Welcome to San Diego!
NAPIPM 2014
34th Annual Education Conference
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POLICIES, PRACTICES & PEOPLE:
PERFORMANCE-BASED
CONVERGENCE IN ACTION
NICK MACCHIONE, FACHE
DIRECTOR
COUNTY OF SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY
August 19, 2014
SAN DIEGO COUNTY
 3.2 million residents
 5th largest county in the U.S.
 Urban & rural, from coast to mountains to desert
 18 municipalities, 18 Indian Sovereign
Nations and several unincorporated
towns
 2010 Census
 White – 48 %
 Hispanic – 32%
 Asians – 11%
 African-American – 5%
 Native American – 1%
San Diego County is
4,200 square miles
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SAN DIEGO COUNTY
GOVERNMENT
Board of Supervisors – publicly elected by District
5 Major Groups
 Health and Human Services Agency
 Created in 1998, Integrated Delivery System
 Public-private partnership emphasis
 $2+ billion annual budget
 6,000 FTEs, 185 advisory boards
 ~ 1 million clients from Womb to Tomb
 Land Use and Environment Group
 Public Safety Group
 Community Services Group
 Finance and General Government
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HEALTH AND HUMAN SERVICES
AGENCY
Departments:
 Aging & Independence Services
 Behavioral Health Services
o Adult Mental Health
o Children's Mental Health
o Alcohol and Drug Services

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


o
Child Welfare Services
Public Health Services
Eligibility Operations
Regional Operations
Administration
Impact the
general public
(3.2M) and
clients at risk
and at high
risk/need
(~1 M)
Programmatic links to many County groups including:
 Probation, Sheriff, Housing, Libraries
PROBLEM
Lack of Exercise
Poor Diet
Smoking
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OVER
Result in
Lead to
RESULT
BEHAVIORS
DISEASES
PERCENT
No Physical Activity
Poor Diet
Tobacco Use
Cancer
Heart Disease & Stroke
Type 2 Diabetes
Lung Disease
of deaths
in San Diego
GRIM OUTCOME…
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COST
ECONOMIC
IMPACT:
$4.6 BILLION IN
SAN DIEGO
COUNTY
SOLUTION
Building
Better
Health
Living
Safely
Thriving
LWSD APPROACH
Change how service is provided to improve health and
social wellbeing:
 Optimize existing healthcare, public health and social service
resources to innovate service delivery, reduce waste and
improve outcomes
 Create local accountability by all, not some
 Health & Safety-In-All-Policies
 Promote individual responsibility
 Achieve fiscal sustainability thru new payment reforms
 Connect the Unconnected thru modernized IT
 Advance evidence-based policy-making and planning
COLLABORATIVE BUSINESS
MODEL
The Harvard Human Services Value Curve
Efficiency in
Achieving
Outcomes
Generative
Business Model
Integrative
Business Model
Collaborative
Business Model
Regulative
Business Model
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Effectiveness in
Achieving
Outcomes
DRIVING FACTORS
We’re all in the business of serving the public.
We need to work together to best leverage existing
resources and meet shared goals. The management
choices we make are influenced by:
Efficiency in
Achieving
Outcomes
 Business Case – Imperatives and Visions
Generative
Business Model
Integrative
Business Model
Collaborative
Business Model
Regulative
Business
Model
 Economy – Budget Cuts and Accountability
 Legislation and Expectations – Healthcare
Reform, Title 4e, Welfare Reform
 Technology Changes – Imposed and
Advanced
Effectiveness in
Achieving
Outcomes
Human Services Value Curve, Antonio Oftelie
INTEGRATED SERVICES ACROSS
THE LIFESPAN
Drivers:
 Vision/Strategy
 Service Delivery
 Financing
 Workforce
 P3 in Action
Behavioral
Health
Services
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Children / Youth
Adults
Older Adults
• We Can’t Wait
• Positive Parenting
Program
• Kickstart
• Behavioral Health /
Primary Care
Integration Summit
• Bridges to Recovery
• In-Home Outreach
Team
• Aging Summit
• Community Care
Transition Program
• Passport to Healthy
Aging
Primary
Care
Human
Services
CHALLENGE
How could the County of San Diego expand the
capacity of its Family Resource Centers to meet
greatly increased demand first for CalFresh (SNAP)
and then Medi-Cal Expansion?
Response:
Re-engineered Eligibility Process, including a new
state-of-the-art Access Customer Service Call Center.
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PERFORMANCE CHALLENGE
Performance
Sept. 2011
Calls Handled via Self-Service
10,612
Calls Answered
32,717
Abandoned Calls
13,978
Total Calls
59,969
Calls Answered Per Work Day
1,558
% Calls Answered
76.7%
ACCESS Average Wait Time
39:02
Average Handle Time
14:52
PROJECT APPROACH
Business Process Re-engineering
Data Analysis
Best Practices: Site visits to 211 San Diego,
Orange County & San Bernardino
Call Center Vendor Consultation
“Customer” Feedback: Caller Surveys, Staff
Focus Groups
ACCESS CENTER PROJECT SCOPE
Staffing
Training
• Immediate intervention
• Long term strategy
• Immediate intervention
• Long term strategy
Call Center
Performance
•Strategic Vision
•Tactical Management
•Interactive Voice
Response (IVR)
ACCESS CENTER
WALLBOARD TRACKING
ACTIVITY
PERFORMANCE MONITORING
Performance Comparison
Sept. 2011
July 2013
July 2014
Calls Handled via Self-Service
10,612
18,909
15,081
Calls Answered*
32,717
56,694
66,440
Abandoned Calls*
13,978
13,567
12,461
Total Calls*
59,969
94,828
95,967
Calls Answered Per Work Day
1,558
2,709
3,020
% Calls Answered
76.7%
85.7%
87.0%
ACCESS Average Wait Time
39:02
15:50
13:50
Average Handle Time
14:52
14:01
15:50
*ACCESS + 211
CUSTOMER SERVICE
FEEDBACK
“I am satisfied with the Call Center.”
64%
60%
59%
40%
30%
26%
20%
11%
9%
0%
Strongly Disagree
Disagree
Neutral
Strongly Agree
Agree
Sep 2011
July 2014
KEY TAKE-AWAYS: IT’S ABOUT
Common Vision—Enables strategic
alignment and silo-busting
Business Imperative—Innovate to adapt.
Changing the Culture from Within—We are
in the wellness business.
Customer, Customer, Customer—Focus on
the customer experience and pathways
through the system.
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FROM “WELFARE” AND SICK
CARE TO WELLNESS
Past
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Present and
Future
Transactional
Transformative
Volume-Based
Value-Based
Competitive Advantage
Co-opetition
Silos & Categorical
Integrated System
Connecting the Unconnected
InterOptimibility
Sick Care/Social Welfare
Wellness
CALL TO ACTION
How do we improve
the wellness of our
communities?
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TO LEARN MORE
Live Well San Diego
Visit
LiveWellSD.org
Or
Email us at
LWSD.HHSA@sdcounty.ca.gov
THANK YOU!
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