Integration and Interoperability
Across Public Health, Human
Services, and Clinical Systems
Tuesday, May 3, 2012
• Listen only mode
• This webinar will be recorded and available on
NACCHO’s website
• The slides will also be available for download
• Please complete the evaluation when you receive
the link
• Type your questions in the box as we go
Tuesday, May 3, 2012
Outline of Webinar
Goal for today
Daniel Stein - Stewards of Change
Uma Ahluwalia – Montgomery County Department
of Health and Human Services (MD)
Questions
Tuesday, May 3, 2012
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
Tuesday, May 3, 2012
NACCHO Webinar
May 3rd, 2012
Stewards of Change Mission
“Advancing Sustainable
Improvements That Transform
Systems Of Care By Integrating
Entrepreneurial Solutions From
The Public, Private And Not-forprofit Sectors.”
Health & Human Services Ecosystem
K-12 Education
Ecosystem
Network of
Community Service
Providers
Seniors
Centers
Child Support
Collections
State Department
Of Education Federal Dept.
of Education
Head
Start
State Tax
No
Child
Left
Behind
Goodwill
Services
Workforce
Develop
Substance
Abuse
Treatment
ABC
Residential
& Group
Care
Criminal Justice
Ecosystem
Community
Mental
Health
Jewish
Community
Center
Courts
Criminal
Civil
Juvenile Justice
Family Court
Divorce
Catholic
Chairities
Head Start
Providers
Police
Schools
Local Social Service Agencies
State Health &
Human Services
Planning &
Resource
Allocation
Financial
Management
Program
Management
Provider
Management
Human Resource
Management
Regional State & Local Client
Plan & Assessment Teams
Child Welfare
MultiWIA
Discipline
Client Plan &
Medicaid
Review
TANF
Compliance
Management
IT Management
Department
Management
One Stop Centers
Multiple Locations
Interdisciplinary
Pre-eligibility Assessment
Emergency Assistance
Child care
Service Delivery (e.g. Empl.)
Facilitate Self-service
Aging
Income
Voc. Rehab
Mental
Retardation
(TANF, Emerg.
Medicaid
Aid
Child Care
Food Stamps
Workforce Inv.
Income Sec.
Caseworker
Team
Child Welfare
Secured
Internet
Information Technology
ERP
Data
Warehouse
TANF
Child Support
SACWIS
BI Tools
EAI Tools
EBT
Portal
Client data
Provider data
Referral data
Performance
Information
Technology
Productivity &
Collaboration
Workflow &
Scheduling
Integration
Technologies
Foster Care
Protective
Adoption
Developmental
Disabilities
Community
Health
Public Health
Mental Health
Child Welfare
Caseworker
Team
Health &
Disability
Caseworker
Team
Medicaid
Federal Dept.
of HHS
Medicaid
Contractor
Banks
Clients
Suppliers
Hospitals
United
Way
Microsoft Architectural Vision
RevMax
Integrated Case
Management
Team-based
Integrated
Intake
State View: Silo’d Architectures, Funding, Services
ACF
Children,
Adults &
Families
Medical
Assistance
Programs
IHS
Public Health
Addictions &
Mental Health
SAMHSA
RSA
Rich Howard – CIO Oregon DHS
Consumer Centric
Children in Foster Care
Student
Patient
Family
Adult
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>C
Learning 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 2.0
A 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.
Structure – The way public and
private human services systems
design, organize and implement
work processes to achieve policy
and practice goals.
Practice – “The way public and
private human services
organizations deliver services and
care, monitor and report results and
achieve intended outcomes
A Conceptual Architecture
“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.
15
InterOptimability Drivers
GOVERNANCE
WORKFORCE
BRIDGING SILOS
OPEN & INCLUSIVE
PROCESSES
CONFIDENTIALITY
INTEROPERABLE
INFORMATION
TECHNOLOGY
PUBLIC AND
POLITICAL WILL
CONSUMER
CENTRIC
PERFORMANCE
MANAGEMENT
FUNDING
InterOptimability
Drivers
A Comprehensive Process
• “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
18
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 Landscape
Produced at the 2007 Annual SOC Conference
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
21
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
Integration and Interoperability within the
Health and Human Services Enterprise
NACCHO WEBINAR
Thursday| May 3, 2012 | 1:00p
Montgomery County, Maryland | Department of Health and Human Services
24
Montgomery County: A Changing Picture
Population Growth (K)
Source: U.S. Census Bureau
Montgomery County, Maryland | Department of Health and Human Services

Most populous
county in
Maryland

Immigration was
the largest
component of
population change
since 2000
25
Montgomery County Diversity: Census 2010
“Minorities” are more than half of Montgomery’s population
 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, Maryland | Department of Health and Human Services
Public Assistance Needs
26

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)
Montgomery County, Maryland | Department of Health and Human Services
27
Heat, Housing and Health Needs
 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
Montgomery County, Maryland | Department of Health and Human Services
28
Medicaid Numbers In Montgomery County
Montgomery County
December December
2007
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
80,559
89,076
101,727
114,465
TOTAL
Montgomery County, Maryland | Department of Health and Human Services
29
Federal Agencies Whose Regulations and
Funding Strategies Impact County Services
 ACF
 Title XIX
 CMS
 Title IVE
 SAMHSA
 HRSA
 CSBG
 CDC
 CDBG
 ONCHIT
 Mental Health Block Grant
 HUD
 Federal and State Grants
 NIH
 Veterans Administration
 Office on Aging
 Homeland Security
 Department of Agriculture
 40% of DHHS Budget is from
State and Federal Sources
 60% of DHHS Budget is from
County Sources
Montgomery County, Maryland | Department of Health and Human Services
Montgomery County Department of Health and Human Services
30
Services and MARYLAND State Department
Connections by Service Type
• 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
Montgomery County, Maryland | Department of Health and Human Services
Department
of Health and
Human Services
31
Used Cases and the Trends They Reveal
Montgomery County, Maryland | Department of Health and Human Services
32






Scenario One
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.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
Public Health TB Clinic
Child Care Services
Maternity Services
WIC Services
Income Support Services
Workforce services
LEP Services
Domestic Violence Service via Abused Persons Program
Adult Mental Health Services
Housing Stabilization Services
Education through Public School System
Montgomery County, Maryland | Department of Health and Human Services
33
Scenario Two

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.
b.
c.
d.
e.
f.
g.
h.
i.
Adult Protective Services
Child Welfare Services
Early Learning and Child Care
Special Needs Housing Services
In-home Aide Services
Income Supports
Workforce Services
Substance Abuse Treatment
Medical and Primary Care
Montgomery County, Maryland | Department of Health and Human Services
34
Scenario Three
 Homeless diabetic woman with Schizophrenia
 Three episodes of hospitalization in last 12 months

H
o
m
e
l
e
s
s
d
i
a
b
e
t
i
c
w
o
m
a
n
 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
Montgomery County, Maryland | Department of Health and Human Services
35
Outcomes to be Achieved

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
Montgomery County, Maryland | Department of Health and Human Services
36
Business Activities
Department of Health and Human Services’ Modernization
 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
Montgomery County, Maryland | Department of Health and Human Services
37
Policy Activities
 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
Montgomery County, Maryland | Department of Health and Human Services
38
Activities to Support Practice

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
Montgomery County, Maryland | Department of Health and Human Services
Department of Health and Human Services
39
Technology Solution

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
Montgomery County, Maryland | Department of Health and Human Services
Department of Health and Human Services
40
Affordable Care Act Response
(An Opportunity for Integration)
Montgomery County, Maryland | Department of Health and Human Services
41
Six Areas of Focus for Affordable Care Act
Implementation in Montgomery County
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
Montgomery County, Maryland | Department of Health and Human Services
42
Health Planning Process
Montgomery County, Maryland | Department of Health and Human Services
43
Community Benefit and Land Use Planning

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
Montgomery County, Maryland | Department of Health and Human Services
44
Integrated
Eligibility
Five Key Focus Areas for Social
Services within Health Care Reform
Navigator
Functions
No Wrong
Door and
Integrated
Case
Management
for Chronically
Ill and Safety
Net
Population
Community
Benefit
Montgomery County, Maryland | Department of Health and Human Services
Use of
Technology
and Data
Analytics
45
Public Health is
very late in the
game
Meaningful Use and Regional
Extension Center Engagement
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
Montgomery County, Maryland | Department of Health and Human Services
Integrating
behavioral
health, social
services and
primary care
Sustainable
Model
Partnerships
46

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
Montgomery County, Maryland | Department of Health and Human Services
47
The Policy Conversation
Integrated Eligibility
Blending and Braiding Funds
Confidentiality
Evidenced Based Practice
Interoperability
Montgomery County, Maryland | Department of Health and Human Services
48
Thank you!
Montgomery County, Maryland | Department of Health and Human Services
Questions
Please type your questions in the box
Tuesday, May 3, 2012
Contact Information
Vanessa Holley, MPH
Program Analyst, ePublic Health
vholley@naccho.org
(202) 507-4239
Tuesday, May 3, 2012