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Integration and Interoperability Across Public Health, Human Services, and Clinical SystemsTuesday, May 3, 2012

Listen only mode This webinar will be recorded and available on NACCHOs websiteThe slides will also be available for downloadPlease complete the evaluation when you receive the linkType your questions in the box as we goTuesday, May 3, 2012

Outline of Webinar Goal for todayDaniel Stein - Stewards of ChangeUma Ahluwalia Montgomery County Department of Health and Human Services (MD)QuestionsTuesday, 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 WebinarMay 3rd, 2012

5Stewards of Change MissionAdvancing Sustainable Improvements That Transform Systems Of Care By Integrating Entrepreneurial Solutions From The Public, Private And Not-for-profit Sectors.

6SOC has been studying IO the past five years We have brought together 500+ people from 25+ states and counties at Yale SOM for national thought leaders conference (Uma Valerie) purpose was to explore the issues including all disciplines and all sectorsWe have convened, researched, synthesized and created an approach for thinking about and addressing this complex work (HS 2.0 more about that a bit later) the last two years we have worked with ACF/HHS to build IO within and across the agency (also CMS, FNS, CCIIO) Last year we supported bringing ACA and HIX forward as key drivers to link human services and health We have achieved some success there is some momentum at the federal level - but NOW is the time to act (12/31/14) NHSIA and HIEM this panel is another step to involve and integrate an important player Public Health in the discussion and planning. HOWEVER much work remains to be done

Microsoft Architectural Vision7System is very complicatedAddressing the complexity requires new tools and approaches and trainingHowever, there is an opportunity to link and use data across systems to provide a comprehensive picture of the child/family and all the systems they touch.It appears that forces are converging to help this? From hardware (thin client), software tools, translation code XML, data base and impetus from industry to make it work best practice around what matters in case management and services/analytics is lacking.

Public HealthAddictions & Mental HealthMedical Assistance ProgramsChildren, Adults & Families

SAMHSA

ACF

IHS

RSAState View: Silod Architectures, Funding, ServicesRich Howard CIO Oregon DHS88Daniel continues

Demonstrates complexity - 5 offices, 132 data systems for 100 programs based in numerous programming methods and languages

Consumer Centric

Children in Foster Care StudentPatientFamilyAdultSenior GOAL: create and deliver customer centric care that crosses all relevant boundaries

Provides more and better information through sharing and linking across silos to inform decision making, and ultimately better outcomes for individuals regardless of the door you enter.

AND we will all enter the systems at some point

9Context: Where We Are TodayTodays Health, Education, Human Services Systems and Justice program generally operate in silosResulting in:Separate and unconnected programs Categorical fundingSeparate and redundant systems and infrastructureTransaction orientation vs outcomes System silos are still the norm although that has begun to change

Separating the whole into pieces; treat symptoms, not root cause We know the best way to help build individual capacity, self sufficiency and well being is through coordinated services not fragmented, uncoordinated services.

(Policy and Advocacy)10Can Silos Be Connected?

Interoperability Can Enable the Process11Use this as a discussion topicHuman Services 2.0 - Core PrincipleL > C

Learning Must Be Greater Than or Equal To the Rate of Change Just To Keep Pace No Less To Provide Leadership and Lead Change12We have been and will be on a learning path that is really the core of HS 2.0

Interoperability poses Challenge of Change for ACF

We have been learning with ACF more about the challenges and possible solutions. We started with a vision session, roadmap, survey, interviews and training internal to ACF. Today's is our first opportunity to bring the learning process to those who serve families directly. This symposium is an opportunity for you to participate in the process. We want to bring you up to speed on what is happening at ACF but more importantly, we want to learn from you n about what is going on in your organizations and communities to inform our HS 2.0 journey and your individual efforts.

Everyone recognizes this is a long journey and will take some time, but progress is being made and that there are encouraging signs internally and externally (took decades to create this system, and will take years to change)

We are going to share some of the learning but there is a lot more to do, and we are supporting that through ongoing activities to continue learning, in various ways.

Achieving true interoperability among programs will require many years and many strategies, of which technological change is just one.

We need to keep learning about how to put clients at the center of the services we provide or enable and eliminate the barriers that make it harder for them to navigate the system

Human Services 2.0A Conceptual ArchitectureVision is to serve every individual uniquely

We have the technology and tools NOW to accomplish it if we can work collaboratively across silos and make necessary changes - we just need to political and public will

Fortunately key changes are now at hand due to ACA and recent changes and exceptions huge overlaps with newly insured populations with human services

It is time to leverage health care reform including HIE, HIN and EMRs to improve services for the most at risk populations and prepare for 20- 30 million new people coming in under HIX/Medicaid

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. Practice The way public and private human services organizations deliver services and care, monitor and report results and achieve intended outcomes

Structure The way public and private human services systems design, organize and implement work processes to achieve policy and practice goals. SOC created a TOC to assist thinking about planning, assessing and implementing interoperability in a standardized fashion PolicyStructurePracticeHuman Services 2.0 is an effort to standardize a conceptual model and approach to achieve IO and it applies to all sectors and disciplines

15Human Services 2.0Describes 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 enabledIt offers guidance about the policies, structure and practices that are necessary for improving outcomes and enhanced operational efficiencyProvides 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.

A Conceptual Architecture15Understanding the power of enabling technologies SOA and the internet and other technical developments we needed a way to integrate it into an overall conceptual model or conceptual architecture. GOVERNANCEWORKFORCEOPEN & INCLUSIVEPROCESSESINTEROPERABLE INFORMATIONTECHNOLOGYPERFORMANCE MANAGEMENTFUNDINGCONSUMERCENTRICPUBLIC ANDPOLITICAL WILLCONFIDENTIALITYBRIDGING SILOSInterOptimability Drivers

16

InterOptimability Drivers18InterOptimabilityProvides 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

A Comprehensive Process18Understanding the power of enabling technologies SOA and the internet and other technical developments we needed a way to integrate it into an overall conceptual model or conceptual architecture. The InterOptimability Process Orientation to Human Services 2.0Create To-Be Change Vision Landscape & RoadmapConduct As Is Business Process ReviewAssess As Is Information Technology Evaluate Organizational Readiness Perform Gap AnalysisBuild To-Be Business Process FrameworkDevelop To-Be Information Technology SolutionSynthesize Learning, Develop Recommendations and Action Plans

Interoperability is a step by step process. We have laid it out in the HS 2.0 Handbook which you each have

A National Change Vision LandscapeProduced at the 2007 Annual SOC Conference

2021Current EngagementsAdministration for Children and Families/HHS HS 2.0 TrainingInteroperability ToolkitConfidentiality ToolkitNational Human Services Interoperability Architecture (NHSIA)National Information Exchange Model (NIEM)California Information Sharing EnvironmentCA Department of Social ServicesCA Department of Health and Human ServicesThe Judiciary (Blue Ribbon Council)Electronic Care Record For Children in Foster Care and the Judiciary (and other populations) EHR + PHR7th Annual Stewards of Change SymposiumCollaboration with the Johns Hopkins Systems Institute21Communications and Resources

ACA 1561 Recommendations; Health and Human Services LinkagesExecutive Order 13563; Administrative simplificationJoint Letters ACF, CMS, CCIIO, USDA/FNSEnhanced Funding: Seven Conditions and Standards to receive 90% matchNational Human Services Interoperability Architecture (NHSIA)National Information Exchange Model for Human Services (NIEM)Confidentiality Guidance A-87 Cost Allocation ExceptionToolkit can be found on ACF website22

Uma S. Ahluwalia, DirectorDepartment of Health and Human Services | Rockville, Maryland

Integration and Interoperability within the Health and Human Services EnterpriseNACCHO WEBINARThursday| May 3, 2012 | 1:00p

Montgomery County, Maryland | Department of Health and Human Services23

Most populous county in Maryland

Immigration was the largest component of population change since 2000

Source: U.S. Census BureauPopulation Growth (K)24Montgomery County: A Changing Picture

Montgomery County, Maryland | Department of Health and Human ServicesLets talk about what our population looks like. Although Montgomery County has long been known as one of the most affluent jurisdictions in the country, its current demographics show a changing picture. Montgomery county Is the most populous county in Maryland, with a population (2006) estimated at 932,131 people.

Immigration was the largest component of population change since 2000 and accounted for the Countys population increase from 873,341 to 932,131 persons.*

Montgomery County's population reached 971,777 in 2010, an increase of nearly 100,000 people (11.3percent) from 2000: Montgomery County is now the 42nd most populous county in the nation, up from 49th place in 2000. It remains the second largest jurisdiction in the Washington, D.C. metro area, next to Fairfax County, Virginia, with 1,081,726 residents.

24Non-Hispanic Whites make up 49.3% of the Countys population, down from 59.5% in 2000

Hispanics are now the Countys 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 Georges counties25

Montgomery County Diversity: Census 2010Minorities are more than half of Montgomerys populationMontgomery County, Maryland | Department of Health and Human Services25Caseloads 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)

Public Assistance Needs26Montgomery County, Maryland | Department of Health and Human Services27Home 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 Heat, Housing and Health NeedsMontgomery County, Maryland | Department of Health and Human Services27 Montgomery CountyDecember 2007December 2008December 2009December 2010 Aged|Disabled17,83018,53319,29719,840 Families and Children (FAC)39,05345,99756,67265,456 Maryland Children's Health Program (MCHP)18,84119,41118,91920,535 Other3,2253,6204,8015,947 PAC1,6101,5152,0382,686 TOTAL80,55989,076101,727114,465Medicaid Numbers In Montgomery County28

Montgomery County, Maryland | Department of Health and Human Services28ACFCMSSAMHSAHRSACDCONCHITHUDNIHVeterans AdministrationOffice on AgingHomeland SecurityDepartment of AgricultureTitle XIXTitle IVECSBGCDBGMental Health Block GrantFederal and State Grants40% of DHHS Budget is from State and Federal Sources60% of DHHS Budget is from County Sources

Federal Agencies Whose Regulations and Funding Strategies Impact County Services29Montgomery County, Maryland | Department of Health and Human Services2930 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

ADSBHCSCYFPHSSNHDepartment of Health and Human ServicesMontgomery County Department of Health and Human ServicesServices and MARYLAND State Department Connections by Service TypeMontgomery County, Maryland | Department of Health and Human Services30

Used Cases and the Trends They Reveal31Montgomery County, Maryland | Department of Health and Human Services313242-year old non-English speaking recent immigrantTests by DHHS indicate she has tuberculosisAppears to be some domestic violence at homeHas two children ages 2 and 6 and is pregnant again2 year old needs child care, family can not afford it6 year old has special needs and housing is unstable

Services offered by DHHS to address these complex needs:Public Health TB ClinicChild Care ServicesMaternity ServicesWIC ServicesIncome Support ServicesWorkforce servicesLEP ServicesDomestic Violence Service via Abused Persons ProgramAdult Mental Health ServicesHousing Stabilization ServicesEducation through Public School System

Scenario One

Montgomery County, Maryland | Department of Health and Human Services323390-year old woman identified as hoarder21-year old great-grand-daughter moved inGreat grand-daughter has two preschool aged childrenGreat grand-daughter a former drug user is abusing againDepartment of Housing believes house not livable

Services offered by DHHS to address these complex needsAdult Protective ServicesChild Welfare ServicesEarly Learning and Child CareSpecial Needs Housing ServicesIn-home Aide ServicesIncome SupportsWorkforce ServicesSubstance Abuse TreatmentMedical and Primary CareScenario Two

Montgomery County, Maryland | Department of Health and Human Services3334Homeless diabetic woman

Homeless diabetic woman with SchizophreniaThree episodes of hospitalization in last 12 monthsHard for her to regularly take medicationsHard for her to have nutritious meals

Services offered by DHHS to address complex needsHomeless ProgramPublic or Medicaid Provider Mental Health TreatmentMontgomery Cares and Possibly Medicaid enrollmentHousing Stabilization ServicesScenario Three Montgomery County, Maryland | Department of Health and Human Services34Quicker Processing of BenefitsLinkages with Community Based Organization and Closer Connectivity of Residents with Government and ServicesImprove comprehensive outcomes for Transition Age Youth sub population pilot to be expanded to the broader HHS enterpriseImprove indicators for children, youth, families and single adults related to Safety, Health, Well-being and Self-sufficiencyImprove indicators related to Job Creation and economic developmentMaximized opportunities related to Health Information Technology under the Affordable Care Act35Outcomes to be AchievedMontgomery County, Maryland | Department of Health and Human Services35Assessment of hardware and software infrastructureBusiness process analysisAnalysis of Policy environment Identified business and programmatic needsBuild the integration prototype with transition age youth and now homeless familiesAnalyzed staff capacities and readiness for changeDeveloped the case for HHS modernization business need to drive technology solutionUrgency increased need, diminished resources need for a new business model supported by new technology solution36Business ActivitiesDepartment of Health and Human Services ModernizationMontgomery County, Maryland | Department of Health and Human Services3637Built a nationally recognized confidentiality policy that enables data sharing across the entire Health and Human Services EnterpriseDeveloped a Neighborhood Opportunity Network Model that combines social engineering with economic empowermentDeveloping the scope and parameters for a true No Wrong Door Approach to the delivery of health and human servicesStrengthening partnerships with non-profits, faith community, business and philanthropy to better leverage limited resources for those in need

Policy Activities

Montgomery County, Maryland | Department of Health and Human Services37Identified Transition Age Youth as our test population includes children aging out of foster care and juvenile justice; mentally ill or substance abusing youth, pregnant and parenting youth and homeless youth. And now working with homeless families

38Built a practice model for integrated practiceDeveloped a universal face sheet and screening tool for our enterpriseIdentified outcomes for our workTested integrated access points through our neighborhood opportunity network activities for both delivery of services and economic development activitiesUsed Health Reform as a catalyst for changeBuilt a work plan for implementationActivities to Support PracticeMontgomery County, Maryland | Department of Health and Human Services3839Build a common client index or master client index to track overlapping and unduplicated client load better anticipate need and improve service deliveryIntegrate eligibility for all programs federal, state and local with eligibility requirementsEnsure compliance with all federal, state and local confidentiality and privacy protocolsDigitize all records and move to a paperless environmentIntegrated case management system that allows for public and private sector users access and use of the systemDHHS Portal and Data Warehouse developmentDepartment of Health and Human ServicesTechnology SolutionMontgomery County, Maryland | Department of Health and Human Services3940Department of Health and Human ServicesAffordable Care Act Response(An Opportunity for Integration)

Montgomery County, Maryland | Department of Health and Human Services4041

Six Areas of Focus for Affordable Care Act Implementation in Montgomery County Montgomery County, Maryland | Department of Health and Human Services4142

Health Planning Process

Montgomery County, Maryland | Department of Health and Human Services42Emphasis on Community and Population Health and well beingCalculating Return on Investment and Social Return on InvestmentMaking the case for re-investmentUsing 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 BenefitInvestments 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

43Community Benefit and Land Use PlanningMontgomery County, Maryland | Department of Health and Human Services4344Five Key Focus Areas for Social Services within Health Care ReformMontgomery County, Maryland | Department of Health and Human Services4445Meaningful Use and Regional Extension Center EngagementMontgomery County, Maryland | Department of Health and Human Services45

46Across GovernmentWith our non-profit providersWith the Faith CommunityWith BusinessWith PhilanthropyWith Advocates and residents

To Impact outcomes at the:a. Individualb. System andc. Population Health and Community levelPartnershipsMontgomery County, Maryland | Department of Health and Human Services46Integrated EligibilityBlending and Braiding FundsConfidentialityEvidenced Based PracticeInteroperability

47The Policy ConversationMontgomery County, Maryland | Department of Health and Human Services47

48Thank you!Montgomery County, Maryland | Department of Health and Human Services48QuestionsPlease type your questions in the box

Tuesday, May 3, 2012

Contact Information Vanessa Holley, MPHProgram Analyst, ePublic Healthvholley@naccho.org(202) 507-4239Tuesday, May 3, 2012

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Building 2

Warehouse

School

K-12 Education Ecosystem

Head Start

Child SupportCollections

Workforce Develop

Income Sec.Caseworker Team

CourtsCriminalCivilJuvenile JusticeFamily CourtDivorce

Workforce Inv.

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