REGULATIVE
COLLABORATIVE
INTEGRATIVE
GENERATIVE
HEALTH AND HUMAN SERVICES INTEGRATION MATURITY MODEL
Based on APHSA’s 21st Century Health and Human Services Business Model1
MATURITY LEVELS
Adapted from The Human Services Value Curve2
2 - COLLABORATIVE
3 - INTEGRATIVE
1 - REGULATIVE
Focus
KEY
FEATURES
Delivering services to constituents
for which they are eligible while
complying with categorical policy and
program regulations.
Ensuring the appropriate mix of existing
services for constituents working across
agency and programmatic boundaries.
Addressing and solving the root
causes of client needs and challenges
by seamlessly coordinating and
integrating services.
4 - GENERATIVE3
Generating healthy communities by
co-creating solutions for multidimensional family and socioeconomic challenges and
opportunities.
Characteristics of the Key Features at Various Maturity Levels of Integration
Vision is to provide all services
available under existing statute and
regulations, effectively and
efficiently, to those who qualify and
make themselves known to the
organization.
Vision is to provide all services available
from the organization, as well as from all
collaborating entities, effectively and
efficiently, to those who qualify and make
themselves known to either the
organization or collaborating entities.
Vision
Vision is to provide all services
available across the fully integrated
health and human services enterprise,
effectively and efficiently, to those
who qualify and either make
themselves known or are identified
through proactive measures taken by
the enterprise to support a consumercentric, outcome-oriented, modern
marketplace experience.
Vision is to provide all services
available across the fully integrated
health and human services enterprise,
effectively and efficiently, including
the identification of additional
services designed to address the
broad range of social determinants of
health, whether available inside or
outside the enterprise. Those who
qualify are identified through a variety
of consumer-friendly, self-reporting
mechanisms and proactive measures
taken by the enterprise, including the
use of sophisticated data analyses
capable of generating predictive
models of consumer current and
future needs. The consumer-centric,
outcome-oriented provision of shared
services and coordinated care is
designed to improve consumer
outcomes, improve population health
1. Cari DeSantis, M.A.L.S. Business Model for Horizontal Integration of Health and Human Services. APHSA. 2012. pp. 13–17.
2. Antonio M. Oftelie. The Pursuit of Outcomes: Leadership Lessons and Insights on Transforming Human Services: A Report from the 2011 Human Services Summit on the Campus of
Harvard University. Leadership for a Networked World. 2011. pp. 5–7.
3. The Generative Level incorporates the 10 key characteristics of the 21st Century Health and Human Services Business Model.
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REGULATIVE
Governance
COLLABORATIVE
INTEGRATIVE
Governing bodies are comprised of
internal, senior executive level
decision-makers. Decision-making is
vertical and top-down. Risk is
minimized by holding each program
accountable for results over which it
has direct authority and control.
Governing bodies are comprised
primarily of internal, senior executives,
although external stakeholders from
collaborating organizations may also be
represented. Decision-making is
influenced by horizontal considerations
associated with collaborating
organizations. Risk is shared across
collaborating entities.
Governing bodies are broadly
representative of the enterprise as a
whole, including stakeholders, and
staff from throughout the
organization. Decision-making,
accountability for outcomes, and risk
are shared by all affected components
of the enterprise, regardless of any
single program’s role.
Leadership views the organization as
“a singular entity, a monolith rich in
sameness, common thinking, and
5
common doing”.
Leadership across the organization views
collaborating organizations as partners
who share common goals and bring
valuable assets to the challenges faced by
their shared consumers.
Leadership across the enterprise
views the organization as “ecosystems
bound together by a common
purpose, but steeped in difference”
that must be understood and
appreciated if the organization is to
move ahead toward a common center
(see footnote 5). It places the highest
value on outcomes-focused goals
even at the expense of organizational
norms. It makes mid-course changes
when necessitated by new
information. It empowers others
within the organization by
deemphasizing hierarchy and silos
(see footnote 5).
Adaptive
Leadership
and
Capabilities
GENERATIVE
over time, and bend the health and
human services cost curve by 2025.
Governing bodies are broadly
representative of the enterprise as a
whole, including stakeholders from
outside the enterprise who can
contribute significantly to a forwardthinking perspective to the
enterprise’s governance deliberations.
Decision-making reflects a proactive,
anticipatory, 360 degree orientation
that takes into consideration drivers
associated with the social
determinants of health and wellbeing. Risk is continually being
balanced with opportunities to
generate new approaches to
improving consumer outcomes and
reducing societal costs associated with
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health and human services.
Leadership across the enterprise views
the organization the same way as in
the Integrative stage but it places the
highest value on outcomes-focused
goals even at the expense of
organizational norms. It makes midcourse changes when necessitated by
new information. It empowers others
within the organization by
deemphasizing hierarchy and silos.
Leadership looks beyond existing
contractual relationships and strives
to generate a new collective of nontraditional public/private sector
partners focused on both sustaining
whole community well-being and
generating new approaches and
solutions (see footnote 5).
4. Cari DeSantis, M.A.L.S. Governance Guidance for Horizontal Integration of Health and Human Services. APHSA. 2012. p. 4.
5. The Art of the Possible, Leading Change in Human Services, Antonio Oftelie, Julie Booth, and Tracy Wareing, Policy and Practice, June 2012, pp. 11–15.
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REGULATIVE
Consumer
Access
Channels
COLLABORATIVE
GENERATIVE
Organizational change is driven by
outside statutory and regulatory
process requirements associated
with error-free and timely service
delivery.
Organizational change is driven by
collaborative efforts to address mutual
challenges. Challenges stem from external
requirements and internal opportunities
identified through information sharing
across organizational boundaries. The
organization’s staff and systems strive to
adapt their business processes and data
flows to reinforce cooperation.
Organizational change is driven by
continual environmental scanning of
the current and anticipated statutory/
regulatory environment as well as the
marketplace of the enterprise and its
trading partners and stakeholders. A
seamless cross-boundary exchange of
information within the enterprise
provides a continuous stream of
useful information that provides
increasingly rich opportunities for
changing traditional practices.
Organizational change is driven by a
culture of receptivity that strives to
generate improved solutions by
constantly leveraging the enterprise’s
strengths with private and public
partners who share common goals.
Information gathering from internal
and external sources plays a key role,
and being highly adaptive to change is
a critically important organizational
value that guides staff actions
routinely.
Access to services is the
responsibility of the consumer
through direct person-to-person
contact at the local office, although
some information may be available
on-line.
Access to services is a joint responsibility
between the consumer and the
collaborating organizations. Guidance
regarding available complementary
services is provided to the consumer by
the collaborating organizations.
Access to services is a joint
opportunity between the consumer
and the enterprise, with the latter
helping the consumer navigate the
service system through the setting of
decision points for choices that lead
the consumer toward health and
wellness.
Access to services is comparable to the
best that can be found in the privatesector retail marketplace. Seamless
technologies incorporating the latest
advances in consumer access channels
are utilized, including readily accessible
24x7 Call Centers.
Use of technology is focused on
processing transactions and reducing
administrative costs.
Use of technology is focused on
facilitating data exchanges between
collaborating organizations. Web-based
technologies such as electronic consumer
portals, central data repositories, and
document imaging and digitization of case
records facilitate consumer access and
enrollment.
Use of technology is focused on
enabling consumers and staff to
effortlessly navigate a variety of
access channels across the enterprise.
Enterprise service busses, master
client indices, workflow management
and identity management tools,
automated account creation
technologies, and readily available
case notes that can be shared with
others (within consumer privacy
constraints), are used widely.
Use of technology is focused on
enabling the enterprise to work
collaboratively with the consumer as
“choice architects”. Online portals,
smart phones, tablets, and kiosks work
together seamlessly with traditional
service centers and personal referrals.
Community-based organizations serve
as portals and extensions of
government. The enterprise serves as a
“beta test site” for innovative
approaches to enhancing existing and
generating new consumer access
channels.
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INTEGRATIVE
REGULATIVE
COLLABORATIVE
GENERATIVE
Application and enrollment activities
are highly customized to individual
programs.
Application and enrollment activities are
handled separately by collaborating
organizations. They make use of crossboundary data to provide coordinated
services.
Application and enrollment are based
on a common application and use of a
Master Client Index. Decision support
tools enhance management’s ability to
make decisions on behalf of
consumers that transcend
organizational boundaries.
Application and enrollment are based
on a common application and use of a
Master Client Index resulting in
integrated case management and
innovative relationship management
strategies to achieve desired
outcomes.
Verification of consumer eligibility is
based primarily on paper records.
Verification of consumer eligibility is
based on a mix of paper and electronic
information. To the extent that legacy
systems use cross-boundary
communication, they are enabled by addons to the existing system rather than
through systems integrated across
components.
Verification of consumer eligibility is
based on electronic data bases in
various locations inside and outside
the enterprise. Systems are
completely integrated within the
enterprise and connected seamlessly
with those outside the organization
based on well-defined data use
agreements.
Verification of consumer eligibility is
based on the application of common
business rules, electronic document
management, and robust privacy and
security controls coupled with robust
data sharing. These resources,
combined with multi-benefit
screening, result in real-time eligibility
determinations, including Express
Lane eligibility.
Workflows are well-organized, rulesdriven, and designed to deliver a
specific output, including
determination of eligibility, benefit
level to be provided, etc.
Workflow processes are updated to build
in efficiencies through collaboration with
other programs, resulting in multiple “one
stop” opportunities.
Workflows are streamlined, seamless
and completely integrated. Focus is on
achieving desired outcomes for the
consumer regardless of the roles of
individual lines of business.
Workflows similar to those of the
Integrative Level are used by a
remote, mobile and continually
innovative workforce that generates
ever faster and more efficient ways of
helping the consumer achieved
desired outcomes.
Consumer history resides exclusively
within the organizational boundaries
of each business line or division.
Consumer history resides within individual
business lines or divisions but is shared
across organizational boundaries.
Consumer history can be centralized
or reside in multiple locations across
the enterprise. Information is easily
accessible by consumers and staff to
ensure efficient, end-to-end
workflows and appropriate outcomes.
Consumer history is available
instantaneously to front-line workers
while maintaining the highest levels of
privacy, security and confidentiality by
relying on impenetrable firewalls,
Federal standards and Public Key
Infrastructure (PKI).
Common
Process
Functions
and Shared
Services
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INTEGRATIVE
REGULATIVE
Coordinated
Service
Delivery
Sustainable
Outcomes
for
Individual
Consumers
and the
General
Population
COLLABORATIVE
GENERATIVE
Services are identified and delivered
within the boundaries of the
organization.
Services are identified and coordinated
across collaborating organizations.
Services are identified and readily
accessed throughout the integrated
enterprise.
Services are identified and readily
accessed throughout the integrated
enterprise and its organizational
partners.
Caseworkers may help consumers
find additional assistance but the
consumer needs take the initiative to
access it.
Caseworkers are knowledgeable about
services available through collaborating
organizations and help consumers access
them in a timely way.
Caseworkers seamlessly across
multiple lines of business in such a
way that consumers’ individual needs
are met and achieved.
Caseworkers ensure that solutions are
customized to meet individual needs,
and that supplementary services are
part of the client’s service plan that
also address the social determinants
of health, such as inclusion of
preventive services, early
intervention, and protective services
available through home and
community-based venues, behavioral
health, long-term care supports for
those with disabilities, transportation,
health education, and job training,
where appropriate.
The service delivery system is
administered efficiently within the
span of control of the organization
responsible for delivering the
services.
Outcomes for individuals are defined
by your agency in terms of regulatory
and statutory requirements
associated with the efficient and
effective processing of client
transactions.
The service delivery system is coordinated
across collaborating organizations. “Best
practices” in other organizations are
viewed as possible sources of efficiency
and innovation.
Outcomes for individuals are defined
collaboratively with other organizations
sharing common values and goals
although the focus remains primarily on
ensuring smooth, efficient transactions.
The service delivery system across the
entire integrated enterprise has an
increased ability to replicate, utilize
and customize evidence-based
practices to achieve cross-program
outcomes.
Outcomes for individuals are defined
by the enterprise as a whole and used
as benchmarks for evaluating progress
toward achieving sustainable results
for individual consumers.
The service delivery system specifically
customizes products into unique
arrays that meet consumer needs
while drawing upon a practice model
that is shared across the enterprise.
Outcomes for individuals are defined
by the enterprise as a whole, and
continually fine-tuned through
feedback mechanisms to ensure that
the outcomes are appropriate for
individual consumers and the general
population.
Transactions, including those involving
collaborating organizations, are processed
accurately and timely.
Sustainable outcomes are defined as
those that favorably impact the
consumer for at least the next year.
Transactions are processed
accurately and timely.
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INTEGRATIVE
Sustainable outcomes, defined by the
enterprise and identified through
feedback mechanisms, continue to
favorably impact the consumer for at
least three years, and, ideally, longer.
REGULATIVE
Sustainable
Outcomes
for the
System/
Enterprise
COLLABORATIVE
Outcomes are defined by the organization
and sister agencies of which close
collaboration leads to jointly shared
outputs.
Outcomes are defined by the
enterprise’s outcomes, rather than
inputs or outputs. The enterprise
works as a seamless whole to achieve
the best outcomes for its users and
accepts unanticipated outcomes
generated from the enterprise.
Outcomes are defined by the
enterprise as it evolves as a result of
cumulative knowledge gained over
time and reflects advancements
attributable to continually evolving
solution sets that are being generated
by the organization.
The determination of whether the
outcomes are sustainable is a
function of how well the organization
captures their inputs and outputs.
The determination of whether the
outcomes are sustainable is a function of
how well the collaborating organizations
share the same goals.
The determination of whether the
outcomes are sustainable is a function
of how well the enterprise
communicates internally and
externally as well as vertically and
horizontally; and has one goal
spanning the enterprise.
The determination of whether the
outcomes are sustainable is a function
of the enterprises continuous
adaptability and ability to improve
performance. Communication among
all stakeholders is efficient and the
enterprise shares goals across other
enterprises.
Measures focus on inputs and
outputs of the organization
delivering services, including
program investment, number of
families served, number or
percentage of cases closed in a given
time period, etc.
Measures focus on inputs and outputs of
the collaborating organizations, rather
than those of a single organization, but
they remain largely of the same type as
those described under the regulative
level.
Measures focus on leveraging trend
and root cause analyses in order to
forecast future performance and
expected effects (such as families
most likely to benefit from new forms
of case management and services) of
new interventions and program
innovation.
Measures focus on generating new
valuation and solutions (such as
performance-based contracting, payfor-success options, etc.) and
improved service design, (creating,
starting and ending programs)
development and delivery.
Measures quantify a specific activity
and provide basic trend data over
time.
Measures quantify actions taken to
achieve goals that serve the collaborating
organizations’ shared mission.
Measures track client outcomes and
are used to project ways in which the
enterprise can be more responsive to
future trends; these measures cut
across the enterprise as a whole.
Measures are used to continually
upgrade the program’s design in ways
that not only affect the immediate
enterprise, but others interested in
business process improvement as
well, toward increasingly higher levels
of client satisfaction and sustained
outcomes.
Structure is designed to be
responsive to administrative process
drivers within the individual service
delivery organization.
Structure is designed to be responsive to
administrative process drivers within the
individual service delivery organization
but with allowances made within the
infrastructure to permit cross-boundary
coordination among collaborating
Structure is designed to be responsive
to administrative and other drivers
within the enterprise; the
infrastructure supports seamless data
transfers with individual service
delivery units contributing resources
Structure is designed to be responsive
to administrative and other drivers
within and external to the enterprise;
the infrastructure supports seamless
data transfers within and across the
enterprise’s boundaries in such a way
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GENERATIVE
Outcomes are defined by the
organizations outputs (e.g., how
many consumers served, types of
services provided, how much money
was spent).
Measures
Integrated
Infrastructure
INTEGRATIVE
REGULATIVE
COLLABORATIVE
INTEGRATIVE
organizations.
and solutions across the enterprise
without being hindered by differences
in rules, vocabulary, or definitions.
as to generate organizational
efficiencies as well as to generate
innovations in policy and practice.
Systems are transaction-driven and
focused upon the individual division
and/or line of business as well as data
sharing across boundaries of collaborating
organizations. The collaborating
organizations may maintain their own
systems and nomenclatures but electronic
translators and other devices are used to
facilitate clear comprehension of crossboundary information, regardless of the
source of the information or platform
used.
Systems are outcome-driven and
focused upon goals that have been
defined for the enterprise as a whole.
Data are universally defined across the
enterprise such that no additional
translation of terms, definitions or
codes is required.
Systems are outcome-driven, focused
upon goals defined for the enterprise
as a whole that are continually being
modified to take into consideration
the larger milieu of drivers associated
with the social determinants of health,
even if those drivers arise from
outside the enterprise’s span of
influence. Data is universally defined
and reflective of this larger health and
human services context; i.e., beyond
the boundaries of the enterprise itself.
A consumer is viewed as a recipient
of services. The design and delivery
of services to the consumer remains
the responsibility of the organization.
A consumer is viewed as both a recipient
of services and as a contributor to their
own service plan. The design and delivery
of services to the consumer is a joint
responsibility shared between the
organization and the consumer.
A consumer is viewed as a contributor
to the development of a single,
integrated service plan with assistance
from the enterprise and community
partners.
A consumer is viewed as a full partner
in the development of a highly
customized service plan with
assistance from the enterprise and
community partners, drawing on, but
not limited by, the services the
enterprise has provided in the past
and services proven in other contexts
to generate positive outcomes.
Accountability for the consumer’s
success rests with the system of
service providers within the
individual line unit’s or division’s
span of control.
Accountability for the consumer’s success
rests with the system of collaborating
services providers with whom the line unit
or division is cooperating to achieve
mutually agreed upon goals, as well as
with the consumer who has contributed
to the service plan in place.
Accountability for the consumer’s
success is seen as a joint responsibility
between the consumer and others,
including consumer advisory groups
that provide input to enterprise
products, services, and strategy across
program areas.
Accountability for the consumer’s
success is shared equally between the
systems of services providers, the
community of which the consumer is a
member and the consumer.
Consumers are full partners with
enterprise and community leaders in
setting strategy for the enterprise.
Systems are transaction-driven and
focused upon the individual division
or line of business meeting its goals.
Consumer
Role
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GENERATIVE