Enterprise HHS Made Real: The Case for an Enterprise Approach (Part One)

Regulation

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October 15, 2018

Helping individuals and families reach a sustainable independence requires a holistic approach to providing supports. In fact, the Families First Act formally recognizes that a multifaceted blend of public and community-based assistance is necessary to help families stay together, as well as to protect children from abuse and neglect. It is also well known that many of our health and human services (HHS) programs have a significant overlap in the citizens they serve. Many users of programs like Medicaid and SNAP have challenges that are documented and partially addressed in our education, job training, substance abuse and behavioral health, and juvenile justice/corrections programs. While an integrated approach has inherent appeal, it is not compatible with the “stove pipe” alignment of programs and their corresponding information system infrastructures. In this blog series, we will discuss the importance of an integrated state enterprise-level approach for delivering HHS programs, and the steps leaders can take to implement sustainable HHS capabilities that improve wanted outcomes and efficiency.

Balancing Buckets of Need Versus Bags of Resources

Understanding the role of HHS programs can be distilled in a simple analogy. Every person has a basic need for goods and services (i.e., food, shelter, healthcare, childcare, education, safety, etc.). When visualizing these needs in the context of HHS, they can be represented by a bucket that is waiting to be filled. Each person also has direct and/or indirect access to resources to meet these needs—essentially, a bag of funds. It is almost universally accepted that the basic focus of HHS programs is to provide a temporary means of helping individuals and families balance those buckets of need with connections to bags of resources when they can’t do so themselves. However, we continuously must address pervasive problems, such as multigenerational poverty and relatively new challenges, like the effect of opioids and other substance abuse disorders. Washington State Department of Social and Human Services determined in 2011 that 43 percent of the funds spent for benefits were used by 11 percent of their clients using three or more programs.  Further, it is estimated that the national economic cost of prescription opioid misuse alone is $78.5 billion. The opioid problem is as widespread as it is pervasive. Worse, it impacts employment, which has an outsized impact in our rural areas. For instance, a report by Georgia Public Broadcasting on the state’s Opioid Crisis indicates that some employers in rural Stephens County are having difficulty finding potential employees that can pass a drug test. These problems represent a hole in the bucket intended to satisfy needs.  To be more effective and efficient in our HHS program delivery, we must address these underlying, pervasive problems that a relatively small, but very impactful, group are experiencing.

An Enterprise Approach to HHS

Addressing the pervasive problems impacting clients of HHS programs requires a much broader, deeper sharing of information and coordination of activities/services focused on citizens and their families. The affected agencies include the HHS agencies, state and local education, labor, corrections, juvenile justice, and public safety. Nonprofit and other community-based organizations are also involved in supporting those citizens that are the costliest users of HHS programs. However, there is a traditional lack of coordination of strategy, planning, and delivery of benefits and services among these agencies and enterprises. HHS leaders have been aware of this need for many years, and some states, such as Texas, have created cabinet-level organizations to manage and maintain this coordination. This enterprise-level coordination must be enabled by an infrastructure that holistically provides client-centered information and insights from multiple sources to a limited supply of social workers that are augmented by tools like an enterprise-level case management function. The enterprise approach we are suggesting consists of several high-level elements outlined below.

As HHS leaders shape effective programs in response to these entrenched challenges, we’ve outlined several actionable considerations to keep in mind:

  • Coordination: Enterprise-level development of a vision of sustainable citizen independence and strategy for coordination across state agencies and community organizations
  • Insights: Discovery and utilization of insights from analysis of available client-centered data
  • Technology Enablement: Sustainable independence focused case management from social workers augmented by real-time information and work flow support available from state-of-the-art information technology
  • Ongoing optimization: Continuous improvement methodology that incorporates knowledge from past success with proactive adjustments to emerging challenges.

In the following articles of this series, we’ll zero in on the elements of an enterprise approach to HHS and how it can best be deployed.

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