Minnesota’s Human Services IT System Transformation 36- Minnesotas Huma… · Minnesota’s Human...

Minnesota’s Human Services IT System Transformation

December 6, 2017

A partnership between the Department of Human Services, Minnesota IT Services and the Minnesota Association of County

Social Service Administrators

Presenter

Presentation Notes

All -- Thank you for attending our session. We appreciate the opportunity to provide an overview of DHS and counties are working together to transform the delivery of human services and modernization IT systems in support of this transformation. Introduction of presenters.

Speakers

Michelle WeberBusiness Solutions OfficerMinnesota Department of Human [email protected]

Minnesota Department of Human Services | mn.gov/dhs 2

Chris LancreteIT ManagerHennepin County Health and Human [email protected]

Greg PoehlingChief Business Technology OfficerMinnesota IT Services, partnering with Human Services and [email protected]

Presenter

Presentation Notes

All

mailto:[email protected]



Agenda

• Current state

• Why modernize?

• What will guide us?

• County and state partnership

• Questions


Presenter

Presentation Notes

Chris - Current state The Human Services environment IT systems Why modernize? What will guide us? Establishing business architecture: Strat plan ISBM Func Model County and state partnership Questions

Human Services Environment


Presenter

Presentation Notes

Chris -- Minnesota Human Services are state-supervised, and county administered, in partnership with a broad network of community partners and providers. A multitude of IT Systems exist at all levels to support this structure. On this slide, each little person represents right around 10,000 people. DHS IT systems are used by over 31,000 county, tribal and state workers (that’s the 3 green people) as well as over 200,000 providers (the yellow people) They provide support for the direct care of over 10,000 clients in treatment annually (the orange person). And finally, these systems serve more than 2.8 million individuals across all programs and systems. Over $100 million dollars of the DHS operating budget in FY17 supports the major systems.

Current state: silos

Program-based Silos

Health CareLong Term

Services and Supports

Continuing Care and

CommunitySupport

Behavioral Health

Cash and Food

AssistanceChild Care

Adult and Child

Protection

Assessment Assessment Assessment Assessment Assessment Assessment AssessmentEligibility Eligibility Eligibility Eligibility Eligibility Eligibility Eligibility

Intake Intake Intake Intake Intake Intake Intake

Case Management

CaseManagement

CaseManagement

CaseManagement

Case Management

Case Management

CaseManagement

Individuals have to “shop” for services


Presenter

Presentation Notes

Chris - The Integrated Services Delivery System is much more than the technology, it’s about transforming how services are provided Right now, people looking for services essentially have to shop across our different program siloes, and it’s not a great experience. We have siloed systems and services based on differing program requirements and separate funding streams, requiring multiple contacts to multiple agencies by those served. There are many participants in the administration and delivery of human services Complex dependencies exist between human services and other agencies There are variations among counties and tribes There are variations in the populations we serve The graphic shown is just meant to be broadly representative, and doesn’t include everything -- Child Support, for example, is not shown.

Why modernize?

• Desire to provide integrated, person-centered service

• Outdated and antiquated systems: not how people currently interact with technology

• Inability to access and share data

• Limited expertise in programming language

• Enhanced federal funding

• Opportunity to achieve better outcomes


Presenter

Presentation Notes

Greg -- The age and state of our human services technology systems is a huge factor, but is not the only factor that is necessitating the need to both modernize and transform our systems. Counties have been pushing for integrated, person-centered services for years and need computer systems to help facilitate that. There are many barriers to this within the current systems. They are siloed and do not talk to each other in a streamlined manner. It is difficult to access and share data. The programming language that these systems exist in is no longer taught in schools, leading to an extremely limited group of individuals who have the expertise to maintain and continue develop these systems. We also need to ensure we maximize the use of enhanced federal funds that are currently available to support the development of modernized systems. Up to 90% of the cost is covered with federal resources, resulting in huge buying power with an investment of state funding. Finally, modernized systems will provide more time for county staff to be working with individuals in a more holistic manner that will support better outcomes for the individuals being served.

What Will Guide Us

DHS & MNIT Strategic Plans

Human Services

Functional Model

Integrated Services Business Model


Presenter

Presentation Notes

Greg -- There are three major efforts happening across DHS to bring the vision to life: Strategic planning, for both DHS and MNIT Human Services Functional Model Integrated Services Business Model Strategic planning is wrapping up next month between DHS, counties and MNIT. While we don’t yet know what the details of the five-year strategic plans will be, we know that both will have some focus on delivering Human Services programs in a more person-centered way. These plans and models will serve as a foundation for us to start with. They are our guides to modernization. They represent the business – what we must do and how we want to do it.

5-Year Modernization Strategic Plan


Key Initiatives:

• Innovation

• Communication

• People

• Governance

Presenter

Presentation Notes

Michelle During the 2017 legislative session, DHS was successful in securing ongoing resources to support systems modernization. While efforts have been underway for several years to plan and build the technical foundation for modernization, we are now ready to develop a more detailed, 5-year strategic plan for how modernization will be approached, what will be developed delivered when, and how to prepare for the change modernization will bring. , in October, county, DHS and MNIT staff spent 4 days together. The first 2 days were focused on learning about where we’ve been and where we are with systems modernization. As part of this process end users were surveyed and some interviews/focus groups were conducted. We had frank discussions to identify our strengths, weaknesses, opportunities and threats. Last Thursday and Friday, we used this information to develop a shared vision for system’s modernization and identify our key initiatives to guide these efforts. These initiatives are focused on: innovation, communication, people and governance. In the coming weeks, we will reconvene to more specifically define each of these iniatives and identify the measurable goals that we will work to accomplish. There was recognition on the size and scope of this work that we are undertaking and that to be successful we have to build off of the innovation that is out there in counties, other states and the new ideas that will be brought forward. A big weakness identified through the survey of end-users was inconsistent communication and that this work is not clearly being conveyed at all levels. We need active and intentional communication strategies to be included in all aspects of this work. From the people perspective, we spoke about the importance of keeping focused on the people we serve. We also want to ensure we are engaging and supporting the workforce that is responsible for doing this work. A strength that came out of the process was that governance exists. A weakness/threat is that the current structure is not transparent and is incredilby complicated to navigate. Many of the bodies see themselves as establishing the strategy. We need to have a structure in place for decision making that is transparent and inclusive of counties, MNIT and DHS. A big theme throughout was the importance of intentional partnerships at all levels. While we didn’t finish as much as we have hoped at the end of the fourth day, we did agree to focus on these initiatives. In the coming weeks, we will reconvene to finalize the vision, establish agreed upon definitions for each of the initiatives and identify the specific goals we intend to accomplish. This strategic plan is incredibly important and we cannot afford to develop it an put it on a shelf. It needs to actively guide our work.

Integrated Services Business Model

• Integrated Services Business Model project - working group across DHS, counties (via MACSSA), and White Earth Nation to develop:

• Shared understanding of the goals, values and need for service integration• Agreed upon integrated, person-centered services business model• Framework to guide technical system development

• Final deliverable: Integrated services business model that is consistent enough to inform DHS technical system development, but flexible enough to support the unique needs of counties, tribes, and individuals being served


Presenter

Presentation Notes

Michelle A working group across DHS, counties, and White Earth Nation was formed to develop an integrated, person-centered business model that will inform DHS technical system development for the next several years, which will be flexible enough to support the unique needs of counties, tribes, and individuals and families we serve. The project team connected with leading-edge programs throughout the country to learn best practices, considered existing feedback from people served by our system, conducted a literature review, made multiple site visits at counties and tribal nations, and have been receiving technical assistance from American Public Human Services Association. The team participated in a series of meetings to build the model, and is now vetting the draft model with stakeholders.

Integrated Services Business Model, continued

Presenter

Presentation Notes

Michelle Key Concepts Model is built from the perspective of individuals and families Model is an ideal state – people often don’t have a linear experience Many ways to access services and tools, from “low touch” to “high touch” The “funnel concept” (at right) represents an individual’s experience: starting with a broad screening to identify both immediate needs and root causes (SDOH), exploring options in referral, narrowing to their best options and providing more information for eligibility, until they reach the point of collaborative service coordination The funnel is just one piece of the model, which helps illustrate the concept. Other pieces of the model are a more detailed process map, a document that expands on the agency & provider perspective, and an outline of the technology-based tools that are envisioned And, importantly, data analytics play a critical role in continuous improvement and driving positive community outcomes

Functional Model

What is a functional model?

• Target Operating Model, developed by KPMG

• Medicaid Information Technology Architecture (MITA)

• National Human Services Interoperability Architecture (NHSIA)

11

Presenter

Presentation Notes

Michelle What is a functional model? A functional model is a way to look at an organization. It is a picture of the functions or processes that a business performs. When the state of Minnesota started thinking about systems modernization, we engaged with a contractor, KPMG, to help us. As a result, the Target Operating Model, or TOM, was developed. Since that time, our work has evolved from the TOM to our current Human Services Functional Model. Luckily, when we were starting this effort, there were already frameworks that we were able to consult to build a functional model for Minnesota. Our functional model was informed by them, as well as with discovery work with various business and IT areas. MITA and NHSIA are just two of the national frameworks that we used to create Minnesota’s Human Services Functional model. MITA, or the Medicaid Information Technology Architecture, was specifically developed to move business and IT transformation forward over the Medicaid enterprise. Its intent is to support systems development and health care management. It establishes common standards and a goal of an integrated system that is interoperable across the nation-wide Medicaid enterprise. The National Human Services Interoperability Architecture (NHSIA) proposes a framework to facilitate information sharing, improve service delivery, prevent fraud, and provide better outcomes for children and families in the administration of human services. It addresses both business and technology perspectives. Its goals are similar to MITA – common standards, promoting sharing and reuse, and creating data structures and standards – all of this to improve operational effectiveness in the delivery of human services. The existing frameworks serve as the starting point of our functional model. We look at and document, at a high level, the functions that must be performed to administer our human services programs. CLICK Here is a small part of our model, with one business area identified, and some of the business processes and functions underneath it.

Functional Model, part 2

Why do we need to do this?Planning

Stat

e

Trib

e

Coun

ty

Com

mun

ity

Prog

ram

1

Prog

ram

3

Prog

ram

2

Prog

ram

4

Syst

em 1

Syst

em 3

Syst

em 2

Syst

em 4

12

Presenter

Presentation Notes

Michelle – Why do we need to do this? One reason that we need to look at our organization functionally is because the federal government is telling us that we have to as part of the MITA standards . However, there is also a great benefit to us to do this. Right now Human Services programs are administered in silos; many entities (state, counties, and tribes), CLICK program areas, CLICK system areas, perform many of the same functions, however they are operating independently from one another. Looking at our organization in a functional model will allow CLICK planning to occur across the silos of our organization. The primary goals for the development and implementation of the functional model are to: Determine overlap of processes across modernization efforts, programs and systems Identify stakeholders for the work Identify business process simplification & redesign opportunities Establish one common language across Human Service work

Functional Model, part 3

Human Services Program Administration Business Relationship Management

Care Management

Client Management

Contractor Management

Facilities Management

Financial Management

Operations Management

Performance Management

Policy & Oversight Management

Program Management

Provider Management

3

11

6

9

110 2

4

57

8

Presenter

Presentation Notes

Michelle – The Human Services functional model currently identifies 11 business areas: Business Relationship Management Care Management Client Management Contractor Management Financial Management Operations Management Performance Management Policy & Oversight Management Program Management Provider Management Facilities Management Under each of these business areas are various functions and processes, 188 processes and counting, that together make up the administration of human services programs. The BSO is engaging with different business partners to map each of those processes to the different business areas.

Modernization: Moving Forward

Driving Factors:

• Integrated, person-centered delivery

• Outdated and antiquated systems

• Inability to access/share data

• Limited staff expertise

• Enhanced federal funding

• Opportunity to achieve better outcomes


Presenter

Presentation Notes

Greg Recently there has been a great deal of discussion (from external parties) around whether or not we should be moving forward with modernization and ISDS or just focusing our efforts on improving METS. The age and state of our human services technology systems is a huge factor, but is not the only factor that is necessitating the need to both modernize and transform our systems. A recent survey of system users indicated overwhelming that end users want these systems modernized. Out of 1,347 responders, 954 indicated that they either need to be updated or completely replaced. Counties have been pushing for integrated, person-centered services for years and need computer systems to help facilitate that. There are many barriers to this within the current systems. They are siloed and do not talk to each other in a streamlined manner. It is difficult to access and share data. The programming language that these systems exist in is no longer taught in schools, leading to an extremely limited group of individuals who have the expertise to maintain and continue develop these systems. We also need to ensure we maximize the use of enhanced federal funds that are currently available to support the development of modernized systems. Up to 90% of the cost is covered with federal resources, resulting in huge buying power with an investment of state funding. Finally, modernized systems will provide more time for county staff to be working with individuals in a more holistic manner that will support better outcomes for the individuals being served.

Integrated Service Delivery System

MAXIS

MEC2

PRISM

SSIS

& OTHER SYSTEMS

METS

Integrated Service Delivery

System

Presenter

Presentation Notes

Greg To achieve modernization, the state's plan is to gradually move all of its human service programs to an integrated service delivery system and eventually retire the old standalone IT systems. Some of these systems are over 25 years old. They include: The MAXIS system, which manages Cash and Food assistance for low income families and individuals. It also manages Medical Assistance for elderly and disabled populations who have been outside of the scope of METS. MEC2, which manages Child Care Assistance for low income families. PRISM, which manages establishment and payment of Child Support. SSIS, a system that manages a wide range of social services, including Child Protection and Child Well-Being, Adult Protection, case management for individuals who have chemical or mental health needs, and long term care services for elderly and disabled people in our community. There are also a variety of other systems that will either move to or connect to the integrated system, for example the state's Medical Assistance payment system, MMIS. METS, as we’ve discussed was developed in Cúram, and serves as a first step for ISDS. Cúram is an off-the-shelf software system that was designed to support the delivery of integrated services. Due to the state’s need to move forward with modernizing health care eligibility, our first use was with METS, which was built under extenuating circumstances. We will not be under the same circumstances as we move forward with ISDS. While Cúram will serve as a core component to ISDS, it’s important to note that it is not the only solution for the integrated service delivery system. We will leverage other more mature modules of Cúram that were specifically designed to support integrated services delivery. If Cúram cannot support the delivery of certain functions, other software tools will be looked at and integrated with Cúram. While there are concerns with continuing with METS and the platform it was developed in, we need to be practical and work with the tools we have. There currently is not federal funding to develop/build another system and we need to continue to work to improve and enhance its functionality (which we are doing). Several large and complex technical systems serve as the backbone for counties, tribes and DHS staff to: Determine program eligibility and enrollment Ensure program integrity and compliance Manage data, cases and referrals Pay for services DHS PRISM MAXIS MMIS SSIS MEC2 Counties Multiple systems The state's plan is to gradually move all of its human service programs to **CLICK** an integrated service delivery system (ISDS) and eventually retire the old standalone IT systems, some of which are over 25 years old. They include: The MAXIS system, which manages Cash and Food assistance for low income families and individuals. It also manages Medical Assistance for elderly and disabled populations who have been outside of the scope of METS, which is MEC2, which manages Child Care Assistance for low income families. PRISM, which manages establishment and payment of Child Support. SSIS, a system that manages a wide range of social services, including Child Protection and Child Well-Being, Adult Protection, case management for individuals who have chemical or mental health needs, and long term care services for elderly and disabled people in our community. There is also a variety of other systems that will either move to or connect to the integrated system, for example the state's Medical Assistance payment system, MMIS. **SPECIFIC METS/CURAM NOTES – DECIDE IF RELEVANT & IF SO, PULL OUT KEY POINTS** METS is the Minnesota Eligibility Technology System, which supports MNSure, the health insurance marketplace for Minnesota. It was developed on a platform called Cúram. Cúram is an off-the-shelf software system that was designed to support the delivery of integrated services. Due to the state’s need to move forward with modernizing health care eligibility, our first use was with METS, which was built under extenuating circumstances. A bit later, we will talk in more detail about METS, what some of the challenges we’ve seen as well as what’s improved. While Cúram will serve as a core component to ISDS, it’s important to note that it is not the only solution for the integrated service delivery system. We will leverage other more mature modules of Cúram that were specifically designed to support integrated services delivery. If Cúram cannot support the delivery of certain functions, other software tools will be looked at and integrated with Cúram. While there are concerns with continuing with METS and the platform it was developed in, we need to be practical and work with the tools we have. There currently is not federal funding to develop/build another system and we need to continue to work to improve and enhance its functionality.

Modernization timeline

2016 2017 2018 2019 2020 2021 2022 20??

Eligibility system

Infrastructure

Data Management

Targeted Functions [Triage & Referral]

MnCHOICES enhancements

Moving programs from legacy systems to Integrated Service Delivery System (ISDS)

• Child Support• Cash, Food and Child Care Assistance• Child & Adult Social Services • Health Care eligibility (merge with

METS, add elderly & disabled populations)

Presenter

Presentation Notes

Greg With all of the long-term planning we’ve just described, you may be wondering – when exactly will the systems finally change? A little background: DHS has been planning this transformation for some time. The eligibility system that supports MNsure, called METS, was meant to be the first step toward the integrated system. When MNsure ran into issues, DHS decided to start developing the ISDS on a separate track. The state has a set of projects in progress to lay the foundation for the ISDS. Investments in technical infrastructure Developing a person-centered data structure that will support better data sharing across programs and make it possible to do better analytics and to monitor and measure how services are leading to desired outcomes; this includes a unique person identifier. Projects to develop person-centered system functions that cut across program areas, like the Triage & Referral project Ongoing work to improve the MnCHOICES assessment tool is also considered to be part of the modernization roadmap. It will be a few years before the major programs start moving into the ISDS. Current plan - Child Support first, and then other programs. A 5 year effort, probably longer.

IT Governance Structure

Enterprise Architecture BoardBusiness

Architecture Domain Team

METS ESC

METS PMT

Data Architecture

Domain Team

ISDS ESC

ISDS PMT

MMIS ESC

MMIS PMT

DCT ESC

DCT PMT

Security Architecture

Domain Team

Technical Architecture

Domain Team

Financial Architecture

Domain Team

Presenter

Presentation Notes

Greg -- ISDS ESC and PMT members/basic structure to show governance is clear and inclusive relationships between IT, DHS Make sure to talk about MACSSA & County involvement and the desire to engage providers and orgs. counties are and continue to be involved in many of the DHS governance teams. Counties serve on both the program management and executive steering committees for METS and ISDS. These are decision-making bodies and the county members have a vote in determining priorities. Ask for feedback on how we can get Community Based Organizations involved.

County partnership

• Counties have independently sourced technology solutions to manage case operations.

• Access to state systems data is critical

• Ability to implement and support local technology solutions varies by resources and political environment, resulting in varied levels of service

Document Management

Systems

Forms (DHS eDocs +

extensions)

Client Indexes, Service

Dashboards

Provider Management

systems

Appointment systems

Phone systems /

(IVR)County-

developed or purchased software

Access databases

Spreadsheets


Presenter

Presentation Notes

Chris

County partnership, continued

County Human Services IT Modernization Alignment Group

• County IT representatives from all regions of Minnesota

• Business and Technology Architects from MN-IT @ DHS

• A representative from the DHS Business Solutions Office (BSO)

• When necessary, Owners/Subject Matter Experts for DHS applications and projects that have especially strong county linkages

Presenter

Presentation Notes

Chris ISDS has formed a Regional County Network to ensure there is the ability to obtain input from all counties in the state. EAB has representation from Dakota and McLeod DADT has membership from Hennepin and Dakota Stearns, Hennepin, Ramsey, Chisago, and Dakota serve on BADT As we move forward with specific IT projects, counties are being asked to serve on project teams in a variety of roles. As subject matter experts, business analysts and in some cases the potential is there to have them serve as developers. Also, both DHS and MNIT are working closely with the newly formed County IT Alignment group which is co-chaired by McLeod and Hennepin and has representation from each region of the state. Finally, the Integrated Services Business Model, which is designing the framework for ISDS, project team includes Ramsey, Olmsted, Crow Wing, Dakota and Hennepin. �

Impact of county partnerships

• Access to data

• Integrations between county and state systems

• Compatibility with county infrastructure (browsers, software and hardware standards)

• Recalibration of state/county technologies needed - modify, redefine, or retire local technologies to adapt to new systems and service delivery landscape

• More…


Presenter

Presentation Notes

Chris

Path to Success

• Strong and meaningful county involvement

• Continued efforts and commitment to improve

• Business-driven IT solutions

• Increased access to and use of data analytics

• Program alignment and simplification


Presenter

Presentation Notes

Greg - Highly complex, huge undertaking Multi-year effort Partnership is key Service delivery redesign and simplification necessary Counties are embedded in the governance structure. They will be involved in the strategic planning efforts that lays out how this will be accomplished. The ISBM project has proven that we can work together to design the model we want the technology to support. There is more thorough engagement of county end-users and county IT resources to shape the future We are not under the same circumstances we were when METS was launched, and DHS and counties are taking the lessons learned from that to ensure the technology is ready and staff are better prepared for the change. We need to focus on removing the barriers to delivering integrated services. The primary barriers, that we heard repeatedly as part of the site visits that were conducted throughout the state were: access to data/information (both for workers and the people who are being served) and the need to vastly simplify human services programs. Emphasize the need to support program simplification

Questions

Presenter

Presentation Notes

Audience Q&A for panel. Plant a couple of questions here in case there aren’t any from audience right away.

Presenter

Presentation Notes

Final slide: Present after Q&A Thank participants for attending Remind them to complete session evaluations on the app!

Minnesota’s Human Services IT System Transformation 36- Minnesotas Huma… · Minnesota’s Human...

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