P&P February 2016

Thosewho responded strongly believe theirH/HS leaders are

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

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) 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 2. Use of Data The Use of Data was only slightly 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.

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 site 4 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. http://www.aphsa.org/content/APHSA/ en/pathways/NWI/BUSINESS_MODELS/ h-hs-integration-maturity-model.html 2. http://aphsa.org/content/APHSA/en/ 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. http://aphsa.org/content/APHSA/en/ pathways/NWI.html visionaryand responsive to change, that their organizations are inclusive andgovernedbypeoplewitha broader,more-encompassingviewof theirmission.

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February 2016   Policy&Practice