Tuesday, May 3, 2012 Integration and Interoperability Across Public Health, Human Services, and Clinical Systems

Tuesday, May 3, 2012

Integration and Interoperability Across Public Health, Human Services, and Clinical Systems


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• This webinar will be recorded and available on

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• Type your questions in the box as we go


Outline of Webinar

Goal for today

Daniel Stein - Stewards of Change

Uma Ahluwalia – Montgomery County Department

of Health and Human Services (MD)

Questions


Goal of Webinar

•Highlight the collaborative work by Montgomery County Department of Health and Human Services and Stewards of Change on achieving a seamless integration across health and human services

NACCHO WebinarMay 3rd, 2012

Stewards of Change Mission

“Advancing Sustainable Improvements That

Transform Systems Of Care By Integrating

Entrepreneurial Solutions From The Public, Private And

Not-for-profit Sectors.”

ABC Residential

& Group Care

Health & Disability

Caseworker Team

Planning & Resource Allocation

Financial Management

Program Management

Information Technology

Child Welfare

Aging Voc. Rehab

Mental Retardation

Seniors Centers

Medicaid Contractor

No Child Left

Behind

GoodwillServices

DevelopmentalDisabilities

Community Health

CommunityMental Health

Workforce Develop

Medicaid

Income(TANF, Emerg.

AidMedicaid

Jewish Community

CenterCatholic

Chairities

Child Care

CourtsCriminalCivilJuvenile JusticeFamily CourtDivorce

Head Start

Team-basedIntegrated

Intake

Head Start Providers

Federal Dept.of HHS

Federal Dept. of Education

Criminal Justice Ecosystem

Health & Human Services Ecosystem

State Health & Human Services

Local Social Service Agencies

Information Technology

State DepartmentOf Education

Multi-Discipline

Client Plan & Review

WIA

PortalClient dataProvider dataReferral dataPerformance

Workflow &Scheduling

TANF

EBT

Data Warehouse

BI ToolsEAI Tools

State Tax

Suppliers

One Stop CentersMultiple LocationsInterdisciplinaryPre-eligibility AssessmentEmergency AssistanceChild careService Delivery (e.g. Empl.)Facilitate Self-service

Secured Internet

Police

Banks ClientsUnited WayHospitals

Network of Community Service

Providers

SACWIS

Child Support

Integrated Case Management

Food Stamps

Child Welfare Caseworker

Team

Child SupportCollections

Income Sec.Caseworker

Team

K-12 Education Ecosystem

Workforce Inv.Child Welfare

Foster CareProtectiveAdoption

Public HealthMental Health

SubstanceAbuse

Treatment

ERP

Schools

RevMax

MedicaidTANF

Regional State & Local Client Plan & Assessment Teams

Productivity &Collaboration

IntegrationTechnologies

Provider Management

Compliance Management

Human Resource Management

IT Management

DepartmentManagement

Microsoft A

rchitectural Vision

Public Health

Addictions & Mental Health

Medical Assistance Programs

Children, Adults & Families

SAMHSA

ACF

IHS

RSA

State View: Silo’d Architectures, Funding, Services

Rich Howard – CIO Oregon DHS

Consumer Centric

Children in Foster Care StudentPatientFamilyAdult

Senior

Context: Where We Are Today

• Today’s Health, Education, Human Services Systems and Justice program generally operate in silos

• Resulting in:– Separate and unconnected programs – Categorical funding– Separate and redundant systems and

infrastructure– Transaction orientation vs outcomes

• System silos are still the norm although that has begun to change

Can Silos Be Connected?

“Interoperability” Can Enable the Process

Human Services 2.0 - Core Principle

L > CLearning Must Be Greater Than or

Equal To the Rate of Change Just To Keep Pace… No Less To

Provide Leadership and Lead Change

Human Services 2.0A Conceptual Architecture

SOC Theory of Change

Policy – The principles or rules that guide decisions by which human services organizations define how they will achieve desired outcomes across the range of programs, activities and disciplines.

Practice – “The way public and private human services organizations deliver services and care, monitor and report results and achieve intended outcomes

Structure – The way public and private human services systems design, organize and implement work processes to achieve policy and practice goals.

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“Human Services 2.0”• Describes the To-Be vision (future state) of

a connected and coordinated Human Services, Health and Education eco-system that is customer-centric; family-focused; community-based and technology enabled

• It offers guidance about the policies, structure and practices that are necessary for improving outcomes and enhanced operational efficiency

• Provides a common language and a set of ten core ‘Drivers’ that describe the business and organizational factors necessary for interoperability and Human Services 2.0.

A Conceptual Architecture

GOVERNANCE

WORKFORCE

OPEN & INCLUSIVEPROCESSES

INTEROPERABLE INFORMATIONTECHNOLOGY

PERFORMANCE MANAGEMENT

FUNDING

CONSUMERCENTRIC

PUBLIC ANDPOLITICAL WILL

CONFIDENTIALITY

BRIDGING SILOS

InterOptimability Drivers

InterOptimability Drivers

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• “InterOptimability”– Provides a language, methodologies and a

nine step process that organizations can use to assess, plan, develop, implement, communicate and measure their interoperability initiatives

– Is built on a holistic consumer-centric view and utilizes the ten critical change drivers needed for successful interoperability

• SOC produced the InterOptimability Handbook to aggregate disseminate the learning

A Comprehensive Process

The InterOptimability Process

1.Orientation to Human Services 2.0

2.Create ‘To-Be’ Change Vision Landscape & Roadmap

3.Conduct ‘As Is’ Business Process Review

4.Assess ‘As Is’ Information Technology

5.Evaluate Organizational Readiness

6.Perform Gap Analysis

7.Build ‘To-Be’ Business Process Framework

8.Develop ‘To-Be’ Information Technology Solution

9.Synthesize Learning, Develop Recommendations and Action Plans

A National Change Vision LandscapeProduced at the 2007 Annual SOC Conference

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Current Engagements• Administration for Children and Families/HHS

– HS 2.0 Training– Interoperability Toolkit– Confidentiality Toolkit– National Human Services Interoperability Architecture (NHSIA)– National Information Exchange Model (NIEM)

• California Information Sharing Environment– CA Department of Social Services– CA Department of Health and Human Services– The Judiciary (Blue Ribbon Council)

• Electronic Care Record For Children in Foster Care and the Judiciary (and other populations) – EHR + PHR

• 7th Annual Stewards of Change Symposium• Collaboration with the Johns Hopkins Systems Institute

Communications and Resources

• ACA 1561 Recommendations; Health and Human Services Linkages

• Executive Order 13563; Administrative simplification

• Joint Letters – ACF, CMS, CCIIO, USDA/FNS

• Enhanced Funding: Seven Conditions and Standards to receive 90% match

• National Human Services Interoperability Architecture (NHSIA)

• National Information Exchange Model for Human Services (NIEM)

• Confidentiality Guidance • A-87 Cost Allocation Exception• Toolkit can be found on ACF

website

Montgomery County, Maryland | Department of Health and Human Services

Uma S. Ahluwalia, DirectorDepartment of Health and Human Services | Rockville, Maryland

Integration and Interoperability within the Health and Human

Services EnterpriseNACCHO WEBINAR

Thursday| May 3, 2012 | 1:00p


Most populous county in Maryland

Immigration was the largest component of population change since 2000

Source: U.S. Census Bureau

Population Growth (K)

24 Montgomery County: A Changing Picture


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Non-Hispanic Whites make up 49.3% of the County’s population, down from 59.5% in 2000

Hispanics are now the County’s second largest population group (17%) followed by Blacks (16.6%), Asian and Pacific Islanders (13.9%) and Other (3.2%)

39% of County households speak a language other than English at home; 14.5% have limited English proficiency

Most neighboring counties also had a decrease in non-Hispanic White population, including Fairfax, Howard and Prince George’s counties

Montgomery County Diversity: Census 2010“Minorities” are more than half of Montgomery’s population


Caseloads have grown every month since FY07 and as of June 30, 2011, are at a high of:

Temporary Cash Assistance (TCA): 1,059 (53% increase)

Food Stamps (FS): 25,554 (126% increase); and,

Medicaid (MA): 45,104 (54% increase)

Public Assistance Needs26


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Home energy assistance applications remained steady in FY11 with 12,356 applications received compared to 12,315 in FY10. Since FY08, applications for assistance have increased 37%

Requests for Emergency Housing Assistance totaled 7,978 in FY11, 36% higher than in FY08

Patient load in Montgomery Cares for FY11 was 26,877 patients, a small (2.3%) increase over 2010. For FY12, patient load is projected at 28,500, a 6% increase over FY11

Heat, Housing and Health Needs


Montgomery County December

2007 December

2008 December

2009 December

2010

Aged|Disabled 17,830 18,533 19,297 19,840

Families and Children (FAC) 39,053 45,997 56,672 65,456

Maryland Children's Health Program (MCHP) 18,841 19,411 18,919 20,535

Other 3,225 3,620 4,801 5,947

PAC 1,610 1,515 2,038 2,686

TOTAL 80,559 89,076 101,727 114,465

Medicaid Numbers In Montgomery County28


ACF CMS SAMHSA HRSA CDC ONCHIT HUD NIH Veterans Administration Office on Aging Homeland Security Department of Agriculture

Title XIX

Title IVE

CSBG

CDBG

Mental Health Block Grant

Federal and State Grants

40% of DHHS Budget is from State and Federal Sources

60% of DHHS Budget is from County Sources

Federal Agencies Whose Regulations and Funding Strategies Impact County Services29


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• Aging and Disability Services DOA, DOD, DHR, DHMH, DVA

• Behavioral Health and Crisis Services DHMH, GOC, DHR, DPSC

• Children, Youth and Family Services DHR, GOC, GOCCP, DJS, MSDE, DLLR

• Public Health Services DHMH, MSDE, DHR

• Special Needs Housing DHR, DHCD, DHMH

• Community Outreach | All Departments

ADS

BHCS

CYF

PHS

SNH

Department of Health and

Human Services

Montgomery County Department of Health and Human Services

Services and MARYLAND State Department Connections by Service Type


31 Used Cases and the Trends They Reveal


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42-year old non-English speaking recent immigrant

Tests by DHHS indicate she has tuberculosis

Appears to be some domestic violence at home

Has two children ages 2 and 6 – and is pregnant again

2 year old needs child care, family can not afford it

6 year old has special needs and housing is unstable

Services offered by DHHS to address these complex needs:a. Public Health TB Clinicb. Child Care Servicesc. Maternity Servicesd. WIC Servicese. Income Support Servicesf. Workforce servicesg. LEP Servicesh. Domestic Violence Service via Abused Persons Programi. Adult Mental Health Servicesj. Housing Stabilization Servicesk. Education through Public School System

Scenario One


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90-year old woman identified as hoarder

21-year old great-grand-daughter moved in

Great grand-daughter has two preschool aged children

Great grand-daughter a former drug user is abusing again

Department of Housing believes house not livable

Services offered by DHHS to address these complex needs

a. Adult Protective Servicesb. Child Welfare Servicesc. Early Learning and Child Cared. Special Needs Housing Servicese. In-home Aide Servicesf. Income Supportsg. Workforce Servicesh. Substance Abuse Treatmenti. Medical and Primary Care

Scenario Two


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H o m eless d iab eti c w o m an

Homeless diabetic woman with Schizophrenia

Three episodes of hospitalization in last 12 months

Hard for her to regularly take medications

Hard for her to have nutritious meals

Services offered by DHHS to address complex needs

a. Homeless Program

b. Public or Medicaid Provider Mental Health Treatment

c. Montgomery Cares and Possibly Medicaid enrollment

d. Housing Stabilization Services

Scenario Three


Quicker Processing of Benefits

Linkages with Community Based Organization and Closer Connectivity of Residents with Government and Services

Improve comprehensive outcomes for Transition Age Youth – sub population pilot to be expanded to the broader HHS enterprise

Improve indicators for children, youth, families and single adults related to Safety, Health, Well-being and Self-sufficiency

Improve indicators related to Job Creation and economic development

Maximized opportunities related to Health Information Technology under the Affordable Care Act

35 Outcomes to be Achieved


Assessment of hardware and software infrastructure

Business process analysis

Analysis of Policy environment

Identified business and programmatic needs

Build the integration prototype with transition age youth and now homeless families

Analyzed staff capacities and readiness for change

Developed the case for HHS modernization – business need to drive technology solution

Urgency – increased need, diminished resources – need for a new business model supported by new technology solution

36 Business ActivitiesDepartment of Health and Human Services’ Modernization


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Built a nationally recognized confidentiality policy that enables data sharing across the entire Health and Human Services Enterprise

Developed a Neighborhood Opportunity Network Model – that combines social engineering with economic empowerment

Developing the scope and parameters for a true “No Wrong Door Approach” to the delivery of health and human services

Strengthening partnerships with non-profits, faith community, business and philanthropy to better leverage limited resources for those in need

Policy Activities


Identified Transition

Age Youth as our test

population includes –

children aging out of

foster care and juvenile

justice; mentally ill or

substance abusing

youth, pregnant and

parenting youth and

homeless youth. And

now working with

homeless families

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Built a practice model for integrated practice

Developed a universal face sheet and screening tool for our enterprise

Identified outcomes for our work

Tested integrated access points through our neighborhood opportunity network activities for both delivery of services and economic development activities

Used Health Reform as a catalyst for change

Built a work plan for implementation

Activities to Support Practice


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Build a common client index or master client index to track overlapping and unduplicated client load – better anticipate need and improve service delivery

Integrate eligibility for all programs federal, state and local with eligibility requirements

Ensure compliance with all federal, state and local confidentiality and privacy protocols

Digitize all records and move to a paperless environment

Integrated case management system that allows for public and private sector users access and use of the system

DHHS Portal and Data Warehouse development

Department of Health and Human Services

Technology Solution


40Department of Health and Human Services

Affordable Care Act Response(An Opportunity for Integration)


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Community Based Delivery System – Impacted by Medicaid Policy and Financing

Public Health and the Community – Impacted by Medicaid Policy and Financing

Aging and Long Term Care – Impacted by Medicaid Policy and Financing

Behavioral Health Financing and Delivery – Impacted by Medicaid Policy and Financing

Workforce – Impacted by Medicaid desirability for providers

Health Information Technology and Exchange – Impacted by Medicaid Policy and Financing

Six Areas of Focus for Affordable Care Act Implementation in Montgomery County


42 Health Planning Process

http://www.healthymontgomery.org/


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Emphasis on Community and Population Health and well being

Calculating Return on Investment and Social Return on Investment

Making the case for re-investment

Using a community health and social planning approach to determine need and the algorithm for reinvestment

Engaging our Hospitals and community providers in the conversation about Community Benefit

Investments in health and human services will follow a trajectory like public safety and education – need will define level of investment and these services will not be considered discretionary

Community Benefit and Land Use Planning


44Five Key Focus Areas for Social Services within Health Care Reform

Integrated Eligibility Navigator FunctionsNo Wrong Door and Integrated Case Management for Chronically Ill and

Safety Net PopulationCommunity Benefit Use of Technology and Data Analytics


45Meaningful Use and Regional Extension Center Engagement

Public Health is very late in the game

Non-availability of dollars

How to create space for readiness

assessment, implementation work plan and

compliance monitoring

How to move the technology

modernization effort

How to use data in HIE for population

health and program

investment decision-making

purposes

Integrating behavioral health, social services and

primary care

Sustainable Model


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Across Government

With our non-profit providers

With the Faith Community

With Business

With Philanthropy

With Advocates and residents

To Impact outcomes at the:

a. Individual

b. System and

c. Population Health and Community level

Partnerships


Integrated Eligibility

Blending and Braiding Funds

Confidentiality

Evidenced Based Practice

Interoperability

47 The Policy Conversation


48

Thank you!


Questions

Please type your questions in the box


Contact Information

Vanessa Holley, MPH

Program Analyst, ePublic Health

[email protected]

(202) 507-4239

mailto:[email protected]

Documents

Tuesday, May 3, 2012 Integration and Interoperability Across Public Health, Human Services, and Clinical Systems