P&P April 2016

Policy&Practice

April 2016

For those of you not yet accustomed

to this journey, the Value Curve

describes how health and human

services are provided to those we serve

four progressive levels of value

each building from and expanding the

consumer value delivered at the more

formative levels:

At the

regulative level

, consumers

receive a specific product or service

that is timely, accurate, cost-effec-

tive, and easy to understand. Many

agencies and systems around the

country are focused on achieving

efficient and effective service within

a specific program area, and to a

large extent this is good for con-

sumers. But we know that there are

value limitations of sending those we

serve through many program doors,

engaging them within a limited

program scope, or focusing primarily

on program compliance and related

output goals as measures of our own

performance and value, whether or

not these outputs have the desired

consumer impact.

At the

collaborative level

, con-

sumers “walk through a single door”

and have access to a more complete

array of products and services that are

available “on the shelf.” At this level,

agencies with their partners focus

on cross-programmatic efficiency

and effectiveness, often requiring

operational innovations like unified

intake and eligibility systems, cross-

program service plans that address

multiple consumer needs, and shared

data platforms or protocols to support

these integrated services. Certainly a

big step up in value for consumers, but

not the best we can do.

At the

integrative level

, products

and services are designed and cus-

tomized with input from consumers

themselves, with the objective

VC stage progression overall, consid-

ering what regulative efforts are likely

to do so, and what regulative efforts

are likely to be barriers (e.g., legal

services supporting data sharing within

the parameters of privacy law, versus

blocking it completely).

Related, the VC stages are at

times not appreciated as mutually

reinforcing building blocks that each,

in turn, enable future stage progres-

sion. Some systems will attempt to

“skip to generative” because it’s the

most advanced stage, only to realize

later that they have a ton of shoring up

to do, especially around technology

and workforce barriers that are best

addressed at the earlier stages.

Most agency leadership teams

aren’t clear on how to translate VC

stages to individual and functional

roles, which is essential in making the

model “real world and grounded” with

the staff. I’ve been asked to reduce the

model stages as closely as possible to

“a simple, single word we can all relate

to” and have come up with these, to

fairly good effect:

Regulative: Integrity (timely,

accurate, cost effective, within the

rules)

Collaborative: Service (making

things easier for your internal/

external customers)

Integrative: Root causes (solving

problems at their root vs. addressing

symptoms)

Generative: Bigger than the family

(using population-level analysis to

drive prevention and structural or

capacity changes at the system level)

It’s unclear to most system leader-

ship teams what change management

methods will best enable VC pro-

gression. For example, viewing the

effort as entirely novel—separating

previously used approaches with an

“entirely new” approach—doesn’t

work well. Rather, building from the

existing approaches by using improve-

ment teams and facilitated critical

thinking to move forward from the

system’s current strengths works

much better—a parallel process to

Integrative casework, by the way.

There is limited understanding

in most systems regarding the respec-

tive roles of local, state, and federal

Phil Basso

is the

deputy director of

APHSA.

of best meeting their true needs

and enabling positive outcomes in

their lives. The focus at this stage

is on more consultative consumer

engagement methods, product and

service flexibility, and enhanced

service delivery. This is all geared

toward supporting people to prevent

problems upstream, versus fixing

or recovering from them down-

stream. This all requires redefining

casework practice and skills, pro-

viding real-time technology tools for

caseworkers, establishing new forms

of data and analysis geared toward

problem prevention, and instituting

highly adaptive program design and

funding mechanisms.

At the

generative level

, different

organizations providing various

products and services are joining

forces to make the consumer’s

overall environment better for them,

resulting in value that is broader and

more systemic than an individual or

family might receive directly. At this

stage of value, agencies with their

partners focus on general consumer

advocacy and co-creating capacity at

a community-wide level as a means to

meet consumer needs. This requires

collective efforts targeted at commu-

nity-level infrastructure building, and

enhancing societal beliefs and norms

about government in general, and

those we serve in particular. This ulti-

mately results in greater commitment

to leveling the playing field, plugging

everyone into the community as a

whole, and employing practical solu-

tions that work.

I’ve now been privileged to “travel

with the Value Curve” and work

hands-on with a number of agencies

and their communities as they

apply models and tools from our

Transformation Toolkit.

Like all such

journeys, the “learning by doing”

benefits have been priceless—by

sharing a few of them with you here,

we hope to provide you with a bit of

this travel access:

The regulative stage of this model is

often viewed as “inferior” to focus upon

and strengthen. This creates significant

confusion and tension in system change

where it isn’t useful. It is important to

look at regulative value as essential for