P&P February 2016

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February 2016 Policy&Practice 17
focused on processing transactions and
reducing administrative costs” (41%—
Regulative); “Our E&E systems are old
and difficult to change without a lot
of work” (25%—Regulative); “Some
limited communication is possible with
our partner organizations due to work-
arounds and add-ons but the current
system is not integrated with other
parts of our organization and partners”
(68%—Collaborative), and; “Systems
are designed to be transaction driven
and focused on the individual division
or line of business meeting its goals.”
(62%—regulative)
2. Use of Data
The Use of Data was only slightly
higher ranked in terms of integration
maturity than the use of technology.
Eight out of 10 responses (82%) were
either Regulative or Collaborative.
When asked about where consumer
history currently resides and who has
access to it, the responses we received
were: “Consumer history resides exclu-
sively within individual programs; it
is not shared with others except where
specifically required to do so by regula-
tion or statute” (Regulative—10%),
and; “Consumer history resides within
individual programs but can be shared
across organizational boundaries with
data owners’ and program participants’
consent.” (72%—Collaborative)
3. Workflows
With both the use of technology
and the use of data not well inte-
grated, perhaps it is not surprising
that respondents felt that their orga-
nization’s workflows were not either.
Three out of four responses (77%) on
this topic were either Regulative or
Collaborative.
4. Eligibility and Enrollment (E&E)
Common Processes/Shared Services
Three out of four respondents (76%)
believed their E&E systems were
not highly integrated as reflected by
the preponderance of Regulative or
Collaborative answers we received
on this topic. For example, 24 percent
of respondents said that “program-
specific applications/intake processes
are used to determine eligibility and
enroll program participants in a given
program” (69%—Regulative) as
compared to the 7 percent of respon-
dents who said, “through the use of a
universal client registry and decision-
support tools, the staff’s ability to
make enrollment decisions is greatly
enhanced— enrollment is centralized,
based on eligibility determinations
established through a common system.”
5. Coordinated Service Delivery/
Role of Front-Line Worker
Seven out of 10 responses (73%)
reflected a less than well-integrated
range of activities. While there appears
to be some training about partner
organizations, achieving a holistic
approach at the level of the front-
line worker still currently appears to
be a steep hill to climb for nearly all
organizations that responded to self-
assessment. For example, none of the
respondents selected two responses we
viewed as Generative; i.e., “Workers
ensure that solutions are customized to
meet program participants’ needs and
that supplementary services are part of
the participants’ service plan that also
addresses the social determinants of
health where appropriate,” or “Workers
utilize universal knowledge within and
external to the enterprise, including the
program participants and community
partners, to anticipate and proactively
address participants’ needs.”
Conclusion
There is much to celebrate in the
responses we received this year. Those
who responded strongly believe their
H/HS leaders are visionary and respon-
sive to change, that their organizations
are inclusive and governed by people
with a broader, more-encompassing
view of their mission, and nearly one
out of every three respondents thought
achieving meaningful outcomes, rather
than measuring outputs (such as the
numbers of people enrolled) was the
true value of their enterprise’s work.
At the same time, opportunities
still abound in the use of technology,
analytics (data), improving workflows,
and empowering front-line workers
through multiple ways. This includes
making improvements to E&E systems,
continuing to move up the systems
integration continuum and, in so
doing, providing even greater value to
taxpayers and service to program par-
ticipants across the country.
We refer you to APHSA’s National
Collaborative web site4 for more
details on this study as well as a wide
range of additional materials we hope
you will find useful in your transfor-
mational journey.
Reference Notes
1.
en/pathways/NWI/BUSINESS_MODELS/
h-hs-integration-maturity-model.html
2.
pathways/NWI.html
3. Note: The questions focused on the use of
technology and the types of technology
currently in place in the respondents’
organizations, not on whether technology
in general was sufficiently sophisticated
enough to handle today’s H/HS
environment.
4.
pathways/NWI.html
FOUR LEVELS OF H/HS
SERVICES INTEGRATION
Level 1: Regulative
Serve constituents who are eligible for
particular services while complying
with categorical policy and program
regulations.
Level 2: Collaborative
Support constituents in receiving all the
services for which they’re eligible by
working across agency and program-
matic boundaries.
Level 3: Integrative
Address the root causes of client needs
and problems by coordinating and inte-
grating services at an optimum level.
Level 4: Generative
Generate healthy communities by
co-creating solutions for multi-
dimensional family and socioeconomic
challenges and opportunities.
Thosewho responded strongly
believe theirH/HS leaders are
visionaryand responsive to change,
that their organizations are inclusive
andgovernedbypeoplewitha
broader,more-encompassingviewof
theirmission.