Integration and Interoperability Across Public Health, Human Services, and Clinical Systems

1. Integration and Interoperability Across Public Health, Human Services, and Clinical Systems

2. Listen only mode • This webinar will be recorded and available on NACCHO’s website • The slides will also be available for download • Please complete the evaluation when you receive the link • Type your questions in the box as we go

3. Outline of Webinar • Goal for today • Daniel Stein - Stewards of Change • Uma Ahluwalia – Montgomery County Department of Health and Human Services (MD) • Questions

4. Goal of Webinar • Highlight the collaborative work by Montgomery County Department of Health and Human Services and Stewards of Change on achieving a seamless integration across health and human services

5. NACCHO Webinar May 3rd, 2012

6. Stewards of Change Mission “Advancing Sustainable Improvements That Transform Systems Of Care By Integrating Entrepreneurial Solutions From The Public, Private And Not-for-profit Sectors.”

7. Microsoft Architectural Vision

8. State View: Silo’d Architectures, Funding, Services IHS ACF Public Health SAMHSA RSA Children, Adults & Families Medical Assistance Programs Addictions & Mental Health Rich Howard – CIO Oregon DHS

9. Consumer Centric Children in Foster Care Student Patient Family Adult Senior

10. Context: Where We Are Today • Today’s Health, Education, Human Services Systems and Justice program generally operate in silos • Resulting in: • Separate and unconnected programs • Categorical funding • Separate and redundant systems and infrastructure • Transaction orientation vs outcomes • System silos are still the norm although that has begun to change

11. Can Silos Be Connected? “Interoperability” Can Enable the Process

12. Human Services 2.0 - Core Principle L > C Learning Must Be Greater Than or Equal To the Rate of Change Just To Keep Pace… No Less To Provide Leadership and Lead Change

13. Human Services 2.0 A Conceptual Architecture

14. SOC Theory of Change Policy – The principles or rules that guide decisions by which human services organizations define how they will achieve desired outcomes across the range of programs, activities and disciplines. Structure – The way public and private human services systems design, organize and implement work processes to achieve policy and practice goals. Practice – “The way public and private human services organizations deliver services and care, monitor and report results and achieve intended outcomes

15. A Conceptual Architecture “Human Services 2.0” • Describes the To-Be vision (future state) of a connected and coordinated Human Services, Health and Education eco-system that is customer-centric; family-focused; community-based and technology enabled • It offers guidance about the policies,structure and practices that are necessary for improving outcomes and enhanced operational efficiency • Provides a common language and a set of ten core ‘Drivers’ that describe the business and organizational factors necessary for interoperability and Human Services 2.0. 15

16. InterOptimability Drivers GOVERNANCE WORKFORCE BRIDGING SILOS OPEN & INCLUSIVE PROCESSES CONFIDENTIALITY INTEROPERABLE INFORMATION TECHNOLOGY PUBLIC AND POLITICAL WILL CONSUMER CENTRIC PERFORMANCE MANAGEMENT FUNDING

17. InterOptimability Drivers

18. A Comprehensive Process • “InterOptimability” • Provides a language, methodologies and a nine step process that organizations can use to assess, plan, develop, implement, communicate and measure their interoperability initiatives • Is built on a holistic consumer-centric view and utilizes the ten critical change drivers needed for successful interoperability • SOC produced the InterOptimability Handbook to aggregate disseminate the learning 18

19. The InterOptimability Process • Orientation to Human Services 2.0 • Create ‘To-Be’ Change Vision Landscape & Roadmap • Conduct ‘As Is’ Business Process Review • Assess ‘As Is’ Information Technology • Evaluate Organizational Readiness • Perform Gap Analysis • Build ‘To-Be’ Business Process Framework • Develop ‘To-Be’ Information Technology Solution • Synthesize Learning, Develop Recommendations and Action Plans

20. A National Change Vision LandscapeProduced at the 2007 Annual SOC Conference

21. Current Engagements • Administration for Children and Families/HHS • HS 2.0 Training • Interoperability Toolkit • Confidentiality Toolkit • National Human Services Interoperability Architecture (NHSIA) • National Information Exchange Model (NIEM) • California Information Sharing Environment • CA Department of Social Services • CA Department of Health and Human Services • The Judiciary (Blue Ribbon Council) • Electronic Care Record For Children in Foster Care and the Judiciary (and other populations) • EHR + PHR • 7th Annual Stewards of Change Symposium • Collaboration with the Johns Hopkins Systems Institute 21

22. Communications and Resources • ACA 1561 Recommendations; Health and Human Services Linkages • Executive Order 13563; Administrative simplification • Joint Letters – ACF, CMS, CCIIO, USDA/FNS • Enhanced Funding: Seven Conditions and Standards to receive 90% match • National Human Services Interoperability Architecture (NHSIA) • National Information Exchange Model for Human Services (NIEM) • Confidentiality Guidance • A-87 Cost Allocation Exception • Toolkit can be found on ACF website

23. Integration and Interoperability within the Health and Human Services Enterprise NACCHO WEBINAR Thursday| May 3, 2012 | 1:00p Uma S. Ahluwalia, Director Department of Health and Human Services | Rockville, Maryland

24. Most populous county in Maryland Immigration was the largest component of population change since 2000 Montgomery County: A Changing Picture Population Growth (K) Source: U.S. Census Bureau

25. Montgomery County Diversity: Census 2010 “Minorities” are more than half of Montgomery’s population • Non-Hispanic Whites make up 49.3% of the County’s population, down from 59.5% in 2000 • Hispanics are now the County’s second largest population group (17%) followed by Blacks (16.6%), Asian and Pacific Islanders (13.9%) and Other (3.2%) • 39% of County households speak a language other than English at home; 14.5% have limited English proficiency • Most neighboring counties also had a decrease in non-Hispanic White population, including Fairfax, Howard and Prince George’s counties

26. Caseloads have grown every month since FY07 and as of June 30, 2011, are at a high of: • Temporary Cash Assistance (TCA): 1,059 (53% increase) • Food Stamps (FS): 25,554 (126% increase); and, • Medicaid (MA): 45,104 (54% increase) Public Assistance Needs

27. Heat, Housing and Health Needs Home energy assistance applications remained steady in FY11 with 12,356 applications received compared to 12,315 in FY10. Since FY08, applications for assistance have increased 37% Requests for Emergency Housing Assistance totaled 7,978 in FY11, 36% higher than in FY08 Patient load in Montgomery Cares for FY11 was 26,877 patients, a small (2.3%) increase over 2010.  For FY12, patient load is projected at 28,500, a 6% increase over FY11

28. Medicaid Numbers In Montgomery County

29. Federal Agencies Whose Regulations and Funding Strategies Impact County Services • Title XIX • Title IVE • CSBG • CDBG • Mental Health Block Grant • Federal and State Grants • 40% of DHHS Budget is from State and Federal Sources • 60% of DHHS Budget is from County Sources • ACF • CMS • SAMHSA • HRSA • CDC • ONCHIT • HUD • NIH • Veterans Administration • Office on Aging • Homeland Security • Department of Agriculture

30. Montgomery County Department of Health and Human Services Services and MARYLAND State Department Connections by Service Type • Aging and Disability Services • DOA, DOD, DHR, DHMH, DVA • Behavioral Health and Crisis Services • DHMH, GOC, DHR, DPSC • Children, Youth and Family Services • DHR, GOC, GOCCP, DJS, MSDE, DLLR • Public Health Services • DHMH, MSDE, DHR • Special Needs Housing • DHR, DHCD, DHMH • Community Outreach | All Departments PHS CYF BHCS SNH ADS Department of Health and Human Services

31. Used Cases and the Trends They Reveal

32. 42-year old non-English speaking recent immigrant Tests by DHHS indicate she has tuberculosis Appears to be some domestic violence at home Has two children ages 2 and 6 – and is pregnant again 2 year old needs child care, family can not afford it 6 year old has special needs and housing is unstable Services offered by DHHS to address these complex needs: Public Health TB Clinic Child Care Services Maternity Services WIC Services Income Support Services Workforce services LEP Services Domestic Violence Service via Abused Persons Program Adult Mental Health Services Housing Stabilization Services Education through Public School System Scenario One

33. 90-year old woman identified as hoarder • 21-year old great-grand-daughter moved in • Great grand-daughter has two preschool aged children • Great grand-daughter a former drug user is abusing again • Department of Housing believes house not livable Services offered by DHHS to address these complex needs • Adult Protective Services • Child Welfare Services • Early Learning and Child Care • Special Needs Housing Services • In-home Aide Services • Income Supports • Workforce Services • Substance Abuse Treatment • Medical and Primary Care Scenario Two

34. Homeless diabetic woman Scenario Three • Homeless diabetic woman with Schizophrenia • Three episodes of hospitalization in last 12 months • Hard for her to regularly take medications • Hard for her to have nutritious meals • Services offered by DHHS to address complex needs • Homeless Program • Public or Medicaid Provider Mental Health Treatment • Montgomery Cares and Possibly Medicaid enrollment • Housing Stabilization Services

35. Quicker Processing of Benefits Linkages with Community Based Organization and Closer Connectivity of Residents with Government and Services Improve comprehensive outcomes for Transition Age Youth – sub population pilot to be expanded to the broader HHS enterprise Improve indicators for children, youth, families and single adults related to Safety, Health, Well-being and Self-sufficiency Improve indicators related to Job Creation and economic development Maximized opportunities related to Health Information Technology under the Affordable Care Act Outcomes to be Achieved

36. Assessment of hardware and software infrastructure Business process analysis Analysis of Policy environment Identified business and programmatic needs Build the integration prototype with transition age youth and now homeless families Analyzed staff capacities and readiness for change Developed the case for HHS modernization – business need to drive technology solution Urgency – increased need, diminished resources – need for a new business model supported by new technology solution Business Activities Department of Health and Human Services’ Modernization

37. Built a nationally recognized confidentiality policy that enables data sharing across the entire Health and Human Services Enterprise Developed a Neighborhood Opportunity Network Model – that combines social engineering with economic empowerment Developing the scope and parameters for a true “No Wrong Door Approach” to the delivery of health and human services Strengthening partnerships with non-profits, faith community, business and philanthropy to better leverage limited resources for those in need Policy Activities

38. Built a practice model for integrated practice Developed a universal face sheet and screening tool for our enterprise Identified outcomes for our work Tested integrated access points through our neighborhood opportunity network activities for both delivery of services and economic development activities Used Health Reform as a catalyst for change Built a work plan for implementation Activities to Support Practice Identified Transition Age Youth as our test population includes – children aging out of foster care and juvenile justice; mentally ill or substance abusing youth, pregnant and parenting youth and homeless youth. And now working with homeless families

39. Department of Health and Human Services Technology Solution Build a common client index or master client index to track overlapping and unduplicated client load – better anticipate need and improve service delivery Integrate eligibility for all programs federal, state and local with eligibility requirements Ensure compliance with all federal, state and local confidentiality and privacy protocols Digitize all records and move to a paperless environment Integrated case management system that allows for public and private sector users access and use of the system DHHS Portal and Data Warehouse development

40. Department of Health and Human Services Affordable Care Act Response (An Opportunity for Integration)

41. Six Areas of Focus for Affordable Care Act Implementation in Montgomery County

42. Health Planning Process

43. Emphasis on Community and Population Health and well being Calculating Return on Investment and Social Return on Investment Making the case for re-investment Using a community health and social planning approach to determine need and the algorithm for reinvestment Engaging our Hospitals and community providers in the conversation about Community Benefit Investments in health and human services will follow a trajectory like public safety and education – need will define level of investment and these services will not be considered discretionary Community Benefit and Land Use Planning

44. Five Key Focus Areas for Social Services within Health Care Reform

45. Meaningful Use and Regional Extension Center Engagement

46. Partnerships Across Government With our non-profit providers With the Faith Community With Business With Philanthropy With Advocates and residents To Impact outcomes at the: a. Individual b. System and c. Population Health and Community level

47. The Policy Conversation • Integrated Eligibility • Blending and Braiding Funds • Confidentiality • Evidenced Based Practice • Interoperability

48. Thank you!

49. Questions • Please type your questions in the box

50. Contact Information • Vanessa Holley, MPH • Program Analyst, ePublic Health • vholley@naccho.org • (202) 507-4239