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Integration and Interoperability in a Health and Human Services Enterprise. Montgomery County, Maryland | Department of Health and Human Services October 7, 2013 . WHO WE ARE:. Information about our County. 3. Department of Health and Human Services. 3. How is the Department Organized?. - PowerPoint PPT Presentation
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Montgomery County, Maryland | Department of Health and Human ServicesOctober 7, 2013
Integration and Interoperability in a Health and Human
Services Enterprise
WHO WE ARE:
3
Information about our County
3Department of Health and Human Services
Almost 1 Million Residents__________
31% Foreign Born
50.6% Ethnic Minority
17% Growth in our senior population
over the next 2years
49,344 out of 148,779 children in the public school system receive
FARMS
6 Zip Codes of Extreme Need —
Poverty on the Rise
Served 120,000 Households in Fiscal Year 2012. One-third used more than two
services from Department
A Staff of 1,600 with over 80 Programs
Caseloads GrowingTCA: 43.4%SNAP: 166%MA: 68.7%
Serving almost 36,000 uninsured
adults, children and pregnant women
4
How is the Department Organized?
In 1994, Four Departments Became One
Entity
OBJECTIVE: Integrated, Coordinated
and Comprehensi
ve Service Delivery
5
Montgomery County Department and Health and Human Services
Continuum of Programs Aging and Disability
Services Behavioral Health and
Crisis Services Children, Youth and
Family Services
Public Health Services
Special Needs Housing Office of Community
Affairs
John J. Kenney Chief
Raymond Crowel Chief
Kate Garvey Chief and Social Services
Officer
Ulder J. Tillman Chief and Health Officer
Nadim Khan Chief
Betty Lam Chief
Information and Assessment Services
Home and Community Support Services
Community Support Network | Disability Services
Home Care Adult Protective Services |
Case Management Services Nutrition Program Assisted Living and Skilled
Nursing Facilities Assisted Living Services Ombudsman Program Boards and Commissions
.. Commission on Aging
.. Commission on People with Disabilities
.. Adult Public Guardianship Review Board
Mental Health Services Adults and Seniors Children and Adolescents Multicultural Mental Health
Services Core Service Agency Substance Abuse | Addiction
Services Crisis Stabilization Juvenile Justice Partner Abuse Victim Abuse Boards and commissions
.. Alcohol and Other Drug Abuse Advisory Committee
.. Mental Health Advisory Committee
Linkages to Learning Child Welfare Child and Adolescent Services Early Childhood Services Gang Prevention Initiative Income Supports and Child Care
Subsidy Liaison Work with MCPS Boards and Commissions
.. Commission on Children and Youth
.. Commission on Child Care
.. Commission on Juvenile Justice
.. Citizens Review Panel
Community Health Services Communicable Disease| Bio-
Terrorism Cancer and Tobacco Initiatives Licensure and Regulatory
Services Assisted Living Facilities
Certification School Health Montgomery Cares Health Promotion Health Partnerships and
Planning Long Term Care Medical
Assistance and Outreach Special Projects Boards and Commissions
.. Commission on Health
.. Montgomery Cares Advisory Board
Housing Stabilization | Emergency Services to Prevent Homelessness Economic Supports Emergency Assistance Grants Welfare Avoidance Grants 60-Month Intervention Resource Supports Preventive Crisis Intervention
with Case Management Rental and Home Energy Assistance Program RAP - Shallow Rental Subsidy
Program SHRAP – Deep Rental Subsidy
Program Handicapped Rental Assistance
Program Home Energy Assistance
Program Homeless Continuum of Care Coordination (Supported through non-profit partners) Single Adult Shelters w|case
management Motel Placements and
Overflow Shelters Transitional Programs Permanent Supportive Housing
Programs
Community Action Agency Community Outreach Disparity Reduction Diversity Initiatives and the
three Minority Health Initiatives
LEP Compliance
6
How is DHHS Organized?
One Director
Centralized Administrat
ive Functions
Moving towards single client
record supported by an
interoperable databaseUniform intake
form to identify all service needs
Designated entire HHS entity as
HIPAA covered – including social
service and income support
programs
7
No Wrong Door in the Future.
Seamless customer experience integrated in all 50 sites (27 program sites and 23 clinic sites)
Key to the experience will be: Access to all DHHS Programs Shared information and data Customer telling their story once
TECHNOLOGY MODERNIZATION
9
An Aspect of Interoperability.
Integrated Case Practices Integrated Business
Process Enterprise-wide Client
View Improved Outcomes Analytics and Individual
Client Focus and Population Health Focus
Technology Modernization
10
The Process and Technology Modernization (PTM) Program lays the foundation for changing DHHS service delivery over the next few years.
Changes in service delivery best practice
Changes required by the Affordable Care Act (ACA) implementation
Difficulty/cost in maintaining many one-off applications supporting programs
Inefficiencies from using multiple state systems
Improve client outcomes Reduce overall costs of
treatment Establish single platform for
most service delivery Prepare for ACA-mandated
changes Simplify ongoing application
maintenance Realize vision of integrated
DHHS
Drivers Goals
11
Service Delivery Today.
Service IntegrationTreatm
entTreatm
entTreatm
entTreatm
entTreatm
entAssessm
entAssessm
entAssessm
entAssessm
entAssessm
entEligibili
tyEligibili
tyEligibili
tyEligibili
tyEligibili
tyIntake Intake Intake Intake IntakeAging
& Disabili
ty
Behavioral
Health
Children Youth
& Familie
s
Public Health
Special Needs Housin
g
The PTM Program will help HHS transform from disjointed, inefficient, program-based silos … Clients have to
“shop” for services
No consolidated view of client engagement with HHS
Integrated service delivery for only the hardest-to-serve clients
12
Service Delivery Tomorrow.
Treatment
Assessment
Eligibility
Intake
Aging &
Disability
Behavioral
Health
Children Youth
& Familie
s
Public Health
Special Needs Housin
g
… to a more integrated service delivery model that treats clients holistically and cost-effectively. No Wrong Door
for residents needing services
Consolidated view of client engagement across most programs
Integrated service delivery where appropriateClien
t
13
Because we want to provide
seamless, consistent services to our clients
across HHS, we seek to define and implement common
processing, approaches
and methods
throughout HHS
Because we want to
maintain and upgrade our systems over time, we will leverage the
existing functionality of the software as fully as possible and minimize customization
Because we want to treat clients in
holistic, integrated
manner, we will share
information about our clients
and their treatment within
HHS, unless prohibited by law
We will never let the
perfect be the enemy of
the good
We adopted four guiding principles to serve as touchstones
as we move forward.
14
The PTM Program includes 7 Interrelated Projects.
1. Enterprise Integrated Case Management (EICM)2. Enterprise Content Management System (ECMS)3. Electronic Health Record (EHR)
4. US HHS Interoperability Grant5. Organizational Change Management (OCM)6. Project Management Office (PMO)7. Quality Assurance (QA)
IT Implementations
Supporting Projects
15
C
B
A Application HUB (share application; eliminate dual entry)
Dependencies -
Integrations/Conversions (single view of client)Dependencies – CIS/SAIL integration – Person Query (existing), Person Registration, Case Query (existing) Case Registration (CARES, OHEP), ECMSData conversion - CIS, CARES, OHEP
C Check-in / Clearance ApplicationRegistratio
n
LotC Com
mon/
Core Functions
Eligibility Determinati
on
WPA
RAPADS Risk AssessmentSubsume
dD
Target Phase 3 First Half
Appointment
Scheduling
Service Area Customization
Service Area / Local
Program
Specific
Check-in / Clearance ApplicationRegistratio
nAppointme
nt Scheduling
Eligibility Determinati
on
Case Assignme
nt
Program Referral
16
C
B
A Application HUB (Add new sources)
Integrations/Conversions (Add new sources)
CRecord
Assessment Results
Service Referrals (Manual)
Provider Enrollment
LotC Com
mon/Co
re Functions
Service Plan
Service Strategy
D
Target Phase 3 Second Half
Case Dispensati
on
Provider / Serice Match
Service Area / Local
Program
Specific
WPA
RAPADS Risk Assessment
Service Area Customization
Reporting/Analytics
MCDHHS Master Clients
Resources Services
Client Demographics
Active Enrollments
Provider/Service History
eICM
Conversion and Batch Integration Strategy
Iterative Conversion Process
State/FederalSystems of Record
18
Integration with Systems of Record
19
NIEM – Based Application Hub
eICM
Case Management Modules
20
CASE MANAGEMENTAutomated in eICM
SERVICE TRANSACTIONCurrent process
Using System of RecordMANAGE CASE ACTIVITY
MANAGE CLIENT PARTICIPATION
MONITOR CLIENTPROGRESS
MANAGE SERVICEBUDGET
DELIVER UNITS OFSERVICE
VERIFY CLIENTPARTICIPATION
REPORT SERVICEMILESTONES
INVOICE FOR SERVICESRENDERED
MONITOR PROVIDERFULFILLMENT
CM/ST Interactions21
eICM Service Referral
State System of
Record
Service Transaction
Details
Case ManagerService Transaction
Details
ProviderBatch
Process
CONFIDENTIALITY AND PRIVACY
23
Policy and Practice Business Process Need to Know Role-Based Access Balance between
Interoperability/Data-sharing and Guarding against Breaches
An Aspect of Interoperability.Sharing of Information
24
Confidentiality:
Sharing Information within
our Multi-
Service Agency
Definition of treatment in the regulations include “related services”
In context of our department, related services include income support and social services Addressing a client’s basic food or shelter needs
greatly impacts the effectiveness of health care Both the intent of the law and
language in the rulemaking process supports this broad interpretation
25
Infrastructure to Promote
Service Integration and Ensure
Privacy Compliance
Revised Notice of Privacy Practices
Common Authorization
Form
Department-Wide Policy
(Example: Safeguarding Policy)Role-based
Access; Access based on a job
related purpose
Minimum Necessary
Training
Resources
26
Why Integrate Data?
Over 30% of our clients use multiple servicesClients often have to tell their story multiple times and data has to be entered multiple times. Increases the risk of errors in the re-telling and re-enteringWithout a master client index, it is hard to tell what services a client is getting across our enterprise and often services are duplicated and there is waste and inefficiencyMakes re-use of data impossible and it makes it more difficult for clients to access multiple services across the enterprise
27
What is our Approach? We have a HIPAA Policy and Risk Manager leading
an office of 2.5 positions Continuously updating and staying on top of the
federal and state policy environment Continuously training and working to align policy Our Process and Technology Modernization efforts
which include the following – ECMS, eICMS, EHR, MCI, Legacy Systems and MCDHHS Portal will have policy, business process and practice alignment for HIPAA, 42CFR and other privacy statutes and regulations
RETURN ON (TAXPAYER) INVESTMENT/SOCIAL RETURN ON INVESTMENT
Work led by JHU Public Health Informatics School and Accenture Slides attributed to Dr. Harold Lehmann
Background Application of cost-effectiveness analysis
to human services Washington State Institute for Public Policy Evidence vs local data
Decision oriented Klazinga, et al. Int Soc Qual Heal Care 2001
Social return on investment Cresswell; sroinetwork.org
vatic
anus
Outcome Measures
Case
Architectural Model
CostsBenefits
To Be As Is
RO(T)I Results
Standard Practice
With Interoperability
Costs Incurre
d
Costs avoide
d
Costs Incurre
d
Costs avoide
d
Net
Test case 1Homeless
Test case 2Youth in
Transition
Monetizing Impact:Net Benefits by Stakeholder
Public DefenderState DOC
District CourtCity Attorney
County AttorneyProbation (Community Corrections)
Arrest (Sheriff)Jail (Sheriff)
0%10%
20%30%
40%50%
60%70%
80%90%
100%
Criminal Justice Cost BreakdownLocalStateFederalOther
Dakota County Other Counties State of MN Federal Other TOTAL
Cost Cost 1 Cost 2… Total Cost of RAP
Benefit (Criminal
Justice Cost Avoidance)
Jail Arrest Probation … Total Cost Avoidance Attributable RAP
Benefit
(Community Impacts)
Benefits Not Quantified Tax Revenue Attributable to RAP
Totals Total Benefits Total Costs Total Net Benefits
Case CostsBenefits
Variables: Functional Model
• Service costs• Data costs
Protocol
Upper model: Trace provenance of data Functional model: Interviews at generic
level Database model: Review database
schemas Result:
Trace data from creation to storage to outcome, along with costs: Interoperability model
Articulate benefits (as represented by the data)
ROTI, SROI:Based on nef, 2006 Understand and
plan Stakeholders Boundaries Impact map,
indicators SROI plan
Collect data Projections Analyse income,
expenditure Calculate SROI Report <Cycle>
Nef=New Economics Foundation (UK)
Questions Raised
What are the IT decisions that matter? How far can we get with generic data? Issue of monetizing the “upper model”
outcomes The biggest costs for the system as a whole
are from NICU stays for premature babies. But those costs are not in our universe.
“Minimal modeling” (David Meltzer): Value × Durability × implementation × incidence × population.
37
What are the Markers of Success?
A seamless integrated Health and Human Services environment
Integration at the point of intake and assessment
Integration at the point of service delivery
Collaborative case practice when case acuity is severe
Improved client and patient outcomes
A more equitable service delivery system
Strong population health and program level data and analytics capabilities in addition accessible case specific data
38Uma S. Ahluwalia, DirectorDepartment of Health and Human Services | Rockville, Maryland 240.777.1266 | uma.ahluwalia@montgomerycountymd.gov
Questions | Answers | More Information
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