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How to identify and prepare change management coaches

04.04.19

If you’ve been tasked with leading a high-impact project for your organization, you may find managing the scope, budget and schedule is not enough to ensure project success—especially when you encounter resistance to change. When embarking on large-scale change projects spanning people, processes and technology, appointing staff as “coaches” to help support stakeholders through the change—and to manage resistance to the change—can help increase adoption and buy-in for a new way of doing things.

The first step is to identify candidates for the coaching role. These candidates are often supervisory staff who have credibility in the organization—whether as a subject matter expert, through internal leadership, or from having a history of client satisfaction. Next, you need a work plan to orient them to this role. One critical component is making sure the coaches themselves understand what the change means for their role, and have fully committed before asking them to coach others. They may exhibit initial resistance to the change you will need to manage before they can be effective coaches. According to research done by Prosci®, a leading change management research organization, some of the most common reasons for supervisor resistance in large-scale change projects are:

  • Lack of awareness about and involvement in the change
  • Loss of control or negative impact on job role
  • Increased work load (i.e., lack of time)
  • Culture of change resistance and past failures
  • Impact to their team

You should anticipate encountering these and other types of resistance from staff while preparing them to be coaches. Once coaches buy into the change, they will need ongoing support and guidance to fulfill their role. This support will vary by individual, but may be correlated to what managerial skills they already possess, or don’t. How can you focus on developing coaching skills among your staff for purposes of the project? Prosci® recommends a successful change coach take on the following roles:

  • Communicator—communicate with direct reports about the change
  • Liaison—engage and liaise with the project team
  • Advocate—advocate and champion the change
  • Resistance manager—identify and manage resistance
  • Coach—coach employees through the change

One of the initial tasks for your coaches will be to assess the existing level of change resistance and evaluate what resistance you may encounter. Prosci® identifies three types of resistance management work for your coaches to begin engaging in as they meet with their employees about the change:

  • Resistance prevention―by providing engagement opportunities for stakeholders throughout the project, building awareness about the change early on, and reinforcing executive-level support, coaches can often head off expected resistance.
  • Proactive resistance management―this approach requires coaches to anticipate the needs and understand the characteristics of their staff, and assess how they might react to change in light of these attributes. Coaches can then plan for likely forms of resistance in advance, with a structured mitigation approach.
  • Reactive resistance management―this focuses on resistance that has not been mitigated with the previous two types of resistance management, but instead persists or endures for an extended amount of time. This type of management may require more analysis and planning, particularly as the project nears its completion date.

Do you have candidates in your organization who may need support transitioning into coaching roles? Do you anticipate change resistance among your stakeholders? Contact us and we can help you develop a plan to address your specific challenges.

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Have you ever had a project derail at the last minute, or discovered that a project’s return on investment did not meet projections? These types of issues happen in the final stages of a project, often as a result of incorrect or incomplete stakeholder identification. Conversely, performing due diligence at the beginning of a project to identify stakeholders, (and updating your stakeholder register throughout the project), can minimize the risks of incorrect scope, excessive change orders, and user resistance. Identify stakeholders early to increase your chances of delivering a better result.

What Is a Stakeholder?

In some projects, the term “stakeholder” only describes those individuals with visible and formalized responsibilities on the core project team. The fifth edition of the Project Management Institute’s (PMI) Project Management Body of Knowledge (PMBOK) more accurately defines it as “an individual, group, or organization who may affect, be affected by or perceive itself to be affected by a decision, activity, or outcome of a project” (italics added for emphasis).

Commonly Overlooked Stakeholders

Stakeholders often overlooked include those not involved in the core project team, but who nonetheless play an important role in achieving project success throughout the organization. They include: regulatory agencies, auditors, IT staff outside of the core project team, internal customers, citizens, and staff. Your Project Management Team should plan ahead and identify the appropriate time and approach to include these groups.

Guidelines for Identifying Stakeholders

Identifying stakeholders is an iterative process that incorporates feedback from multiple levels of the project’s governance structure, and identifies stakeholders. When our team works on larger projects, for example an ERP system selection and implementation project, we recommend project leadership identify an Executive Sponsor, who in turn selects an Executive Steering Committee to provide executive-level support to the project by committing resources and weighing in on escalated decisions.

The Executive Sponsor chooses the Project Manager and Project Management Team. Because the Project Management Team works with the Project Manager to accomplish project tasks and reach project decisions, this team assigns staff with appropriate knowledge and other characteristics to be Functional Area Leads (FALs). FALs play an important role in selecting Subject Matter Experts (SMEs) for their respective functional areas, as FALs are typically already leading day-to-day operations for the area they will represent. These leads often have a more detailed knowledge of SME resource availability than those in the project’s executive roles, and can identify the extent of each SME’s areas of strength. Engaging FALs in this exercise can enhance buy-in and ownership of the project, strengthen the quality of the project team, and address nuances where the project structure and organization’s structure do not necessarily align.  

We recommend you create a stakeholder register to conduct a thorough inventory of the stakeholder groups involved in (or impacted by) the project’s work. Conducting this exercise identifies relevant characteristics (role in the organization, on the project, supervisory, and communication responsibilities) that can help the Project Management Team make decisions related to issue management activities, risk mitigation, communications strategies, and change management planning. Your Executive Sponsor and Project Management Team should create this stakeholder register early, and update it frequently, as stakeholders often change during a project. Taking multiple stakeholder inventories throughout the project helps set the project up for greater success, less user resistance, and better-informed decision-making.

Do you have questions about our guidelines for identifying stakeholders? Unsure about the best approach for communicating with stakeholders once identified? We can help you get started.

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We're all in this together: How to identify stakeholders and achieve project success

Here’s a challenge for you: Can you identify the number one predictor of project success?


According to Prosci, the leading change-management research organization, the answer is the project sponsor. In fact, project sponsor has topped Prosci’s biannual Best Practices in Change Management benchmark study as the number one predictor of success since 1998. Yet it’s one thing to simply name a project sponsor; it’s another to have the sponsor actively engaged in the project.

In order to achieve project success, a project sponsor must play an active and visible role, and should be prepared to assume the following responsibilities — what we call the Four C's of Project Sponsorship:

Commit resources. The role of project sponsor is best filled by an executive who has access to, and authority over, human and financial resources dedicated to the project. As organizations search for ways to “do more with less,” projects and daily operations often compete for the same resources. Because resource shortages can severely impact a project’s scope, schedule, and budget, your project sponsor should have the authority necessary to communicate a project’s priority and commit the necessary resources accordingly.

Communicate the project’s strategic purpose. Research has repeatedly shown that the project sponsor is the preferred sender of communications about the project’s strategic purpose. Indeed, the project sponsor should communicate with each stakeholder about the project’s goals and how these goals align with the organization’s strategic vision. Setting this expectation at the organizational level can provide answers to the age-old question, “What’s in it for me?” and help inform future conversations between supervisors and direct reports about the project’s impact on individual job responsibilities.

Conscript other leaders as change champions. To demonstrate support for the change across the organization, your project sponsor can empower leaders, including executives and mid-level managers, to communicate their support for the change. This support:

  • Allows the project’s messaging to reach a broader audience. 
  • Demonstrates endorsement of the change by other leaders, which enhances credibility and positive perceptions of their commitment to the organization’s success. 
  • Enables the project team to collect more feedback from different perspectives as these change champions liaise to relay information from end users back to the project team.

Command enforcement of project changes. This can be the most challenging aspect of a project sponsor’s role. Resistance is a natural reaction to change; it is present to some degree on nearly every project. Despite the most thorough efforts to mitigate resistance, certain users may choose to resist changes brought about by the project, finding workarounds or reverting to previous business processes. In these instances, it is important that your project sponsor leads and commands the effort to communicate how and why the changes should be adhered to, provide any necessary remedial training, then follow through with corrective action if needed. Although this may be a challenging task, it can boost the credibility of the project and the project sponsor, and help realize the project’s return on investment.

Mastering the Four C's of Project Sponsorship will allow project sponsors to more successfully take on other important responsibilities, such as providing support and encouragement to the team, giving direction on escalated decisions, granting security to allow changes despite initial decreases in productivity or returns in investment, and clearing barriers to project success.

When the Fours C's of Project Sponsorship are executed from the project’s outset, the value of a project sponsor is substantially increased. Our Local Practice Area has experience in advising clients on how to add or restructure the role of project sponsor — even in the midst of the most challenging projects — to leverage the benefits of this role for the project’s success. Take charge and reach out to us. 

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The four C's of project sponsorship

Read this if you are at a state Medicaid agency.

In early March 2021, the Biden administration passed the American Rescue Plan of 2021 (H.R.1319) with the primary goal of providing emergency supplemental funding for the ongoing response to the COVID-19 pandemic. Importantly, in addition to vaccines, unemployment, and other critical developments, the plan provided a number of Medicaid opportunities for states that expand eligibility and coverage, including the following:

  • Funding increases—a new incentive to expand Medicaid eligibility through a two-year, 5% increase in the state’s base Federal Medical Assistance Percentage (FMAP).
  • Coverage—the option to extend Medicaid coverage for women up to 12 months postpartum and with full Medicaid benefits.
  • System transformation—a one-year, time-limited FMAP increase of 7.35% for states to make improvements and rate increases to Medicaid home-and-community-based services (HCBS).
  • Waiver opportunities—a new incentive (enhanced FMAP for five years through bundled payments) for state Medicaid programs’ mobile crisis intervention services for individuals experiencing a mental health or substance use disorder crisis via a state plan amendment (SPA) or 1115 waiver demonstration.

What’s next?

It seems likely that the American Rescue Plan’s Medicaid provisions signal upcoming changes and opportunities for healthcare transformation for state Medicaid programs. The administration has consistently articulated a desire to “strengthen Medicaid” and while additional legislative actions are likely coming, there are also legislative limitations that may limit or curtail the type of broad reform we’ve seen in the past. As a result, it’s likely that the vehicle the administration will use to disseminate healthcare transformation in Medicaid are administrative actions such as executive orders, regulations, and administrative rule-making through the Centers for Medicaid and Medicare Services (CMS). This is likely to result in opportunities in two areas: waivers and the funding incentives to adopt new policies.

Waivers

The best tool the administration has is also one of its oldest: demonstration waivers. As noted above, the American Rescue Plan of 2021 includes the option for states to take advantage of waivers (as well as SPAs) to exercise new flexibilities. Unlike the Affordable Care Act (ACA) which was rolled out nationally, it’s likely the administration will seek out volunteer states that are innovative and willing to collaborate. The result will be more experimentation, more tailoring of policy, and a more gradual—even organic—approach to transformation.

In the short term for state Medicaid agencies this will mean a rebalancing of pending waivers and guidance. Prior policy priorities like work requirements and aggregate enrollment caps may be revised through the regulatory process in coming months or years. It is anticipated that CMS will execute a vision with a renewed focus on expanding services or coverage, much like those seen with the opportunities already presented under the American Rescue Plan.

Funding

Budget is a consistent challenge states have faced over the past year resulting largely from the COVID-19 pandemic. Even with recent aid to states and local governments there is likely to be uncertainty for the immediate future. The American Rescue Plan, like the ACA before it, finds mechanisms and incentives to raise the FMAP for states and potentially ease the state’s portion of Medicaid funding, particularly in the short term. Fitting with the theme of states as active partners, going forward there will likely be opportunities to maintain some type of increase to the FMAP. Beyond direct funding, opportunities like the recent CMS guidance on social determinants of heath, value-based payments, and models like the Community Health Access and Rural Transformation (CHART) hint at a continued focus on payment reform. States looking to lower costs and/or increase the quality of care will have ample opportunities to undertake projects in these areas.

State considerations

Regardless of next steps, states should expect both compliance needs and opportunities. States should begin to consider strategy, resources, and their priorities now. This process begins with knowing your agency’s strengths and potential limitations. Once states set their policy priorities and are ready to get underway with the business of transformation, time and resource constraints will likely be common barriers. Having a mature, flexible, and capable project management office, the right subject matter knowledge, and prequalified vendor lists to assist with Medicaid transformation can go a long way towards addressing time and resource constraints—making state Medicaid agencies agile in their response to the unique opportunities in the coming years.

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What's past is prologue: How the American Rescue Plan shows us what's next for Medicaid 

Read this if you’re considering (or in the middle of) an initiative that involves multiple Health and Human Services (HHS) programs or agencies.

During times of tight program budgets and rising need, the chance to collaborate with sister HHS agencies often presents a unique opportunity to do more with less. However, as you might find, these initiatives have their own challenges ranging from the minor (e.g., different program vocabulary) to major considerations (e.g., state and federal funding streams).

While interagency initiatives are worthwhile—usually aiming to reduce silos between HHS programs and better support citizens and staff—they can quickly grow complicated. Whether you’re just starting to think about your next interagency initiative or you’re halfway through, asking the right questions is half the battle. Answering those questions, of course, is the other—and more time-consuming—half!

In our team’s work with states on interagency initiatives, we have found it helpful to focus planning on the following four areas to minimize implementation timelines and maximize stakeholder support:

  • Policy: The sources, both internal and external, that govern who is covered by programs, what services are covered, how services are reimbursed, and how the program is administered
  • Funding: How a program is financed, including cost allocation methodologies, limitations on use of funds, and reporting mechanisms
  • Systems: The technical infrastructure that supports program operations
  • Operations: The staff and physical facilities that make every program possible, including staff resources such as training

Here are some questions you can ask to make the best use of available time, funding, and interagency relationships:

  • What is the goal? Do other departments or units have an aligning goal? Who do you know at those departments or units who could direct you to the best point of contact, the status of the other department or unit’s goal, and the current environment for change? Perhaps you can create a cross-unit team with the other unit(s), resulting in more resources to go around and stronger cross-unit relationships. If the other unit either isn’t ready or has already implemented its change, learning about the unit’s barriers or lessons learned will inform your efforts.
  • What does your governance model look like? Do you have one decision-maker or a consensus-builder leading a team? How does your governance model incorporate the right people from across all agencies so they have a voice? If the process is collaborative, can an oversight entity play a role in resolving disagreements or bottlenecks? Without a governance model, your team might be composed of subject matter experts (SMEs) who feel they do not have authority to make decisions, and the project could stall. On the other hand, if you only have leadership positions on the team without SME representation, the project plan might miss critical factors. Having the right people at the table—with defined lines of expertise, authority, and accountability—increases your chances of success.
  • Which federal partners are involved, who are the points of contact, and how open are they to this change? In addition to providing necessary approvals that could lead to funding, federal partners might offer lessons learned from other states, flexibilities for consideration, or even a pilot project to explore an initiative with you and your state partners. 
  • How will this initiative be funded? If more than one funding stream is available—for example, federal financial participation, grant dollars, state dollars—can (and should) all funding streams be utilized? What requirements, such as permissible use of funds and reporting, do you need to meet? Are these requirements truly required, or just how things have always been done? Some federal matches are higher than others, and some federal dollars can be combined while others must remain separate/mutually exclusive to be reimbursed. One approach for using multiple sources of funding is “braiding”—separate strands that, together, form a stronger strand—versus “blending,” which combines all sources into one pot of funding.
  • What systems are involved? After securing funding, system changes can be the largest barrier to a timely and effective interagency initiative. Many state agencies are already undertaking major system changes—and/or data quality and governance initiatives—which can be an advantage or disadvantage. To turn this into an advantage, consider how to proactively sync your initiative with the system or data initiative’s timing and scope.
     
    • When and how will you engage technical staff—state, vendor, or both—in the discussion?
    • Do these systems already exchange data? Are they modernized or legacy systems? 
    • Do you need to consult legal counsel regarding permissible data-sharing? 
    • Do your program(s)/agencies have a common data governance structure, or will that need to be built? 
    • What is the level of effort for system changes? Would your initiative conflict with other technical changes in the queue, and if so, how do you weigh priority with impacts to time and budget?
  • What policies and procedures will be impacted, both public-facing and internally? Are there differences in terminology that need to be resolved so everyone is speaking the same language? For example, the word “case” can mean something different for Medicaid business staff, child welfare staff, and technical staff.
  • Will this initiative result in fewer staff as roles are streamlined, or more staff if adding a new function or additional complexity? How will this be communicated and approved if necessary? While it’s critical to form a governance model and bring the right people to the table, it’s also imperative to consider long-term stakeholder structure, with an eye toward hiring new positions if needed and managing potential resistance in existing staff. For the project to have lasting impact, the project team must transition to a trained operations team and an ongoing governance model.

Ultimately, this checklist of considerations—goal-setting, decision-making, accountability, federal support, funding, systems, policies and procedures, and staffing—creates a blueprint for working across programs and funding streams to improve services, streamline processes, and better coordinate care.

For more information about interagency coordination, stay with us as we post more lessons learned on the following topics in the coming months: interagency policy, interagency funding, interagency systems, and interagency operations.
 

Article
Coordinating initiatives across state HHS: Questions to ask

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.
 

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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.

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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.

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

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. In this article we will explore what the choices are to address these challenges. 

System elements to consider

Many jurisdictions are under the impression that there are only one or two choices for victim notification systems. Though there are certainly market leaders in this space, you should select a system model that best meets your jurisdiction’s profile. The profile may include some of these elements:

  • Risk aversion (i.e., How risk averse is your organization regarding system implementations?)
  • Budget (i.e., How will the initial project be funded? Does your jurisdiction prefer an annual subscription model, or a traditional perpetual license with annual maintenance and support fees?)
  • Staff (Who do you need to implement and maintain the operational system?)
  • Time (i.e., Are you already out of compliance with state statutes?)
  • Hosting environment (i.e., Do you want to host in the cloud or on premise?)
  • Victim notification reach (i.e., state-wide, single jurisdiction, multiple justice partners)
  • Victim notification policy and statute complexity
  • Data ownership (i.e., To what degree does your jurisdiction enable the selling of victim notification data outside of the jurisdiction?)

Victim notification solutions range from hosted commercial off the shelf (COTS) solutions, which are typically least expensive; to custom solutions developed to address jurisdiction-specific needs. The latter tend to be more expensive, riskier than turnkey solutions, and take longer to operationalize. However, if your jurisdiction has unique requirements for victim notification, this may be a viable option. Unless you plan to engage the development vendor in a long-term contract for maintenance of this type of system, you must consider the impact on your existing IT staff. “Platform” solutions are a hybrid of COTS and custom development. With these solutions, there is typically a platform (i.e., Customer Relationship Management or CRM) on which the victim notification system is developed. Using a platform de-risks the development of the application’s architecture, may be a slightly less costly approach, and may simplify the maintenance of a system that is addressing unique requirements.

You may also already have licenses for victim notification capabilities, and not even realize it. Some offender management systems (OMS), jail management systems (JMS), and even prosecution systems (that support victim advocacy functions) may have built-in victim notification functionality included for the licensing price you are currently paying, or may include the option to purchase an add-on module. 

Advantages of using victim notification capabilities packaged with an existing system may include:

  • Lower acquisition and maintenance costs
  • Tighter integration with the OMS, JMS, or prosecution system may result in more seamless utilization of offender and victim data
  • You have a single contract, with a single vendor, reducing contract management overhead

A likely disadvantage, however, is the victim notification functionality may not be a robust as a point solution, or custom-built system. Additionally, if the “reach” of the JMS is a single county, then victim notification capabilities built into your JMS may not suffice for statewide use. However, if the built-in functionality meets your needs, then this is certainly a viable path to consider.

As mentioned in the first article, regardless of your approach the integration between your victim notification system and the JMS, OMS, prosecution system, and court system is critical to reducing redundancy and increasing the timeliness with which both offender and victim data is entered into the victim notification system―and used to trigger the notifications themselves.

Determining the best option for your victim notification system

So how do you determine which choice is best for your jurisdiction? The first step is to determine your jurisdiction’s risk profile versus the need to for jurisdiction-specific functionality. 

Mature market-based solutions are typically less risky to implement, since multiple jurisdictions are likely successfully using them to support their victim notification operations. However, these solutions may not be customizable or flexible enough to address your specific needs. 

“Build” models (using platform solutions or other application development models) tend to be a bit more risky (as many “from scratch” development projects can be); however these are more likely to address your specific needs. Here are a few questions that you should ask before making a determination between a COTS solution and a custom-build:

  1. Do we really have jurisdiction-specific victim notification needs?
  2. Can a COTS solution meet the statutes and policies in our jurisdiction?
  3. How risk-averse is our jurisdiction?
  4. Do we have time to develop a customized solution?
  5. Do we have the talent and capacity to maintain a custom solution?

Budget considerations

The next step is to determine your budget. We recommend you assess a budget over a 10-year total cost of ownership. The cost of a traditional, perpetual license-based COTS solution, including initial acquisition and implementation, will be higher in the first few years of use, but the ongoing annual fees will be lower. The cost of a custom-build solution will be even higher in the first few years, but annual maintenance should drop off dramatically. The cost of a subscription-based COTS solution will be relative even year over year. However, if you model these costs over 10 years, you will have a reasonable sense for how these costs trend (i.e., the cost of a subscription-based model will likely be higher over 10 years than the perpetual license model). 

The other consideration is how you plan to fund the system. If there are capital funds in the budget for initial acquisition and implementation, this may benefit the perpetual license model more than the subscription-based model. Regardless of the funding approach, you will likely be using the selected victim notification method for a significant period of time, so don’t settle.

Finally, determine how to acquire the system (or systems integration vendor that will help you develop the system), which is the subject of the third article in our series.

If you have questions about your specific situation, please contact our Justice & Public Safety team. We’re here to help. To learn more about other choices in victim notification procedures and systems, stay tuned for our third article in this series where we explore the process (and pitfalls) of procuring a statewide victim notification system.

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Victim notification systems: What choice do you have?