Skip to Main Content

insightsarticles

COVID-
19 laws and their impact on state public health agencies

By: Sarah Stacki,

Laura Hill is a Consultant with BerryDunn working in the State Government Practice Area. She specializes in public health. She has experience working with state and local government public health agencies, not-for-profit organizations, and healthcare systems on strategic planning and project implementation. In addition, she has specialized training and expertise in food security, outdoor play environments for children, and obesity prevention in children and teens.

 Laura Hill
04.16.20

Read this if you work at a public health department and would like a brief summary of how you can maximize funding and meet new federal requirements.

Unpacking the trillions

In response to the COVID-19 pandemic, several pieces of legislation were passed by congress and signed into law. The three bills, H.R. 6074 Coronavirus Preparedness and Response Supplemental Appropriations Act, H.R. 6201 Families First Coronavirus Response Act, and H.R. 748 Coronavirus Aid, Relief, and Economic Security (CARES) Act, have provided funding for various federal agencies with different roles in responding to the crisis. Because of the urgency required, much of the guidance for use of funds and reporting requirements were released after passage of the bills or have yet to be released.

Here is a brief timeline and summary of the acts:

Implication and next steps for state public health departments

While little guidance has been provided for how state public health departments should prepare to access federal funds, BerryDunn will continue to monitor and release updates as they become available. 

While at this point HR 6074 has the greatest implications for public health departments, here are some actions that states should take now for their public health programs from the recent legislation:

  1. H.R. 6074: Provides appropriations to the CDC to be allocated to states for COVID-19 expenses.
    • To ensure maximum funding, prepare a spend plan to submit to CDC.
    • To ensure compliance, provide CDC with copies or access to COVID-19 data collected with these funds.
    • To maximize the impact of new funding, develop a COVID-19 community intervention plan.
    • To support streamlined operations, submit revised work plans to CDC.
    • To prevent missed deadlines, submit any requests for deadline extensions to the CDC.
  2. H.R. 6201: Provides guidance specific to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs.
    • To encourage social distancing and loosen administrative requirements, seek waivers through the USDA’s Food and Nutrition Service (FNS).
    • To ensure compliance, prepare to submit a report summarizing the use of waivers on population outcomes by March 2021.
  3. H.R. 748: Allocates $150 billion to a coronavirus relief fund for state, local, and tribal governments.
  • To secure funding, monitor the US Department of Health & Human Services (HHS) for guidance on using funds for:
    • Coronavirus prevention and preparation
    • Tools to build health data infrastructure
    • COVID-19 Public Health Emergency expenses
    • Developing countermeasures and vaccines for coronavirus
    • Telehealth and rural health activities
       
  • To ensure HIPAA compliance when sharing protected patient health information, monitor the US Department of Health & Human Services (HHS) for guidance.

For more information

For specific issues your agency has, or if you have other questions, please contact us. We’re here to help. 

Related Services

Consulting

Information Systems

Organizational and Governance

Related Professionals

CYSHCN programs have new care coordination standards―how does your agency measure up?

On October 15, 2020, the National Academy for State Health Policy (NASHP) released new care coordination standards for Children and Youth with Special Health Care Needs (CYSHCN) programs. The National Care Coordination Standards supplement the National Standards for Systems of Care, helping to ensure that children and youth with special health care needs receive the high-quality care coordination needed to address their specific health conditions.

The standards also set requirements for screening, identification, and assessment, a comprehensive shared plan of care, coordinated team-based communication, development of child and family empowerment skills, a well-trained care coordination workforce, and smooth care transitions. 

What do the standards mean for CYSHCN programs

The National Care Coordination Standards are more than guidelines for CYSHCN programs; aligning with the standards can lead to operational efficiencies, greater program capacity, and improved health outcomes. The standards can serve as a lens for continuous improvement, highlighting where programs can make changes that reduce the burden on care coordinators and program administrators.

However, striving to meet the standards can be challenging for many programs—as the standards develop and evolve over time, many programs struggle to keep up with the work required to update processes and retrain staff. Assessing a CYSHCN program’s processes and procedures takes time and resources that many state agencies do not have available. Despite the challenge, when state agencies are the most strapped is often when making change is the most needed. A shrinking public health workforce and growing population of CYSHCN means smooth processes are essential. To take steps towards National Care Coordination Standards alignment, BerryDunn recommends the following approach: 

A proven methodology for national standards alignment

There are many ways you can align with the standards. Here are three areas to focus on that can help you guide your agency to successful alignment. 

  1. Know your program
    It can be easy for processes to deteriorate over time. Process mapping is an effective way to shed light on current work flows and begin to determine holes in the processes. Conducting fact-finding sessions to map out exactly how your program functions can help pinpoint areas of strength―and areas where there is room for improvement.
  2. Compare to the national standards
    Identify the gaps with a cross-walk of your program’s current procedures with the National Care Coordination Standards. We assess your alignment through a gap analysis of the process, highlighting how your program lines up with the new standards.
  3. Adopt the changes and reap the benefits
    Process redesign can help implement the standards, and even small adjustments to processes can lead to better outcomes. Additionally, you can deploy proven change management methodologies programs that ease staff into new processes to produce real results.

Meeting national standards doesn’t have to be complicated. Our team partners with state public health agencies, helping to meet best practices without adding additional burden to program staff. We can help you take the moving pieces and complex tasks and funnel them into a streamlined process that gives your state’s children and youth the best care coordination. 

Article
Using process redesign to align with new CYSHCN standards

Revolutionizing the way information is stored and received, blockchain is one of the most influential technologies of the past decade. Mostly known for its success with the digital payment system, Bitcoin, blockchain also has potential to transform the public sector, and further, the way citizens interact with government. Many states are considering this potential, but are stuck asking the most basic question: How can the public sector implement blockchain? The first step is to understand exactly what blockchain really is.

Blockchain—What is it?
At the highest level, blockchain is termed a Distributed Ledger Technology (DLT): data within a blockchain is not controlled by a single, centralized entity, but rather, is held by millions of systems simultaneously. This “chain” of systems, or DLT, not only decentralizes data, but also ensures it is incorruptible, as each “block” of data in the DLT connects using highly advanced encryption technology. Further, you can share each “block” without exposing the entirety of the blockchain’s data, enabling data sharing without compromising sensitive information. Blockchain’s opportunity lies in the core of its model, as being able to securely share records (containing sensitive information such as birth certificates, marriage licenses, property deeds, professional licenses, etc.), could connect different government services and create more efficient processes.

States across the nation are intrigued by the potential of blockchain, but unsure of just how to implement it successfully. Illinois, through the Illinois Blockchain Initiative, has been a leader in exploring blockchain’s possibilities in government. Here is some of their first-hand insight and advice.

Blockchain in Government—Illinois’ Perspective
Sunil Thomas, Cluster CIO, State of Illinois, assisted in the creation of the Illinois Blockchain Initiative in 2016, and is now a leader in testing and implementing blockchain technology across state services. BerryDunn connected with Sunil in August 2018, and he provided unique advice for other states considering a blockchain initiative.

Specifically, Sunil broke down the processes the Initiative used to advance the technology within the state, and shared three key pieces of advice for successful blockchain implementation:

  1. Host a statewide education campaign for blockchain to ensure all state leaders, including legislators, are equipped with a clear understanding of blockchain technology and its place in government. This education campaign may include extensive research into blockchain technology. Illinois, for instance, began their initiative by issuing a Request for Information (RFI) from vendors within the blockchain market. Additionally, Illinois collaborated with a local start-up that specializes in blockchain in order to gain subject matter expertise into blockchain development. 
  2. Initiate organized pilot projects to guide the direction of blockchain in the state and select what use cases should go through the full implementation process. At first, you should use blockchain projects to complement current state services. This ensures continuation of services, and allows for comprehensive transition time. Additionally, states should ask the questions: Why shouldn’t this service be delivered using a traditional solution?, and further, Why do we specifically need blockchain for this solution?, before each pilot. This will help you leverage the right services, with the greatest potential, as pilot blockchain projects.
  3. Create a statewide roadmap for blockchain to build an ecosystem that supports the technology. This “Blockchain Roadmap” should highlight a navigation plan for both state and federal regulations, and ensure that blockchain procurement strategies are understood. The roadmap can include a comprehensive cost-benefit analysis to determine a return on investment (ROI) for specific services considered for blockchain leverage. Overall, the roadmap will act as a guide throughout the entirety of the blockchain initiative, and will ensure the state’s vision for blockchain is achievable.

These key pieces of advice can provide a foundation for state’s looking to leverage blockchain to improve services; although each state should tailor blockchain technology to its specific needs. The Illinois Blockchain Initiative’s experience clearly demonstrates there is a way to navigate blockchain successfully in the public sector, and shows that the technology truly can assist in the transformation of government services moving forward.

Article
Blockchain in government: Advice from leaders at the Illinois Blockchain Initiative

Modernization means different things to different people—especially in the context of state government. For some, it is the cause of a messy chain reaction that ends (at best) in frustration and inefficiency. For others, it is the beneficial effect of a thoughtful and well-planned series of steps. The difference lies in the approach to transition - and states will soon discover this as they begin using the new Comprehensive Child Welfare Information System (CCWIS), a case management information system that helps them provide citizens with customized child welfare services.

The benefits of CCWIS are numerous and impressive, raising the bar for child welfare and providing opportunities to advance through innovative technology that promotes interoperability, flexibility, improved management, mobility, and integration. However, taking advantage of these benefits will also present challenges. Gone are the days of the cookie-cutter, “one-size-fits-all” approach. Here are five facts to consider as you transition toward an effective modernization.

  1. There are advantages and challenges to buying a system versus building a system internally. CCWIS transition may involve either purchasing a complete commercial off-the-shelf (COTS) product that suits the state, or constructing a new system internally with the implementation of a few purchased modules. To decide which option is best, first assess your current systems and staff needs. Specifically, consider executing a cost-benefit analysis of options, taking into account internal resource capabilities, feasibility, flexibility, and time. This analysis will provide valuable data that help you assess the current environment and identify functional gaps. Equipped with this information, you should be ready to decide whether to invest in a COTS product, or an internally-built system that supports the state’s vision and complies with new CCWIS regulations.
     
  2. Employ a modular approach to upgrading current systems or building new systems. The Children’s Bureau—an office of the Administration for Children & Families within the U.S. Department of Health and Human Services—defines “modularity” as the breaking down of complex functions into separate, manageable, and independent components. Using this modular approach, CCWIS will feature components that function independently, simplifying future upgrades or procurements because they can be completed on singular modules rather than the entire system. Modular systems create flexibility, and enable you to break down complex functions such as “Assessment and Intake,” “Case Management,” and “Claims and Payment” into modules during CCWIS transition. This facilitates the development of a sustainable system that is customized to the unique needs of your state, and easily allows for future augmentation.
     
  3. Use Organizational Change Management (OCM) techniques to mitigate stakeholder resistance to change. People are notoriously resistant to change. This is especially true during a disruptive project that impacts day-to-day operations—such as building a new or transitional CCWIS system. Having a comprehensive OCM plan in place before your CCWIS implementation can help ensure that you assign an effective project sponsor, develop thorough project communications, and enact strong training methods. A clear OCM strategy should help mitigate employee resistance to change and can also support your organization in reaching CCWIS goals, due to early buy-in from stakeholders who are key to the project’s success.
     
  4. Data governance policies can help ensure you standardize mandatory data sharing. For example, the Children’s Bureau notes that a Title IV-E agency with a CCWIS must support collaboration, interoperability, and data sharing by exchanging data with Child Support Systems?Title IV-D, Child Abuse/Neglect Systems, Medicaid Management Information Systems (MMIS), and many others as described by the Children’s Bureau.

    Security is a concern due to the large amount of data sharing involved with CCWIS systems. Specifically, if a Title IV-E agency with a CCWIS does not implement foundational data security measures across all jurisdictions, data could become vulnerable, rendering the system non-compliant. However, a data governance framework with standardized policies in place can protect data and surrounding processes.
     
  5. Continuously refer to federal regulations and resources. With the change of systems comes changes in federal regulations. Fortunately, the Children’s Bureau provides guidance and toolkits to assist you in the planning, development, and implementation of CCWIS. Particularly useful documents include the “Child Welfare Policy Manual,” “Data Sharing for Courts and Child Welfare Agencies Toolkit,” and the “CCWIS Final Rule”. A comprehensive list of federal regulations and resources is located on the Children’s Bureau website.

    Additionally, the Children’s Bureau will assign an analyst to each state who can provide direction and counsel during the CCWIS transition. Continual use of these resources will help you reduce confusion, avoid obstacles, and ultimately achieve an efficient modernization program.

Modernization doesn’t have to be messy. Learn more about how OCM and data governance can benefit your agency or organization.

Article
Five things to keep in mind during your CCWIS transition

Read this if your agency is involved with COVID-19 vaccination distribution.

Although states have already created COVID-19 vaccination plans, your state can still implement critical strategies to improve your distribution plan. In October 2020, the Centers for Disease Control (CDC) released the Interim Playbook version 2.0, providing a key framework for states and jurisdictions to build their COVID-19 vaccine distribution plans. The federal government asked that immunization programs in each state plans based on this model. The Playbook contains 15 sections of planning elements for states to consider in the development of their plan. Completing a plan of this extent while simultaneously trying to manage the pandemic has led some states to leave out or not thoroughly address critical components in their plans. 

The Kaiser Family Foundation (KFF) analyzed and collected common themes from each of the 47 state vaccination plans. Their analysis identified areas of weakness in the following areas of each plan: 

  • Priority populations for vaccinations in states 
  • Identifying networks of providers 
  • Developing data collection and reporting
  • Forming communication strategies

Each of the four areas each contained multiple findings, but since the vaccine has already started to roll out, some aspects of the plan cannot be revised. However, it is not too late to improve upon certain elements, especially for data collection and reporting, as well as communication strategies. 

The following recommendations for improvement of state plans are based on the findings from the KFF State COVID-19 vaccine distribution analysis report

States should identify a clear data reporting and collection plan that accounts for the COVID-19-specific data requirements.

According to KFF, an immunization registry or database has been included in 53% of the state COVID-19 plans; in the others it was an unclear component of the plan. The data collection process for COVID-19 vaccinations will be complex and unique due to a number of factors including the nature of a phased rollout, new provider enrollment and onboarding, storage requirements, multiple vaccines and doses, and off-site vaccination locations

Since a little over half of all states have arranged for either new systems or are developing or adding features to current immunization registries, states that are lacking a comprehensive approach could benefit from adopting elements present in the other plans. For example, some states detail how their current immunization system is being utilized for the COVID-19 vaccine, in addition to upgrading certain features in order to meet the anticipated increase in demand. 

Other states have also described their transition to the Immunization Gateway, a centralized technical infrastructure sponsored by the CDC Immunization Information Systems Support Branch, and led by the US Department of Health and Human Services Office of the Chief Technology Officer. The Gateway is securely hosted through the Association of Public Health Laboratories (APHL). States can review the data collection and reporting sections of other states’ plans to gain a greater understanding of how their plan can be improved by describing data reporting and collection processes.   

States should address racial and ethnic disparities in vaccine distribution and acceptance through targeted and evidence-based communication strategies. 

The KFF analysis of state COVID-19 plans indicated about 49% of state plans include specific mention of racial or ethnic minority populations in regards to communication. Communication plans need to include targeted strategies as minority populations and people of color have shown greater hesitation in receiving the vaccine, even if it is free and determined safe by scientists and federal authorities. The virus has had a disproportionate impact on communities of color and minority populations, and a lack of communication to these populations may continue to enhance these disparate health outcomes.

One way to improve a communication plan by addressing racial or ethnic minority populations would be by incorporating the National Standards for Culturally and Linguistically Appropriate Services (CLAS), specifically the standards for Communication and Language Assistance:

  • Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services
  • Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing
  • Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided
  • Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area

A communication plan that considers the racial and ethnic minority populations most vulnerable to adverse health outcomes and have shown a lack of trust in the scientific community would be advisable in order to combat disproportionate negative outcomes from the COVID-19 virus in the future. 

A COVID-19 vaccine distribution plan is an important aspect of each state’s strategy to control the spread of the virus. In order to lead to effective vaccine distribution, it is vital for the plans to thoroughly address data collection, reporting, and tracking. It is also important to consider implementing a communication plan that incorporates strategies to reach racial and ethnic minority groups who might have been disproportionality impacted by COVID-19 as a way to improve your state’s health equity approach to COVID-19 vaccination efforts. By implementing these considerations, your state’s COVID-19 vaccine distribution plan could become more effective in improving the health outcomes of your population. 

Article
Two ways states can improve their COVID-19 vaccination distribution plans

Read this if you have a responsibility for acquiring and implementing victim notifications for your jurisdiction.

In the first article of this three-part series we explored the challenges and risks associated with utilizing multiple victim notification systems across your state, while the second focused on exploring what the choices are to address these challenges. In this final installment, we demystify the process of developing requirements for a victim notification system. Here are some things to address when developing requirements:

  • Considering all of your victim notification stakeholders and their specific needs
  • “Mining” requirements from your current victim notification system to ensure that your current needs are met in the future system 
  • Determining what the market can support (and what it can’t)
  • Utilizing standards to increase the likelihood that market solutions, designed based on these standards, will meet the needs of your jurisdiction 

Understanding the needs (and wants) of your stakeholder group is critical to defining a successful set of requirements that meets your specific needs. Representative stakeholders may include:

  • Victim advocacy groups (both government run and private sector)
  • Police and sheriff departments
  • Department of Corrections 
  • The courts
  • Probation department
  • Prosecutor offices
  • The victims themselves

Of course the stakeholder group in your jurisdiction may differ, and the needs of these groups will also differ. For example, victims and advocacy groups are concerned about ease of use, accuracy, and timeliness of notifications. Police and sheriff departments may be concerned about ensuring they are meeting their statutory and moral obligations to notify the victims when offenders are released from custody. 

Since these groups have varied needs, it’s important to engage them early and throughout the requirements development process. Talk to them, observe their practices, and review their current systems. It’s possible, for example, that it’s important that sheriff departments can integrate their jail management system to the replacement victim notification system and the integration creates a seamless and timeline notification process when an offender is processed out of jail and into the community. Because the Department of Corrections is designed to hold offenders for a longer period of time, the department may require that their offender management system triggers an alert to victims when pre-release planning activities begin.

Scaling victim notification systems

Utilization of victim notification systems can also include a broad spectrum; from a single jail engaging with a victim notification system vendor to provide specific notification services, to a statewide victim notification system that provides these services for the larger stakeholder group. Because of this, your requirements must reflect that “scale.” Consider the utilization of the system before developing your requirements so that you don’t over (or under) engineer the system for your jurisdiction.

As mentioned in the second article in this series, there are many victim notification system options to consider, from home-grown applications to turnkey software as a service (SaaS) services. Regardless of the path you choose, consider leveraging the victim notification system standards as defined by the Department of Justice (DOJ) Bureau of Justice Assistance (BJA SAVIN Guidelines). These guidelines and standards are terrific sources for victim notification system requirements, and can be thought-provoking as you engage your stakeholder groups. 

Though these standards are extremely useful, be sure to identify and include any jurisdiction-specific needs in your set of requirements. They may be driven by state statutes or by local policy or process. In defining your unique requirements, just ask, “Why are they important? Were they defined based on processes put in place because you don’t have a strong victim notification system, or are they critical to satisfying statute or policy?”

Stakeholder communication and engagement

Once you develop a preliminary set of requirements, it’s important to meet with the stakeholder groups to refine and prioritize the requirements. This exercise will result in a clear and concise set of requirements that are understandable by victim notification system vendors that may be responding to the resulting solicitation. When defining the requirements themselves, we find it useful to follow the guidelines from the Institute of Electrical and Electronics Engineers, Inc. (IEEE) called “IEEE Recommended Practice for Software Requirements Specifications.” According to the IEEE standard, good software and hardware requirements should be: 

  1. Correct
  2. Unambiguous
  3. Complete
  4. Consistent
  5. Ranked for importance
  6. Verifiable
  7. Modifiable
  8. Traceable

Prioritization of the requirements also helps responding vendors understand which requirements are most important to your jurisdiction. This prioritization model can also be used when scoring the vendors’ responses to the requirements once proposals have been received. 

Conclusion

In summary, it is important your victim notification system requirements reflect the needs of your stakeholders, are realistic, and clear. Vendors will be asked to respond to how they can accommodate the requirements, so using the IEEE method described above can be useful. 

Though this article doesn’t dive deeply into the development of the request for proposals (RFP) for the victim notification system, below are some actions to take to improve your chances for a successful system selection project:

  1. Define a meaningful project scope to scale the vendor market
  2. Assign a balanced evaluation committee with impartial scoring criteria
  3. Craft a structured procurement package that attracts multiple vendors
  4. Design a reasonable and achievable RFP schedule of events
  5. Reduce ambiguity and increasing clarity of RFP terms

If you have questions about your specific situation, please contact our Justice & Public Safety consulting team. We’re here to help. The BerryDunn team has developed a mature methodology for determining victim notification system requirements, and has a rich repository of requirements to start with so that you don’t need to start from scratch.
 

Article
Victim notification system requirements: It's easier (and harder) than you think

Read this if you are a state Medicaid agency (SMA) or managed care organization (MCO).

Value-based care (VBC) can help stabilize healthcare revenues during times of unexpected challenges and market volatility. Implementing or solidifying value-based payment (VBP) or purchasing arrangements between payers and providers is one pathway to stabilizing provider revenues, especially during the era of COVID-19.

On September 15, 2020, the Centers for Medicare & Medicaid Services (CMS) released a letter to state Medicaid directors (SMDs) on how states can advance VBC across healthcare systems. Earlier in 2020, the CMS Administrator indicated that value-based or capitated payments can help promote provider resiliency, allowing providers to focus on quality of care as opposed to increasing utilization for short-term reimbursement gains. 

Promoting the adoption of VBC in Medicaid managed care is a long-term strategy to create stable and predictable revenues for providers, and potentially critical to successfully react to market disruptions caused by COVID-19. Providers are encouraged or obligated to see patients to drive quality outcomes, receiving VBPs or capitation that shifts revenue streams away from traditional fee-for-service models. VBP arrangements focus on quality of care, and can promote beneficiary health while reducing total costs.

A roadmap to advancing VBP in Medicaid

As healthcare costs continue to increase, states, payers, and providers have started transitioning to VBC to reimburse services based upon particular conditions (e.g., diabetes), Episodes of Care (EOC) (e.g., pregnancy and delivery), or different population healthcare needs (e.g., immunizations and well-child visits). VBP arrangements can incentivize the delivery of healthcare innovations that prioritize care coordination and quality outcomes over volume of services rendered, and help to avoid waste and duplication of services. VBP seeks to incentivize providers based on performance, and can result in shared savings for both providers and healthcare payers.

While many states have made significant progress moving towards VBP arrangements in their Medicaid managed care programs, data from the Health Care Payment Learning and Action Network (HCP-LAN) indicates there is still opportunity for improvement. In 2018, 90% of Medicare payments were made through a VBP arrangement, yet only 34% of Medicaid payments were made through VBP.  

Through its recent guidance, CMS provides a roadmap, strategies, and alternative payment methodology frameworks for states and health plans to implement successful VBP models in collaboration with the provider community. Key considerations for successful VBP implementation include:

  • Defining level and scope of financial risk, and developing associated performance benchmarks
  • Selecting established quality metrics that incentivize provider performance without undue administrative burden
  • Encouraging multi-payer participation (e.g., Medicaid managed care, Medicare, commercial health plans) to align provider incentives across payers and delivery systems
  • Advancing Health Information Technology (HIT) capabilities across providers and delivery systems
  • Assessing health plan and provider/delivery system readiness
  • Promoting stakeholder engagement and transparency
  • Developing VBC programs focusing on sustainability

Regarding HIT and the exchange of data between providers, MCOs, and SMAs, CMS recommends states take advantage of the Advanced Planning Document (APD) process to request 90/10 funding to address technology infrastructure needs associated to help implement a robust VBC program and help ensure delivery system readiness. Facilitating data sharing and promoting real-time and reliable data transactions between payers and providers engaged in VBC is critical to measurement, monitoring, and programmatic success. Additionally, SMAs can leverage VBP arrangements to focus on areas of waste in the healthcare system, including care delivery, and care coordination. 

If you would like more information or have questions about VBC and guidance on assessing, developing or implementing changes to your managed care program, please contact us. We also offer services related to value-based payment, as detailed here. We’re here to help.

Article
Value-based care to increase provider and delivery system resiliency

Read this if you are a director or manager at a Health and Human Services agency in charge of modernizing your state's Health and Human Services systems. 

When states start to look at outdated Health and Human Services systems like Eligibility Systems or Medicaid Enterprise Systems, they spend a lot of time on strategic planning efforts and addressing technology deficiencies that set the direction for their agencies. While they pay a lot of attention to the technology aspects of the work, they often overlook others. Here are three to pay attention to: 

  1. Business process improvement
  2. Organization development
  3. Organizational change management

Including these important steps in strategic planning often improves the likelihood of an implementation of Health and Human Service systems that provide the fully intended value or benefit to the citizen they help serve. When planning major system improvements, agencies need to have the courage to ask other critical questions that, when answered, will help guarantee greater success upon implementation of modernized system.

Don’t forget, it’s not only about new technology—it’s about gaining efficiencies in your business processes, structuring your organization in a manner that supports business process improvements, and helping the people in your organization and external stakeholders accept change.  

Business process improvement 

When thinking about improving business processes, a major consideration is to identify what processes can be improved to save time and money, and deliver services to those in need faster. When organizations experience inefficiencies in their business processes, more often than not the underlying processes and systems are at fault, not the people. Determining which processes require improvement can be challenging. However, analyzing your business processes is a key factor in strategic planning, understanding the challenges in existing processes and their underlying causes, and developing solutions to eliminate or mitigate those causes are essential to business process improvement.

Once you pinpoint areas of process improvement, you can move forward with reviewing your organization, classifying needs for potential organization development, and begin developing requirements for the change your organization needs.

Organization development

An ideal organizational structure fully aligns with the mission, vision, values, goals, and strategy of an organization. One question to ask when considering the need for organization development is, “What does your organization need to look like to support your state’s to-be vision?” Answering this question can provide a roadmap that helps you achieve:

  1. Improved outcomes for vulnerable populations, such as those receiving Medicaid, TANF, SNAP, or other Health and Human Services benefits 
  2. Positive impacts on social determinants of health in the state
  3. Significant cost savings through a more leveraged workforce and consolidated offices with related fixed expenses—and turning focus to organizational change management

Organization development does not stop at reviewing an organization’s structure. It should include reviewing job design, cultural changes, training systems, team design, and human resource systems. Organizational change is inherent in organization development, which involves integration of a change management strategy. When working through organization development, consideration of the need for organizational change should be included in both resource development and as part of the cultural shift.

Organizational change management

Diverging from the norm can be an intimidating prospect for many people. Within your organization, you likely have diverse team members who have different perspectives about change. Some team members will be willing to accept change easily, some will see the positive outcomes from change, but have reservations about learning a new way of approaching their jobs, and there will be others who are completely resistant to change. 

Successful organizational change management happens by allowing team members to understand why the organization needs to change. Leaders can help staff gain this understanding by explaining the urgency for change that might include:

  • Aging technology: Outdated systems sometimes have difficulty transmitting data or completing simple automated tasks.
  • Outdated processes: “Because we’ve always done it this way” is a red flag, and a good reason to examine processes and possibly help alleviate stressors created by day-to-day tasks. It might also allow your organization to take care of some vital projects that had been neglected because before there wasn’t time to address them as a result of outdated processes taking longer than necessary.
  • Barriers to efficiency: Duplicative processes caused by lack of communication between departments within the organization, refusal to change, or lack of training can all lead to less efficiency.

To help remove stakeholder resistance to change and increase excitement (and adoption) around new initiatives, you must make constant communication and training an integral component of your strategic plan. 

Investing in business process improvement, organization development, and organizational change management will help your state obtain the intended value and benefits from technology investments and most importantly, better serve citizens in need. 

Does your organization have interest in learning more about how to help obtain the fully intended value and benefits from your technology investments? Contact our Health and Human Services consulting team to talk about how you can incorporate business process improvement, organization development, and organizational change management activities into your strategic planning efforts.

Article
People and processes: Planning health and human services IT systems modernization to improve outcomes