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No wrong door in mcdhhs md

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NO WRONG DOOR IN MCDHHS/MD

NACCHO HIT WORKSESSION

July 14, 2010

An integrated and interoperable health and human services care delivery system!


Today s agenda

CONTEXT ABOUT MONTGOMERY COUNTY

WHY THIS IS IMPORTANT

OUR SERVICE INTEGRATION EFFORTS

3 AREAS NEEDING INPUT:

ELIGIBILITY

DATA SHARING

FUNDING FLEXIBILITY

HEALTH CARE REFORM AND THE OPPORTUNITY BEFORE US

NEXT STEPS

Today’s agenda


Information about our county
INFORMATION ABOUT OUR COUNTY:

  • 1 MILLION RESIDENTS

  • 29% FOREIGN BORN

  • 44% ETHNIC MINORITY

  • 40,000 OUT OF 140,000 CHILDREN IN THE PUBLIC SCHOOL SYSTEM ON FARMS

  • OVER 32,000 UNINSURED ADULTS, CHILDREN AND WOMEN SERVED THROUGH HEALTH CARE SERVICES

  • SERVED 70,000 HOUSEHOLDS IN FY09 AND 39,000 USED MORE THAN TWO SERVICES FROM THE DEPARTMENT

  • A STAFF OF 1500 WITH OVER 80 PROGRAMS

  • TANF/SNAP, MA AND EA CASELOAD GROWING – APPLICATION VOLUME GREW BY ALMOST 42%

  • 6 ZIPCODES OF EXTREME NEED – POVERTY ON THE RISE


Interoptimability drivers consumer centric family focused technology enabled
InterOptimability Drivers: Consumer-centric, Family Focused, Technology Enabled

TANF

Food Stamps

Health

Child Welfare

Juvenile Justice

Mental Health

Education

Early Learning

Substance Abuse


How is dhhs organized
How is DHHS Organized?

  • In 1996, 4 County departments became one entity.

  • Objective: Integrated, coordinated and comprehensive service delivery.


How is dhhs organized1
How is DHHS Organized?

  • One Director

  • Centralized administrative functions

  • Moving towards single client record supported by an interoperable database

  • Uniform intake form to identify all service needs

  • Designated entire HHS entity as HIPAA covered – including social service and income support programs.


Outcomes to be achieved
Outcomes to be achieved

Earlier comprehensive identification of individual/family needs

Quicker delivery of comprehensive and integrated services – would reflect a public and private partnership effort

Individuals/families achieving outcomes identified in their respective case plans

Improved cooperation and collaborationamong staff of the public and private partners

Improved client functioning – place based approach to care delivery where possible

Improved client satisfaction

Reduction in length of stay in services/treatment/care

Reduction in recidivism

Increased efficiencies – an ROI/SROI metric


Montgomery County Department of Health and Human Services

Services andMD State Department Connections by Service Type

  • Aging and Disability Services

  • DOA, DOD, DHR, DHMH, DVA

  • Behavioral Health and Crisis Services

  • DHMH, GOC, DHR, DPSC

  • Children, Youth and Family Services

  • DHR, GOC, GOCCP, DJS, MSDE

  • Public Health Services

  • DHMH, MSDE, DHR

  • Special Needs Housing

  • DHR, DHCD, DHMH

  • Community Outreach | All Departments

PHS

CYF

BHCS

SNH

Department of Health and Human Services

ADS


Federal agencies whose regulations and funding strategies impact county services
FEDERAL AGENCIES WHOSE REGULATIONS AND FUNDING STRATEGIES IMPACT COUNTY SERVICES

  • ACF

  • CMS

  • SAMHSA

  • HRSA

  • CDC

  • ONCHIT

  • HUD

  • NIH

  • VA

  • OFFICE ON AGING

  • HOMELAND SECURITY

  • TITLE XIX

  • TITLE IVE

  • CSBG

  • CDBG

  • MENTAL HEALTH BLOCK GRANT

  • FEDERAL and STATE GRANTS

  • 40% DHHS BUDGET IS FROM STATE AND FEDERAL SOURCES

  • 60% OF DHHS BUDGET IS FROM COUNTY SOURCES


Eco map of dhhs state federal agencies

DHHS IMPACT COUNTY SERVICES

CYF

PHS

ADS

SNH

BHCS

ECO Map of DHHS, State & Federal Agencies

Federal:

ACF

ONCHIT

HRSA

SAMHSA

CMS

HUD

State:

GOC

MSDE

DHR

DHMH

DOA

County:

Montgomery County

DTS

Enterprise infrastructure

Policies

Security

CIO support and outreach


How is DHHS Organized? IMPACT COUNTY SERVICES

  • One Director

  • Centralized Administrative Functions

  • Moving towards single client record supported by an interoperable database

  • Uniform intake form to identify all service needs

  • Designated entire HHS entity as HIPAA covered — including social service and income support programs


\ IMPACT COUNTY SERVICES

HHS Team Member

INTEGRATED SERVICE TEAM

Customer TeamMember

Community Partner Team Member

Team Member

Labor Management Partnership

CHIP-Community Health Improvement Process

Information Technology

QSR-Quality Service Review

One HHS Lane

Equity

Trust

Customer Service

Accountability

Children Youth and Family Services

Community Outreach

Aging and Disability Services

Special Needs Housing

Behavioral Health and Crisis Services

Public HealthServices

NO WRONG DOOR--ONE HHS


Timeline IMPACT COUNTY SERVICES

Opportunities emerge from Stewards of Change convening at Yale with federal partners; built our Beacon proposal with a clear vision for a unified Electronic Health and Human Services Record. Change Management and small test of change

Successor to the Director with the integrated vision takes office. She hires APHSA to help with integration. More conversations, focus groups and activities occur. Work stops though at point that deepening integration runs into workforce resistance

Integrated Department created by State Legislative action from Four local departments. Legislation also creates a single entity for purposes of HIPAA

Co-location deepens partnership and coordinated and integrated business practices

I take the job and believe that the County Executive has given a mandate to further integrate the department. Assess activities and accomplishments to date and begin to build on past work. Get grant from Casey Family Programs at the start of December 2007. Grant commences January 2008. Conduct assessment and vision map

Work continues with many outreach opportunities with State and Federal entities


Scenario One IMPACT COUNTY SERVICES

Homeless diabetic woman with Schizophrenia

Three episodes of hospitalization in last 12 months

Hard for her to regularly take medications

Hard for her to have nutritious meals

Services offeded by DHHS to address these complex needs

Homeless Program

Mental Health Treatment

Montgomery Cares

Housing Stabilization Services


Scenario Two IMPACT COUNTY SERVICES

  • 15 Year old Latino Male

  • Referred to Crisis Center after school suspension

  • Indicates to counselor his desire to commit suicide

  • Mother receiving mental health services

  • Father believes the family troubles are a private matter

  • Father is strict and bruises on client may indicate abuse

    Services Offered by DHHS for this family

  • High School Wellness Center

  • Mental health services for child, mother and family unit

  • Anger management

  • Culturally competent service delivery

  • Meaningful after school time activities


Scenario Three IMPACT COUNTY SERVICES

42-year old non-English speaking recent immigrant

Tests by DHHS indicate she has tuberculosis

Appears to be some domestic violence at home

Has two children ages 2 and 6 – and is pregnant again

2 year old needs child care, family can not afford it

6 year old has special needs and housing is unstable

Services offered by DHHS to address these complex needs

Public Health TB Clinic

Child Care Services

Maternity Services

Income Support Services

LEP Services

Domestic Violence Service via Abused Persons Program

Adult Mental Health Services

Housing Stabilization Services

Education through Public School System


Scenario Four IMPACT COUNTY SERVICES

  • 90 year old woman identified as hoarder

  • 21 year old great-grand-daughter moved in

  • Great grand-daughter has two preschool aged children

  • Great grand-daughter a former drug user is abusing again

  • Department of Housing believes house not livable

    Services offered by DHHS to address these complex needs

  • Adult Protective Services

  • Child Welfare Services

  • Early Learning and Child Care

  • Special Needs Housing Services

  • In-home Aide Services

  • Income Supports

  • Substance Abuse Treatment

  • Medical and Primary Care



She will be greeted and provided the face sheet IMPACT COUNTY SERVICES

Service Request

Form

Needs

Questionnaire

Check in screen


She will fill out service request form and needs questionnaire

Client identified

needs

Basic demographic

information


Triage worker interviews her questionnaire

Confirms needs and schedules appointments

or provides referrals


She leaves session with appointments for follow-up assessments

Appointment and referral letters in six languages


TCA assessments

Y

System provided

feedback regarding

assessments outcomes

HIV-Aids

Y

Housing

N

Child care

Y

Care coordinator gets feedback from program assessments

If client meets criteria coordinator calls for a service team


Service Team established and coordination with client begins – Virtual or in person with client as core participant – self directed care as much as possible

Better outcomes with coordinated care


Tools we have developed
TOOLS WE HAVE DEVELOPED – Virtual or in person with client as core participant – self directed care as much as possible

  • Universal Screening tool

  • Face Sheet

  • Confidentiality Policy

  • Practice Model

  • Scheduling tool

  • Customer service protocols

  • Qualitative Evaluation tools

  • Enterprise tools

    • Oracle ERP

    • Seibel CRM


Microsoft Architectural Vision – Virtual or in person with client as core participant – self directed care as much as possible


Dhhs change vision 2015
DHHS Change Vision 2015 – Virtual or in person with client as core participant – self directed care as much as possible


Areas of Practice – Virtual or in person with client as core participant – self directed care as much as possible

Intake and Eligibility — Opportunity with Health Reform

Outreach and Navigation — Budget related opportunities

Practice Model Re-Design with Stratified Case Types — Define levels of intervention and train to expectations and the role of a family advocate

Accountability — What does this look like

Change Management

Fiscal Year 2012 Budget


Feedback from our work to date
Feedback from our work to date: – Virtual or in person with client as core participant – self directed care as much as possible

  • If we identify redundancies will they translate into efficiencies that will save money? And if so what happens?

  • Eligibility – even if you get it right without the right outcomes the eligibility intervention could be misplaced

  • Capacity of current staff and their willingness to learn – a huge challenge

  • Assumption as well that if you get clients to the right places then outcomes will be achieved – how would you evaluate this assumption and what is the basis for it and why do we believe that there is a high probability of success with this approach

  • Technology – the what, the why and the how and will it streamline and improve process and outcomes?


The Policy Conversation – Virtual or in person with client as core participant – self directed care as much as possible

  • Integrated Eligibility

  • Blending and Braiding Funds

  • Confidentiality

  • Evidenced Based Practice

  • Interoperability

    Place Based Initiatives in the Context of:

  • Health Reform

  • TANF Reauthorization

  • Medicaid Waivers

  • Home and Community-based Services

  • Universal Pre-K

  • Employment Strategies

  • Housing First and 10 year plans to end chronic Homelessness

  • New American Strategies

  • Equity in Service Delivery

  • Role of Technology in Supporting Integrated Practice


Questions – Virtual or in person with client as core participant – self directed care as much as possibleandDiscussion


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