@APHSA1
Building a Better Service Delivery
System: Breaking Down Silos
June 9, 2015
Speakers
Libby Bacon
Principal, Deloitte
@APHSA1
Amy S. Lapierre, LICSW
Administrator for System
Integration for the Rhode
Island Executive Office of
Health and Human Services
Medicaid program
Mary Ann Cooney, RN, MSN, MPH
Associate Commissioner, Human
Services Strategy, NH Department of
Health and Human Services
Lindsay Hough
Principal, Deloitte
@APHSA1
HOW AGENCIES ARE ADDRESSING
PEOPLE, PROCESS & POLICY
CHALLENGES IN HHS INTEGRATION
LINDSAY HOUGH
APHSA National
Collaborative
@APHSA1
DifficultyDeliveringClient-CentricHealth
& Human Services
Services
• 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
Technology
• 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
@APHSA1
Workforce
• 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
Solutions
• Review core business services to
remove duplication and streamline
across programs
• Safeguard information through
security protocols that allow
information sharing
• 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
Understanding Your Assets: Moving to
an Outcome-Centric Delivery System
Quality
Management
Contact Log/ Case
Notes
@APHSA1
Outcomes
Monitoring
Outcome(s)
Referrals /
Authorizations
Service & Provider
Coordination
Goal & Service
Plan Development
Align
Case &
Demographic Data
Management
Intake
Management &
Eligibility
No Wrong /
Single Door
Issue/Incident
Management
Needs Assessment
Integrated Service Delivery
Rules Engine and
Predictive Analysis
Programs /
Services
Understanding your Service Delivery
Footprint: Program Overlaps
Program
Total
Enrollment
Total Medicaid
2,073,181
•Medicaid only
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
CC Only
74K
160,626
Child Welfare
HCBS
40K
1,397,702
•SSI
@APHSA1
CW
38K
MA, HCBS
29K
MA, CW
29K
MA Only
375K
MA, LTC
48K
MA, CC
18K
MA, SSI,
HCBS
21K
MA, SSI
69K
MA, SSI,
MA, LIHEAP
LIHEAP 18K
86K
MA, SSI,
MA, SSI,
SNAP 99K
MA, SNAP,
SNAP, LIHEAP
GA 36K
110K
SNAP, MA,
TANF, SNAP,
LIHEAP
MA 69K
351K
TANF, SNAP,
SNAP, MA, CC,
MA, SNAP,
MA, CC
LIHEAP 40K
CC 42K
23K
SNAP, LIHEAP
SNAP, MA
TANF, SNAP, MA,
132K
338K
LIHEAP 56K
TANF, SNAP, MA,
CC, LIHEAP 15K
SNAP Only
154K
TANF, SNAP,
LIHEAP
56K
LIHEAP Only
300K
LIHEAP,
CHIP
20K
CHIP Only
129K
LIHEAP, CHIP, SNAP 14K
* Data is approximations to show overlap
Understanding your Customer
Experience
I’m
Michelle
Families /
Children
@APHSA1
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
WIC
Immunizations
SNAP
Head
Start
Additional Service
Opportunities
Screening &
Referrals
Lead
Screening
PCMS
Diversion /
Prevention
@APHSA1
New Hampshire Department of Health and Human Services
Organization ReDesign
American Public Human Services Association
June 9, 2015
Center of Perpetual Storm
@APHSA1
Factors Impacting DHHS
Client Profile
and Needs
Global
Economy
Technology
State
Economy
DHHS
Litigation
Federal
Government
Demographics
Uninsured
DHHS Workforce Over Time
Reductions from 2008 to Present
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
Current Staff Allocations
Organization ReDesign to Support
Strategic Initiatives
@APHSA1
DHHS Strategic Initiatives
Expanded
Health
Coverage
Medicaid
Transformation
•
Medicaid Care
Management (MCM)
•
Substance Use
Disorder (SUD) Benefit
•
•
Medicaid Expansion:
New Hampshire
Health Protection
Program
Section 1115
Demonstration Waiver
•
•
Mental Health
System
Reform
Population
Health
•
State Health
Improvement Plan
(SHIP)
•
Community Mental
Health Agreement
(CMHA)
•
State Innovation
Model (SIM) Model
Design Round Two
•
10 Year Mental Health
Plan
District Office Modernization
Human Services Integration
Office of
Medicaid
Business &
Policy
Resource
Prioritization
Client Services
Delivery
Coordination
Compliance
Division of
Community
Based Care
Services
Resource
Prioritization
Client Services
Delivery
Coordination
Compliance
Resource
Prioritization
Client Services
Delivery
Coordination
Compliance
Service Areas
Policy
Development
Office of
Human
Services
Division
of Public
Health
Enablers
Information
Management
Resource
Prioritization
Support
Services
Client Services
Delivery
Coordination
Finance
Alignment of programs is driven by funding streams
Compliance
Legal & Regulatory
MISSION: To join communities and families in providing opportunities for
citizens to achieve health and independence
Leadership, Vision,
& Strategic Management
Current State DHHS Business Model
DHHS ReDesign Goals
@APHSA1
Enable a team based
environment that
organizes DHHS
around the complex
needs of those we
serve
Streamline and
rationalize the
delivery of services
and support
functions across
DHHS
Whole Person
Centered
Promote a DHHS
organizational
culture that
encourages working
across traditional
boundaries
“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”
http://www.dhhs.nh.gov/media/av/redesign.htm
Future State Vision for a Whole Person
Approach
The Need
Whole Person
Goals
@APHSA1
DHHS
Partners
DISTRICT OFFICE
PARTNERS
.........
.........
.........
.........
.........
A client enters the
DHHS system with
a specific, primary
request, or the
“need”
We base our
assessment of
health status
beyond the “need”,
and consider all
physical, emotional,
intellectual,
capable, social, and
spiritual
characteristics
We develop a set
of goals to address
the “need”, and in
doing so we make
connections to any
existing secondary
needs
We coordinate
care and services
across all
appropriate areas
of DHHS to meet
both primary and
secondary needs
We connect the
client with
relevant partners
necessary to
ensure all goals
are met
DHHS ReDesign Business Model
@APHSA1
Whole Person and Population Health
Customer
Service
Assessment
Information &
Education
Policy Development
Intake &
Assessment
Assurance
Provider
Enrollment &
Inquiry
Planning &
Referral
Eligibility
Strategic Management of Medical, Behavioral Health, Human Services , and LTSS Service Lines
Leadership, Vision,
& Strategic Management
Families
Strategy
Policy
Development
Children
Quality
Goals
Inter-Agency
&
Government
Synergy
Resource
Prioritization
Adults
Seniors
Delivery
Quality
Management
Enablers
Plan Coordination &
Network Management
Data
Analytics
Information
Management
Direct
Dashboards
Support
Services
Contract
Outcomes
Gaps
Finance
Partners
Accountability
Legal & Regulatory
MISSION: To join communities and families in providing opportunities for citizens to
achieve health and independence
Population
Health
DHHS ReDesign Business Model
@APHSA1
Whole Person and Population Health
Customer
Service
Assessment
Information &
Education
Policy Development
Intake &
Assessment
Assurance
Provider
Enrollment &
Inquiry
Planning &
Referral
Eligibility
Strategic Management of Medical, Behavioral Health, Human Services , and LTSS Service Lines
Leadership, Vision,
& Strategic Management
Families
Strategy
Policy
Development
Children
Quality
Goals
Inter-Agency
&
Government
Synergy
Resource
Prioritization
Adults
Seniors
Delivery
Quality
Management
Enablers
Plan Coordination &
Network Management
Data
Analytics
Information
Management
Direct
Dashboards
Support
Services
Contract
Outcomes
Gaps
Finance
Partners
Accountability
Legal & Regulatory
MISSION: To join communities and families in providing opportunities for citizens to
achieve health and independence
Population
Health
How Strategy Drives Delivery
Strategy
•
•
•
•
•
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?
Delivery
•
•
•
•
How will we deliver services?
Where will they be delivered?
What new or expanded services will be needed?
Who will we partner with?
@APHSA1
Department of Health and Human Services
Operating Model for Population and Whole Person Health
Strategy
•
•
Assessment
Policy Development
•
•
Delivery
•
Assurance
Resource Prioritization
•
•
Inter-Agency & Gov. Synergy
Plan Coordination
Provider Network Management
•
Delivery Systems Management
Public Health
Medical
General
Population
Behavioral
Children
&
Families
Adults
Seniors
State-Wide
Service
Delivery
LTSS
Regional
Service
Delivery
Regional
Service
Delivery
Regional
Service
Delivery
Region 1
Region 2
Region N
Human Services
Quality Management
Data Analytics & Dashboards
Outcomes & Gaps
Accountability
Customer Service
Information & Education
Intake & Assessment
Eligibility
Planning & Referral
Business Enablers
Human Resources
Business Function
Communications
Includes Matrixed Functions
Information
Management
Service Line
Finance
Legal & Regulatory
Other Business
Enablers
Revised 4/9/15
Summary of ReDesign Functions
@APHSA1
Customer Service
•
•
•
•
•
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
Delivery
•
•
•
•
Enablers
•
•
•
•
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
Population Health*
•
•
•
Quality Management
•
•
•
•
•
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
*Definitions summarized from CDC Core Functions for Public Health
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
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 populationbased health services and enforce laws and regulations
that protect health and ensure safety
Strategy
•
•
•
•
•
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
Department of Health and Human Services
Functional Architecture for Population and Whole Person Health
Commissioner
Deputy
Commissioner
Commissioner’s Staff
Strategy
Population
Health
Infectious
Disease
Laboratories
Public Health
Protection
Public Health
Statistics &
Informatics
Health
Services
Human
Services
Medical
Human Services
Behavioral
Other
Services
LTSS
Populations
Delivery
Plan
Coordination
Provider
Network Mgmt
State-Wide Service
Delivery
Quality Management
Customer
Service
Business
Enablers
Data Analytics &
Dashboards
Information &
Education
Finance
Outcomes &
Gaps
Intake &
Assessment /
Eligibility
Information
Management
Accountability
Planning &
Referral
Human
Resources
Legal &
Regulatory
Other
Health Services
Regional
Service Delivery
Communications
Other
Support Services
Revised 4/9/15
ReDesign Approach
Assess Organization
@APHSA1
Design Business Model
Develop Operating
Model
Transition & Evolve
Organization
Key Activities
Identified objectives, guiding
principles, and value
expectations for redesign
Incorporated ‘Key
Considerations’ into Future
State Assumptions
Develop functional matrix and
map current DHHS functions
and capabilities to Business
Model
Design Organization Charts for
Operating Model
Interviewed Select Sr. Mgmt
and Program Directors
Facilitated Visioning Sessions
with Sr. Mgmt to develop a
Business Model
Identify overlaps and gaps in
functional capabilities
Identify transitional activities
(training, staffing, etc..)
Gathered HR employee data for
all DHHS staff
Validated the Business Model
through scenario planning
Facilitate Visioning Sessions
with Sr. Mgmt to design
Operating Model
Develop and prioritize
implementation roadmap
Communication and feedback with staff
Key Outcomes
Current State Documentation
of the DHHS Organization
Future State DHHS
Business Model
Functional capabilities aligned
to Future State DHHS Business
Model
Future State DHHS Organization
Charts Developed
List of ‘Key Considerations’
raised by staff for Redesign
Vision Statement for Future
State DHHS Organization
Operating Model for Future
State DHHS Organization
Implementation Roadmap with
prioritized activities and
schedule designed
Implementation of new
Organizational Structure
@APHSA1
Rhode Island’s Approach to
Health and Human Services
Integration
Amy Lapierre, LICSW
Rhode Island Executive Office of Health and Human Services
HHS Integration
Intersection of Policy & Technology
@APHSA1
Where we
are going….
Where
we
were….
Legacy MMIS and
Manual Eligibility Processes
With passage of
Health Care Reform,
an early decision to
integrate eligibility
systems
Multi-agency
Coordination &
Integration Strategy:
Medicaid Office, DHS,
and OHIC agree on
single solution for
health exchange and
eligibility system
Integrated UHIP Vision and Principles
@APHSA1
Our Solution: Unified Health
Infrastructure Project - UHIP
State-Based
Marketplace
Rhode Island
Unified Health
Infrastructure
Project
UHIP
Self-Service
Portal
Medicaid and
Human
Services
Programs
UHIP Approach to Integration &
Coordination
@APHSA1
Medicaid
•
•
Exchanges
•
•
State Plan
•
Managed Care
•
Waivers
Accountability to CMS
Eligibility Processes
Customer Assistance
Shopping Experience
•
Premiums
Plan Management
•
SHOP
Accountability to CCIIO
•
•
Human Services
Program Design &
Delivery
Accountability to FNS &
ACF
UHIP Approach

POLICY

Policy “Alignment”

Eligibility rules

Benefits and coverage

Carriers and networks
Operations “Coordination”

OPERATIONS

TECHNOLOGY
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
Operating Practices for Successful
Integraiton
@APHSA1
• 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?
Thank you
Libby Bacon
Principal, Deloitte
@APHSA1
Amy S. Lapierre, LICSW
Administrator for System
Integration for the Rhode
Island Executive Office of
Health and Human Services
Medicaid program
Mary Ann Cooney, RN, MSN, MPH
Associate Commissioner, Human
Services Strategy, NH Department of
Health and Human Services
Lindsay Hough
Principal, Deloitte