11/6/2015 CONTEXT ABOUT MONTGOMERY COUNTY WHY THIS IS IMPORTANT OUR SERVICE INTEGRATION EFFORTS 3 AREAS NEEDING INPUT: › ELIGIBILITY › DATA SHARING ›
Download ReportTranscript 11/6/2015 CONTEXT ABOUT MONTGOMERY COUNTY WHY THIS IS IMPORTANT OUR SERVICE INTEGRATION EFFORTS 3 AREAS NEEDING INPUT: › ELIGIBILITY › DATA SHARING ›
11/6/2015 1 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 11/6/2015 2 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 11/6/2015 3 GOVERNANCE BRIDGING SILOS WORKFORCE OPEN & INCLUSIVE PROCESSES CONFIDENTIALITY PUBLIC AND POLITICAL WILL INTEROPERABLE INFORMATION TECHNOLOGY CONSUMER CENTRIC PERFORMANCE MANAGEMENT FUNDING 11/6/2015 4 In 1996, 4 County departments became one entity. Objective: Integrated, coordinated and comprehensive service delivery. 11/6/2015 5 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. 11/6/2015 6 Department of Health and Human Services Organizational Overview Office of the Director Uma S. Ahluwalia Director Special Assistant to the Director Traci Anderson Labor Relations Special Assistant to the Director Robert Debernardis Legislative Coordination Intergovernmental Relations Patricia Brennan, Manager Policy Oversight & Integration Public Information Labor Relations Special Initiatives Advisory Boards, Commissions and Committees Federal Congressional Delegation State General Assembly County Council Liaison Facilities Management Community Affairs Betty Lam, Chief Community Action Agency and Board Community Outreach Disparity Reduction Diversity Initiatives LEP Compliance Aging and Disabilities Services John J. Kenney, Chief Information and Assessment Services Home and Community Support Services o Community Support Network/Disability Services o Home Care o Adult Protective Services/Case Management Services o Nutrition Program Assisted Living and Skilled Nursing Facilities o Assisted Living Services o Ombudsman Program Boards and Commissions o Commission on Aging o Commission on People w/Disabilities Disabilities o Adult Public Guardianship Review Board Chief Operating Officer Sherry White, COO Budget and Finance Contracts Logistics and Facilities Information Technology Human Resources Operations and Administration Compliance (ADA, HIPAA, Olmstead) Behavioral Health and Crisis Services Raymond L. Crowel, Chief Mental Health Services o Adults and Seniors o Children and Adolescents o Multicultural Mental Health Services Core Service Agency Substance Abuse/Addiction Services Crisis Stabilization Partner Abuse Victim Abuse Boards and Commissions o Alcohol and Other Drug Abuse Advisory Committee o Mental Health Advisory Committee Planning, Accountability and Customer Service JoAnne Calderone, Manager Customer Service Grants Information and Referral Performance Management Strategic Planning Children, Youth and Family Services Kate Garvey, Chief and Social Service Officer Linkages to Learning Child Welfare Child and Adolescent Services Juvenile Justice Early Childhood Services Gang Prevention Initiative Income Supports and Child Care Subsidy Liaison work with MCPS Boards and Commissions o Commission on Children and Youth o Commission on Child Care o Commission on Juvenile Justice o Citizen Review Panel Public Health Services Ulder Tillman, Chief and Health Officer Community Health Services Communicable Disease/ Bio-Terrorism Cancer and Tobacco Initiatives Licensure and Regulatory Services o Assisted Living Facilities Certification School Health Montgomery Cares Health Promotion Health Partnerships and Planning Long Term Care Medical Assistance & Outreach Special Projects Boards and Commissions o Commission on Health o Montgomery Cares Advisory Board 11/6/2015 Special Needs Housing Nadim A. Khan, Chief Housing Stabilization / Emergency Services To Prevent Homelessness o Economic Supports Emergency Assistance Grants Welfare Avoidance Grants 60-Month Intervention o Resource Supports Preventive Crisis Intervention with case management Rental and Home Energy Assistance Programs o RAP-Shallow Rental Subsidy Program o SHRAP-Deep Rental Subsidy Program w/Service Coordination o Handicapped Rental Assistance Program o Home Energy Assistance Programs Homeless Continuum of Care Coordination (Supported through non profit partners) o Single Adult Shelters w/case management o Family Shelters w/case management o Motels Placement and Overflow Shelters o Transitional Programs o Permanent Supportive Housing Programs Interagency Housing Workgroup 7 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 collaboration among 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 8 Montgomery County Department of Health and Human Services Services and MD 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 9 Department of Health and Human 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 10 Federal: ACF ONCHIT HRSA SAMHSA CMS HUD State: GOC MSDE DHR DHMH DOA County: CYF PHS ADS DHHS BHCS SNH 11/6/2015 Montgomery County DTS Enterprise infrastructure Policies Security CIO support and outreach 11 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 12 Equity INTEGRATED SERVICE TEAM Customer Team Member Team Member Trust Customer Service 11/6/2015 QSR-Quality Service Review Community Partner Team Member Public Health Services One HHS Lane Information Technology CHIP-Community Health Improvement Process HHS Team Member Labor Management Partnership \ Accountability 13 Timeline Integrated Department created by State Legislative action from Four local departments. Legislation also creates a single entity for purposes of HIPAA 1995 1995 2003 Co-location deepens partnership and coordinated and integrated business practices 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 2003 – 2007 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 2007 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 2009 2010 Work continues with many outreach opportunities with State and Federal entities 14 Scenario One 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 a. b. c. Homeless Program Mental Health Treatment Montgomery Cares 15 Scenario Two 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 a. High School Wellness Center b. Mental health services for child, mother and family unit c. Anger management d. Culturally competent service delivery e. Meaningful after school time activities 16 Scenario Three 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 a. Public Health TB Clinic b. Child Care Services c. Maternity Services d. Income Support Services e. LEP Services f. Domestic Violence Service via Abused Persons Program g. Adult Mental Health Services h. Housing Stabilization Services i. Education through Public School System 17 Scenario Four 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 a. Adult Protective Services b. Child Welfare Services c. Early Learning and Child Care d. Special Needs Housing Services e. In-home Aide Services f. Income Supports g. Substance Abuse Treatment h. Medical and Primary Care 18 No matter which door she arrives through 11/6/2015 19 She will be greeted and provided the face sheet Service Request Form Check in screen Needs Questionnaire 11/6/2015 20 She will fill out service request form and needs questionnaire Basic demographic information Client identified needs 11/6/2015 21 Triage worker interviews her Confirms needs and schedules appointments or provides referrals 11/6/2015 22 She leaves session with appointments for follow-up assessments Appointment and referral letters in six languages 11/6/2015 23 Care coordinator gets feedback from program assessments TCA Y HIV-Aids Y System provided feedback regarding assessments outcomes Housing N Child care Y If client meets criteria coordinator calls for a service team 11/6/2015 24 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 11/6/2015 25 › Universal Screening tool › Face Sheet › Confidentiality Policy › Practice Model › Scheduling tool › Customer service protocols › Qualitative Evaluation tools › Enterprise tools Oracle ERP Seibel CRM 11/6/2015 26 Complexity of the Health & Human Services Ecosystem K-12 Education Ecosystem Network of Community Service Providers Seniors Centers Child Support Collections State Department Of Education Federal Dept. of Education Head Start State Tax No Child Left Behind Goodwill Services Workforce Develop Substance Abuse Treatment ABC Residential & Group Care Criminal Justice Ecosystem Community Mental Health Jewish Community Center Courts Criminal Civil Juvenile Justice Family Court Divorce Catholic Chairities Head Start Providers Police Schools Local Social Service Agencies State Health & Human Services Planning & Resource Allocation Financial Management Program Management Provider Management Human Resource Management Regional State & Local Client Plan & Assessment Teams Child Welfare MultiWIA Discipline Client Plan & Medicaid Review TANF Compliance Management IT Management Department Management One Stop Centers Multiple Locations Interdisciplinary Pre-eligibility Assessment Emergency Assistance Child care Service Delivery (e.g. Empl.) Facilitate Self-service Aging Income Voc. Rehab Mental Retardation (TANF, Emerg. Medicaid Aid Child Care Food Stamps Workforce Inv. Income Sec. Caseworker Team Child Welfare Secured Internet Information Technology ERP RevMax Data Warehouse TANF Child Support EBT Portal Client data Provider data Referral data Performance Developmental Disabilities Community Health Public Health Mental Health Information Technology Productivity & Collaboration Workflow & Scheduling Integration Technologies Child Welfare Caseworker Team Health & Disability Caseworker Team Medicaid Federal Dept. of HHS Medicaid Contractor Banks Clients Suppliers 11/6/2015 Hospitals United Way 27 Microsoft Architectural Vision SACWIS BI Tools EAI Tools Integrated Case Management Foster Care Protective Adoption Team-based Integrated Intake 11/6/2015 28 11/6/2015 29 Areas of Practice 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 30 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? 31 The Policy Conversation Integrated Eligibility Blending and Braiding Funds Confidentiality Evidenced Based Practice Interoperability Place Based Initiatives in the Context of: a. Health Reform b. TANF Reauthorization c. Medicaid Waivers d. Home and Community-based Services e. Universal Pre-K f. Employment Strategies g. Housing First and 10 year plans to end chronic Homelessness h. New American Strategies i. Equity in Service Delivery j. Role of Technology in Supporting 32 Integrated Practice 33 Questions and Discussion