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Integration and Interoperability Across Public Health, Human Services, and Clinical Systems. Listen only mode This webinar will be recorded and available on NACCHO’s website The slides will also be available for download Please complete the evaluation when you receive the link

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Presentation Transcript

Listen only mode

  • This webinar will be recorded and available on NACCHO’s website
  • The slides will also be available for download
  • Please complete the evaluation when you receive the link
  • Type your questions in the box as we go
outline of webinar
Outline of Webinar
  • Goal for today
  • Daniel Stein - Stewards of Change
  • Uma Ahluwalia – Montgomery County Department of Health and Human Services (MD)
  • Questions
goal of webinar
Goal of Webinar
  • Highlight the collaborative work by Montgomery County Department of Health and Human Services and Stewards of Change on achieving a seamless integration across health and human services

NACCHO Webinar

May 3rd, 2012

stewards of change mission
Stewards of Change Mission

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

state view silo d architectures funding services
State View: Silo’d Architectures, Funding, Services



Public Health



Children, Adults & Families

Medical Assistance Programs

Addictions & Mental Health

Rich Howard – CIO Oregon DHS


Consumer Centric

Children in Foster Care






context where we are today
Context: Where We Are Today
  • Today’s Health, Education, Human Services Systems and Justice program generally operate in silos
  • Resulting in:
    • Separate and unconnected programs
    • Categorical funding
    • Separate and redundant systems and infrastructure
    • Transaction orientation vs outcomes
  • System silos are still the norm although that has begun to change
can silos be connected
Can Silos Be Connected?

“Interoperability” Can Enable the Process

human services 2 0 core principle
Human Services 2.0 - Core Principle

L > C

Learning Must Be Greater Than or Equal To the Rate of Change Just To Keep Pace… No Less To Provide Leadership and Lead Change


Human Services 2.0

A Conceptual Architecture

soc theory of change
SOC Theory of Change

Policy – The principles or rules that guide decisions by which human services organizations define how they will achieve desired outcomes across the range of programs, activities and disciplines.

Structure – The way public and private human services systems design, organize and implement work processes to achieve policy and practice goals.

Practice – “The way public and private human services organizations deliver services and care, monitor and report results and achieve intended outcomes


A Conceptual Architecture

“Human Services 2.0”

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



InterOptimability Drivers
















A Comprehensive Process

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


the interoptimability process
The InterOptimability Process
  • Orientation to Human Services 2.0
  • Create ‘To-Be’ Change Vision Landscape & Roadmap
  • Conduct ‘As Is’ Business Process Review
  • Assess ‘As Is’ Information Technology
  • Evaluate Organizational Readiness
  • Perform Gap Analysis
  • Build ‘To-Be’ Business Process Framework
  • Develop ‘To-Be’ Information Technology Solution
  • Synthesize Learning, Develop Recommendations and Action Plans
current engagements
Current Engagements
  • Administration for Children and Families/HHS
    • HS 2.0 Training
    • Interoperability Toolkit
    • Confidentiality Toolkit
    • National Human Services Interoperability Architecture (NHSIA)
    • National Information Exchange Model (NIEM)
  • California Information Sharing Environment
    • CA Department of Social Services
    • CA Department of Health and Human Services
    • The Judiciary (Blue Ribbon Council)
  • Electronic Care Record For Children in Foster Care and the Judiciary (and other populations)
    • EHR + PHR
  • 7th Annual Stewards of Change Symposium
  • Collaboration with the Johns Hopkins Systems Institute


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

Integration and Interoperability within the Health and Human Services Enterprise


Thursday| May 3, 2012 | 1:00p

Uma S. Ahluwalia, Director

Department of Health and Human Services | Rockville, Maryland


Most populous county in Maryland

Immigration was the largest component of population change since 2000

Montgomery County: A Changing Picture

Population Growth (K)

Source: U.S. Census Bureau


Montgomery County Diversity: Census 2010

“Minorities” are more than half of Montgomery’s population

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

Caseloads have grown every month since FY07 and as of June 30, 2011, are at a high of:

    • Temporary Cash Assistance (TCA): 1,059 (53% increase)
    • Food Stamps (FS): 25,554 (126% increase); and,
    • Medicaid (MA): 45,104 (54% increase)

Public Assistance Needs


Heat, Housing and Health Needs

Home energy assistance applications remained steady in FY11 with 12,356 applications received compared to 12,315 in FY10. Since FY08, applications for assistance have increased 37%

Requests for Emergency Housing Assistance totaled 7,978 in FY11, 36% higher than in FY08

Patient load in Montgomery Cares for FY11 was 26,877 patients, a small (2.3%) increase over 2010.  For FY12, patient load is projected at 28,500, a 6% increase over FY11


Federal Agencies Whose Regulations and Funding Strategies Impact County Services

  • Title XIX
  • Title IVE
  • CSBG
  • CDBG
  • Mental Health Block Grant
  • Federal and State Grants
  • 40% of DHHS Budget is from State and Federal Sources
  • 60% of DHHS Budget is from County Sources
  • ACF
  • CMS
  • HRSA
  • CDC
  • HUD
  • NIH
  • Veterans Administration
  • Office on Aging
  • Homeland Security
  • Department of Agriculture

Montgomery County Department of Health and Human Services

Services and MARYLAND State Department Connections by Service Type

  • Aging and Disability Services
  • Behavioral Health and Crisis Services
  • Children, Youth and Family Services
  • Public Health Services
  • Special Needs Housing
  • Community Outreach | All Departments







of Health and Human 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

WIC Services

Income Support Services

Workforce services

LEP Services

Domestic Violence Service via Abused Persons Program

Adult Mental Health Services

Housing Stabilization Services

Education through Public School System

Scenario One


90-year old woman identified as hoarder

  • 21-year old great-grand-daughter moved in
  • Great grand-daughter has two preschool aged children
  • Great grand-daughter a former drug user is abusing again
  • Department of Housing believes house not livable

Services offered by DHHS to address these complex needs

  • Adult Protective Services
  • Child Welfare Services
  • Early Learning and Child Care
  • Special Needs Housing Services
  • In-home Aide Services
  • Income Supports
  • Workforce Services
  • Substance Abuse Treatment
  • Medical and Primary Care

Scenario Two

Homeless diabetic woman

Scenario Three

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

Quicker Processing of Benefits

Linkages with Community Based Organization and Closer Connectivity of Residents with Government and Services

Improve comprehensive outcomes for Transition Age Youth – sub population pilot to be expanded to the broader HHS enterprise

Improve indicators for children, youth, families and single adults related to Safety, Health, Well-being and Self-sufficiency

Improve indicators related to Job Creation and economic development

Maximized opportunities related to Health Information Technology under the Affordable Care Act

Outcomes to be Achieved


Assessment of hardware and software infrastructure

Business process analysis

Analysis of Policy environment

Identified business and programmatic needs

Build the integration prototype with transition age youth and now homeless families

Analyzed staff capacities and readiness for change

Developed the case for HHS modernization – business need to drive technology solution

Urgency – increased need, diminished resources – need for a new business model supported by new technology solution

Business Activities

Department of Health and Human Services’ Modernization


Built a nationally recognized confidentiality policy that enables data sharing across the entire Health and Human Services Enterprise

Developed a Neighborhood Opportunity Network Model – that combines social engineering with economic empowerment

Developing the scope and parameters for a true “No Wrong Door Approach” to the delivery of health and human services

Strengthening partnerships with non-profits, faith community, business and philanthropy to better leverage limited resources for those in need

Policy Activities


Built a practice model for integrated practice

Developed a universal face sheet and screening tool for our enterprise

Identified outcomes for our work

Tested integrated access points through our neighborhood opportunity network activities for both delivery of services and economic development activities

Used Health Reform as a catalyst for change

Built a work plan for implementation

Activities to Support Practice

Identified Transition Age Youth as our test population includes – children aging out of foster care and juvenile justice; mentally ill or substance abusing youth, pregnant and parenting youth and homeless youth. And now working with homeless families


Department of Health and Human Services

Technology Solution

Build a common client index or master client index to track overlapping and unduplicated client load – better anticipate need and improve service delivery

Integrate eligibility for all programs federal, state and local with eligibility requirements

Ensure compliance with all federal, state and local confidentiality and privacy protocols

Digitize all records and move to a paperless environment

Integrated case management system that allows for public and private sector users access and use of the system

DHHS Portal and Data Warehouse development


Department of Health and Human Services

Affordable Care Act Response

(An Opportunity for Integration)


Emphasis on Community and Population Health and well being

Calculating Return on Investment and Social Return on Investment

Making the case for re-investment

Using a community health and social planning approach to determine need and the algorithm for reinvestment

Engaging our Hospitals and community providers in the conversation about Community Benefit

Investments in health and human services will follow a trajectory like public safety and education – need will define level of investment and these services will not be considered discretionary

Community Benefit and Land Use Planning



Across Government

With our non-profit providers

With the Faith Community

With Business

With Philanthropy

With Advocates and residents

To Impact outcomes at the:

a. Individual

b. System and

c. Population Health and Community level


The Policy Conversation

  • Integrated Eligibility
  • Blending and Braiding Funds
  • Confidentiality
  • Evidenced Based Practice
  • Interoperability
  • Please type your questions in the box
contact information
Contact Information
  • Vanessa Holley, MPH
  • Program Analyst, ePublic Health
  • (202) 507-4239