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Achieving Effective Service Delivery and Operational Efficiency in State Health and Human Services Organizations

ACHIEVING EFFECTIVE SERVICE DELIVERY AND OPERATIONAL EFFICIENCY

Table of Contents
Introduction ....................................................................................... 1 Client-Centric View ............................................................................. 2 Predictive Analytics ............................................................................ 6

ACHIEVING EFFECTIVE SERVICE DELIVERY AND OPERATIONAL EFFICIENCY

Introduction
Health and human service agencies can comprise up to 40 percent of state budgets. Yet, in spite of this large investment and the best intentions of these agencies, individuals and families regularly fall through the cracks. Health and human services (HHS) goals are not simply to provide services to individuals. Their goals are generally more far-reaching: to empower or strengthen clients and help them become self-sufficient. In order to achieve such far-reaching goals, agencies must recognize the need to treat clients holistically: (1) On the individual level, aggregate all programs and services applicable to the client to obtain a comprehensive view of the client. (2) Within families, obtain a comprehensive picture of their service use, as a number of programs and systems may serve multiple individuals within the family unit. (3) In addition to immediate needs, see that clients long-term needs are also addressed. Health and human services systems include a variety of data sources residing in a large number of standalone legacy systems, which are interoperable. As a result, service delivery is often fragmented and inefficient. This prevents the majority of service recipients from getting programs delivered to them in a way that accelerates their wellness and independence. Service fragmentation is characterized by numerous, uncoordinated programs that can lead to delayed service delivery, inadequate care or failure to provide needed services. One factor contributing to fragmentation is many limited-focus programs that seek to prevent or mitigate specific, narrowly-defined problems or behaviors, rather than responding holistically to the long-term needs of individuals. This is due to the lack of information sharing among single and/or statewide HHS agencies. Most data sources for these programs have operated independently in the past, with integration and information sharing generally occurring only when specific client and/or program needs have required the development of individual system interfaces. While there are various explanations for the existence of fragmented systems, there is growing recognition that collaboration across HHS agencies, and with agencies outside of HHS, is important. Cross-collaboration would not only address the multifaceted needs of citizens and provide effective service delivery, but would also efficiently use limited agency resources at the state and local levels. HHS entities are uniquely organized in each state, with some states grouping their programs under a broader HHS umbrella and other states treating programs and services as separate entities. Regardless of the organization of these agencies, many state HHS systems are more like a maze than a coordinated system of service delivery. The resulting confusion is alleviated by integrating data from various standalone HHS programs in ways that magnify its impact and improve its usability. This enables HHS agencies to work much more collaboratively with the clients they serve.
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ACHIEVING EFFECTIVE SERVICE DELIVERY AND OPERATIONAL EFFICIENCY

The ability to easily access and share data among various systems and databases can provide numerous benefits: Efficiencies in Client Services. Reduce duplicated efforts and time needed to enter identical client-related data in multiple systems, or retrieve data from multiple systems. As a result, staff members spend less time on data entry, accuracy is improved and client services can be implemented and managed faster. Coordination of Client Services. Easily track and coordinate services provided by multiple HHS agencies and non-HHS state agencies. Expanded Access to Critical Management Information. Readily pull critical management information together in a timely, accurate and beneficial fashion. This ability can be enhanced by accessing HHS databases, and potentially accessing other systems across state and county governments. Program Integrity and Accuracy. Have a greater capacity to compare information and verify accuracy and compliance among related programs, services, providers and consumers. Documentation and Reporting. Efficiently generate the documents and reports needed to meet state statutory and federal regulatory requirements, reducing the potential for federal disallowances and large paybacks, and reducing instances of federal and state financial resources being inappropriately distributed. Performance Measurement. Accurately track and measure overall program outcomes, contractor performance and provide a more comprehensive approach to measure client outcomes. Responses to Legislative Information Requests. Provide HHS staff with the data needed to respond to requests for information, and efficiently complete accurate and beneficial studies required by the legislature.

Client-Centric View
The client-centric view is an innovative approach to data integration that encompasses the entirety of a persons interactions with the HHS system, based on integrated, realtime information across all programs and services. This allows HHS agencies to create a holistic view of individual clients, providing the opportunity to review all HHS-related programs and services applicable to any given client using a single, integrated service. Providing integrated views of clients across all service areas gives HHS agencies an opportunity to dramatically increase the quality of services and efficiencies, while reducing costs.

ACHIEVING EFFECTIVE SERVICE DELIVERY AND OPERATIONAL EFFICIENCY

To visualize the client-centric view, the services received by clients can be thought of as layers (Figure 1). Traditionally, each layer correlates to a specific program or service and is viewed independently. A client-centric view, however, combines all layers allowing a single, comprehensive view of the client instead of several disconnected agency views. A client-centric view is not limited to an individual; it is also comprised of data related to an individuals family (Figure 2), allowing the entire usage of the HHS system by a family unit to be addressed. This helps agencies better understand the distribution of needs and service use among families, how various family issues affect an individual and how to more efficiently deploy resources.

Public Health Medicaid SNAP (Food Stamps) Mental Health Vocational Health
Figure 1

Mother

Father

SNAP Medicaid Substance Abuse

Child

SNAP Mental Health Medicaid

Child Care Child Welfare

Stepfather

Child

Substance Abuse Mental Health Medicaid

Sibling

Child Care Child Welfare

Public Health Vocational Rehab

Figure 2

ACHIEVING EFFECTIVE SERVICE DELIVERY AND OPERATIONAL EFFICIENCY

A holistic view of a family allows several questions to be considered: How long has the family been in the HHS system? Has the family or a member of the family received duplicative services? What are the costs associated with serving this family? Has the family or a member of the family not received services needed in a timely manner or at all? What costs were incurred through redundant services? Are there any recent additions to this family unit in the HHS system (e.g., an uncle or an aunt)?

To access the benefits of the client-centric view, divisional management teams across HHS agencies can consider these questions below in an effort to identify potential opportunities. How can HHS agencies discover greater opportunities for proactive rather than reactive management? Departments of HHS, in an effort to enhance their care coordination and delivery of programs, seek to gain a better understanding of the clients they serve. While departments have the ability to view individuals served by a single program, they seek a more coordinated approach of serving the family, across agencies and systems. A client-centric view across all HHS-related programs (e.g., public health, mental health, social services, vocational rehabilitation, hearing impaired, etc.) provides HHS organizations with the ability to detect overlaps of service delivery; view the impact on the agency resources and budgets; and offer direction on how services might be organized and provided in a more efficient and effective manner. Additionally, integrating data allows HHS to view regions of the state that may be in public health distress, which can have a direct impact on the family units economic stability. This could serve as an early indication of the need for mental health services, substance abuse services or programs of social services (e.g., food and nutrition, SNAP, child welfare, child care, etc.). How can client services be improved and better managed, avoiding omissions and duplications? A client-centric view allows for improved client services and better program management by reducing repetitive intake processes, enabling better decision-making metrics through enhanced analytics, targeting services for at-risk children (or other target populations), and coordinating approaches to information intake and sharing.

ACHIEVING EFFECTIVE SERVICE DELIVERY AND OPERATIONAL EFFICIENCY

Each of the programs and services provided by the local county department of social services is contained in a standalone legacy system that collects information regarding the clients income, household makeup, financial resources, etc., to determine eligibility for that particular program or service. Currently, clients must complete an individual, hard-copy application to apply for each program or service offered by the local department of social services (DSS). Upon completion of each of the various applications, the client is required to meet with a different case worker dedicated to each particular program area. A client-centric view can improve services to the client by reducing the time spent completing multiple applications (each requiring identical information), time spent making duplicate copies of the required documentation for multiple programs and time spent in the local DSS; thereby, time away from work and family is also reduced. The ability to capture the required client-specific information and documentation required for multiple programs once, and share it with programspecific, dedicated case workers and multiple standalone legacy systems, makes the client application process more efficient. Additionally, the workload of the various program case workers is reduced by eliminating redundant data collection and time spent interviewing clients. Local departments of social services can now meet the needs of the client holistically, rather than in a siloed manner. Often a client will make multiple trips to the local DSS to apply for various services. The data provided by the client over time can vary due to changes in the clients income and household makeup. With the ability to integrate data obtained by the client over time and from multiple applications for program services, local DSS management can analyze the data to identify inconsistencies in client information. For example, a single mother has reported on her food and nutrition application that her household consists of a single mother and two children. Subsequently, information is obtained via an application for Medicaid (or from other data sources), that the household really consists of the single mother, her two children and an aunt who is employed and living at the same residence. With the ability to gather and integrate information from data residing in multiple systems, DSS can now get a holistic view of the client and her household and accurately determine proper eligibility for programs. In this case, the client is only eligible for a reduced food and nutrition benefit. What problems can be averted if critical data and analysis are readily available in a timely and accurate manner? Often an early indication of continued family distress in a household is a childs extended periods of absence from school. If a comprehensive data integration repository exists for the various state agencies, local case workers can intervene and potentially avert child abuse, neglect or family violence, and offer needed services for the family. This repository can facilitate the evaluation of program effectiveness and efforts to improve the lives of the most vulnerable clients.

ACHIEVING EFFECTIVE SERVICE DELIVERY AND OPERATIONAL EFFICIENCY

Predictive Analytics
A client-centric view presents a vast array of opportunities for HHS organizations to take service delivery to the next level with predictive analytics. Predictive analytics give organizations the ability to answer high-impact questions such as What will happen next? and What is the best that can happen? In the past, people enrolled in the HHS system may have received benefits that they were not eligible for, that did not result in their betterment, or that they did not need. Rather than just solve a single crisis, predictive analytics help deliver the best services to address immediate and future needs, and give families the resources to stay on their feet. Applying predictive analytics to a holistic view of a client or a family unit introduces new, more dynamic questions to consider: Which individuals could be at risk based on issues affecting their family members? Are there any early indicators of future potential issues? What interventions can be put in place to prevent a negative outcome? What combination of programs and services should this client be on to achieve self-sufficiency? What actions can we take now with this client to prevent future issues that may arise? Analytics allows HHS organizations to group citizens of like characteristics to discern trends and patterns, and discover successful routes for self-sufficiency and independence. Predictive analytics can answer questions such as: Which programs and services have been successful for clients of this type? What interventions should be put in place for this family based what has been successful for similar families? How long will this individual or family likely be in the HHS system? What are the future costs associated with serving this family?

The ability to use a client-centric view in a predictive analytical environment can have several benefits: Optimize Resources. Predict where, when and who to provide programs and services to when they are most needed. Reduce Long-Term Impact. Predict which early indicators could raise future issues within a family in order to take action now to prevent a negative outcome later. Accelerate the Self-Sufficiency Process. Predict which combination of programs and services an individual will benefit from the most, based on patterns of the entire HHS system population.

ACHIEVING EFFECTIVE SERVICE DELIVERY AND OPERATIONAL EFFICIENCY

A Hypothetical Case
Revisiting the client in Figure 1, a client-centric view shows us that the client is part of multiple health and social service programs. Put into an analytical environment, this client can be compared to many clients that have passed through the system with similar characteristics in order to find the best combination of programs and services for this client and his family. Analytics will discover a path for this citizen that will allow him to eventually be independent from the HHS system. Based on what has been successful in the past for children with similar parents, analytics can predict what types of issues may arise and which programs and services should be put in place in order to prevent a poor outcome. Maybe the children need to be enrolled in a child protective services program, and a food and nutrition program. Ultimately, the goal is to implement early interventions to pre-empt future potential issues. In doing this, not only are clients on an accelerated path to self sufficiency, but HHS organizations benefit from a variety of program and cost efficiencies.

Thinking Beyond HHS

What issues could be resolved if other data sources could be integrated with HHS data into an analytic environment, to obtain a 360-degree view of a citizen across several departments and agencies? What if you could integrate data from HHS with that of: Departments of public instruction? Departments of correction? Departments of juvenile justice? Departments of public safety? Other state agencies?

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