Policy & Practice June 2015

director‘s memo By Tracy Wareing Evans

The Changing Human Service Landscape

A s we convene this month with human service leaders from across the country for our annual Policy Forum, I have been reflecting on how the health and human service land- scape has changed in just a few short years as we collectively work to bridge systems of care and create a path to the improved outcomes our members and partners envision for our communities. It is worth stepping back and examining the evolution of system integration at the macro level. Think back to the state environment a few years ago when nearly all the energy was directed—and understandably so—to modernizing Medicaid eligi- bility and enrollment systems, setting up health care exchanges, and the debates and politics surrounding the Affordable Care Act (ACA). At that time, “horizontal integration,” our name for linking the health and human service systems, barely registered as a blip on the radar screen. Fortunately, leaders within our network stood committed to ensuring that the opportunity to better connect health care with the human service system did not fade away. Instead, we embarked on a path to leverage the changes occurring in the health arena by harnessing the expertise of public and private sector leaders to ensure that the tiny blip on that screen came into full view. 1 As we move beyond creating health care exchanges and meeting

innovations across sectors, and break down longstanding service delivery practices organized around specific programs that alone do little to achieve the desired outcomes for children and families. We should not underestimate how deeply embedded and institution- alized these historic practices have become in agencies, legislatures, and even in the best-intentioned commu- nity partnerships. And, second, we must be mindful of the need to bring together health and social service leaders—across all levels of government—including public, non- profit, and private industry providers. Without open dialogue and an under- standing of what is happening in all sectors, we risk building duplicative systems of care that do not recognize how to leverage services or identify opportunities to bend the projected cost curve in both systems. This means that hospital associations, community health organizations, and associated providers and networks must be inten- tionally connected with social service providers and industry leaders in human services. Without a concerted effort to address the bias inherent in our organizational structures, we will miss the opportunity to make the kind of changes we need to sustain integra- tion efforts in the long term. Fortunately, despite these chal- lenges, there is a convergence of

ACA-driven deadlines, more juris- dictions are focusing on health and human service systems interoper- ability, particularly in eligibility and enrollment, and data-sharing efforts across programs. Human service leaders are more often players at the table now, and no longer simply trying to get in the door. Early innovators are setting the stage for a much broader national focus on how to maximize interoperable systems toward reducing costs and producing better outcomes. States and localities have moved the needle on connecting human services to health, not just behind the scenes, but more important, for what it can mean in overall population health and well-being. While many challenges remain, we know much more about the potential obstacles and the underlying causes, which are driving solutions. Two of the bigger challenges have come to light through the work of our National Collaborative for Health and Human Services Integration (formerly known as the National Workgroup on Integration). First, our moderniza- tion of governance lags behind our modernization in technology. As a result, keeping the sequence straight (i.e., ensuring that business is driving technology and not the reverse) con- tinues to challenge even the most innovative states and localities. We must continue to support the system changes required to allow for blended and braided funding, incentivize

See Director’s Memo on page 37

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June 2015 Policy&Practice