate care and services across all appropriate areas of DHHS to meet both primary and secondary needs
We base our assessment of health status beyond the “need”, and consider all physical, emotional, intellectual, capable, social, and spiritual characteristics
PARTNERS
We develop a set of goals to address the “need”, and in doing so we make connections to any existing secondary needs
.........
.........
.........
.........
.........
The Need Whole Person Goals DHHS Partners
@APHSA1DHHS ReDesign Business Model
Customer Service
Strategy
Delivery
Lead
ersh
ip, V
isio
n,
& S
trat
egic
Man
agem
ent
Quality Management
DashboardsDataAnalytics Outcomes Gaps
Plan Coordination & Network Management
Enablers Information Management
SupportServices Finance
Population Health
Accountability
Legal & Regulatory
Direct Contract Partners
MISSIO
N: To join com
munities and fam
ilies in providing opportunities for citizens to achieve health and independence
Whole Person and Population Health
Families
Children
Adults
Seniors
Strategic Management of Medical, Behavioral Health, Human Services , and LTSS Service Lines
Assessment Policy Development Assurance
Inter-Agency &
Government Synergy
Resource Prioritization
QualityGoals
PolicyDevelopment
Intake & Assessment
Information & Education Eligibility Planning &
Referral
Provider Enrollment &
Inquiry
@APHSA1DHHS ReDesign Business Model
Customer Service
Strategy
Delivery
Lead
ersh
ip, V
isio
n,
& S
trat
egic
Man
agem
ent
Quality Management
DashboardsDataAnalytics Outcomes Gaps
Plan Coordination & Network Management
Enablers Information Management
SupportServices Finance
Population Health
Accountability
Legal & Regulatory
Direct Contract Partners
MISSIO
N: To join com
munities and fam
ilies in providing opportunities for citizens to achieve health and independence
Whole Person and Population Health
Families
Children
Adults
Seniors
Strategic Management of Medical, Behavioral Health, Human Services , and LTSS Service Lines
Assessment Policy Development Assurance
Inter-Agency &
Government Synergy
Resource Prioritization
QualityGoals
PolicyDevelopment
Intake & Assessment
Information & Education Eligibility Planning &
Referral
Provider Enrollment &
Inquiry
@APHSA1How Strategy Drives Delivery
Strategy
Delivery
• Who are we serving?• Why are we serving them?• What are we trying to achieve?• What outcomes are we looking for?• How much are we willing to pay?
• How will we deliver services?• Where will they be delivered?• What new or expanded services will be needed?• Who will we partner with?
Behavioral
Medical
LTSS
Human Services
Public Health
Department of Health and Human Services
Quality Management
Outcomes & GapsData Analytics & Dashboards Accountability
RegionalServiceDelivery
Region 2
RegionalServiceDelivery
Region N
RegionalServiceDelivery
Region 1
State-Wide ServiceDelivery
Business Enablers
CommunicationsHuman Resources Other Business Enablers
Information Management Finance Legal & Regulatory
• Assessment• Policy Development
• Assurance• Resource Prioritization
Delivery
• Plan Coordination• Provider Network Management
• Delivery Systems Management
Customer Service
Intake & AssessmentInformation & Education Eligibility Planning & Referral
General Population
Adults SeniorsChildren&
Families
Strategy
Operating Model for Population and Whole Person Health
• Inter-Agency & Gov. Synergy
Revised 4/9/15Business Function Includes Matrixed Functions Service Line
@APHSA1
• Assessment of Population needs & Service Line offerings
• Policy Development• Assurance that services across Populations and
Service Lines increase the likelihood of desired health outcomes
• Resource Prioritization• Inter-Agency & Gov. Synergy
Summary of ReDesign Functions
• Plan Coordination & Network Management of services across all delivery systems and provider networks
• Provide direct care services• Oversee and manage services delivered through
contract• Establish and oversee service and program
partnerships
• Perform data analytics for DHHS impact areas• Develop dashboards to measure impact areas and
service offerings• Measure, track, and communicate outcomes• Identify gaps in service offerings • Monitor program integrity, grant compliance, and
performance improvement across delivery systems and provider networks
• Coordinate with Service Lines and Delivery functions to inform and educate the public on available services
• Assess and advise clients seeking assistance• Determine eligibility for DHHS assistance• Develop a whole person care plan• Process provider enrollment information and respond
to provider queries
Customer Service
Enablers Population Health*
Quality Management Strategy
• Statewide assessment and monitoring of health status to identify, investigate, and solve community health problems and/or hazards
• Develop policies and plans that educate individuals on health issues and influence state institutions/community partners who identify and solve health problems
• Assure effective, accessible, and quality population-based health services and enforce laws and regulations that protect health and ensure safety
• Manages the information assets of DHHS, including hardware, software, applications, infrastructure, and technology support
• Manage, control, and accurately report on the financial affairs of DHHS
• Support DHHS and all sub-organizations with legal tasks as well as proactive risk management
• Provide general support to improve efficiencies across the department and enable staff to do business
*Definitions summarized from CDC Core Functions for Public Health
Delivery
Commissioner
PopulationHealth
Infectious Disease
Laboratories
Public Health Protection
Public Health Statistics & Informatics
HealthServices
Medical
Behavioral
LTSS
OtherHealth Services
Quality Management
Data Analytics & Dashboards
Outcomes &Gaps
Accountability
Delivery
PlanCoordination
ProviderNetwork Mgmt
State-Wide Service Delivery
RegionalService Delivery
HumanServices
Human Services
OtherServices
Populations
CustomerService
Information &Education
Intake &Assessment /
Eligibility
Planning &Referral
Commissioner’s Staff
Finance
Information Management
HumanResources
Legal &Regulatory
OtherSupport Services
DeputyCommissioner
Revised 4/9/15
Strategy
BusinessEnablers
Communications
Department of Health and Human ServicesFunctional Architecture for Population and Whole Person Health
@APHSA1ReDesign Approach
Key Activities
Key Outcomes
Assess Organization Design Business Model Develop Operating Model
Transition & Evolve Organization
Identified objectives, guiding principles, and value
expectations for redesign
Interviewed Select Sr. Mgmt and Program Directors
Gathered HR employee data for all DHHS staff
Incorporated ‘Key Considerations’ into Future
State Assumptions
Facilitated Visioning Sessions with Sr. Mgmt to develop a
Business Model
Validated the Business Model through scenario planning
Develop functional matrix and map current DHHS functions and capabilities to Business
Model
Identify overlaps and gaps in functional capabilities
Facilitate Visioning Sessions with Sr. Mgmt to design
Operating Model
Design Organization Charts for Operating Model
Identify transitional activities (training, staffing, etc..)
Develop and prioritize implementation roadmap
Current State Documentation of the DHHS Organization
List of ‘Key Considerations’ raised by staff for Redesign
Future State DHHS Business Model
Vision Statement for Future State DHHS Organization
Functional capabilities aligned to Future State DHHS Business
Model
Operating Model for Future State DHHS Organization
Future State DHHS Organization Charts Developed
Implementation Roadmap with prioritized activities and
schedule designed
Implementation of new Organizational Structure
Communication and feedback with staff
@APHSA1
Rhode Island’s Approach to Health and Human Services
Integration
Amy Lapierre, LICSW
Rhode Island Executive Office of Health and Human Services
@APHSA1
HHS IntegrationIntersection of Policy & Technology
Multi-agency Coordination & Integration Strategy: Medicaid Office, DHS, and OHIC agree on single solution for health exchange and eligibility system
Where we were….
Where we are going….
With passage of Health Care Reform, an early decision to integrate eligibility systems
Legacy MMIS and
Manual Eligibility Processes
@APHSA1Integrated UHIP Vision and Principles
Our Solution: Unified Health Infrastructure Project - UHIP
State-Based Marketplace
Self-Service Portal
Medicaid and Human
Services Programs
Rhode IslandUnified Health Infrastructure
ProjectUHIP
@APHSA1UHIP Approach to Integration & Coordination
Eligibility ProcessesCustomer AssistanceShopping Experience
• Premiums• Plan Management
• SHOP• Accountability to CCIIO
• Program Design & Delivery
• Accountability to FNS & ACF
• State Plan• Managed Care
• Waivers • Accountability to CMS
Exchanges
Medicaid
Human Services
UHIP Approach
POLICY
OPERATIONS
TECHNOLOGY
Policy “Alignment” Eligibility rules
Benefits and coverage
Carriers and networks
Operations “Coordination” Three integrated business processes
serving individuals, employers/employees, carriers
Technology “Integration” Service Delivery Channels
Aligned Customer Service
Single eligibility system
Integrated plan management
Separate enrollment/billing
@APHSA1Operating Practices for Successful Integraiton
• Speak the same language– Read each other’s regulations
Find the common denominator– What processes can we adopt for multiple programs?
Question the source– Why are we doing it this way? Federal requirement?
State Requirement? – If Federal, can we get a waiver?– If State, change we change it?
@APHSA1Thank you
Libby BaconPrincipal, Deloitte
Mary Ann Cooney, RN, MSN, MPHAssociate Commissioner, Human
Services Strategy, NH Department of Health and Human Services
Amy S. Lapierre, LICSWAdministrator for System Integration for the Rhode Island Executive Office of
Health and Human Services Medicaid program
Lindsay HoughPrincipal, Deloitte
