April 23, 2012 - Integrating Services

APHSA Panel on Integrating Services

Integrating Services

April 23, 2012

As the lead for the human services programs within HHS, ACF has a number of initiatives underway that will lead to greater program integration across the spectrum of human services. The challenge before us is to find new ways to serve our clients – ways that reduce both the burdens of program administration at all levels of government, and the frustrations that bureaucracy can often entail for the client.  I know it sounds shopworn and cliché, but I believe we really can find ways to do the business of delivering human services to America’s families and children, better, faster, and more efficiently.

Systems interoperability addresses some of the problem by placing clients at the center of the services we provide, reducing technical and bureaucratic barriers between programs that make it hard for people to get the services they need.  Fortunately, ACF has much of what it takes to make our systems more interoperable.  We have experts, who understand the challenges and the opportunities associated with trying to herd our many disparate human services programs, and get them all heading in the same direction.  The rewards for us to do so, however, are just too great to ignore, regardless of the effort involved. 

Despite the numerous deadlines and milestones set out before state Medicaid and Insurance directors and commissioners, hard and fast dates that they must meet, most importantly January 1, 2014, they will all get met in a year and 10 months from now.  My counterpart in CMS, Julie Boughn, makes it imminently clear that, like ACF and our partners at FNS, we are all focused on getting the word out every way we can that there are still two more years of enhanced 90/10 funding remaining available to States to use, along with the exception to OMB’s A-87 cost allocation requirements.

Having said that, let me share with you two success stories we recently had the privilege of seeing and hearing about.  Let me qualify the term “success.”  This is success from the standpoint of having a few more States “get it” about the availability of 90/10 funding until December 2015 and using the A-87 waiver authority to help ensure real, viable integrated systems that do more than just get our clients in the door.  This is about understanding how health and human services can collaborate to provide an enhanced, customer-centric, tightly integrated customer service solution.

Over the course of the last six weeks, our staffs in child support and child welfare, collaborating with our partners in CMS, who by the way did the heavy lifting here, and FNS, worked with staff from Rhode Island to change their multi-phase project to include integration of the human services side sooner to take advantage of the 90/10 funding in 2014 and 2015 using the A-87 waiver.  Our joint staffs, State and Federal labored hard to do this as expeditiously as possible.  We shared best-of-breed APD’s and RFP’s from other States to help jumpstart Rhode Island’s work.  And a big accelerator for the State came when Sharon Santilli, Rhode Island’s Child Support program director reached out to Joe Bodmer, the Director of our systems division in child support, and who is also now heading up our interoperability Initiatives in ACF.  Together they arranged a conference call with all of the important players in Rhode Island’s health and human services programs:  IT, finance, program heads, leadership, to discuss the ins and outs of how the State could take advantage of the 90/10 enhanced funding and the A-87 waiver.  The design of Rhode Island’s planning efforts changed that day.  With one good phone call between all of the important players listening and collaborating, Rhode Island moved onto a fast track to horizontal systems integration.

Virginia is another example of a State recognizing the opportunity before it and moving forward to seize this moment.  Virginia has been working to develop an enterprise view of data and information sharing across their health and human services systems.  Using many of the concepts of MITA, including service oriented architectures and an enterprise service bus, technical terms that mean their multiple systems can exchange data readily as if they were joined together.  They are also building unified front ends for workers to be able to view a client’s data from across multiple programs to determine not just what services are being delivered, but also what additional services the client may be eligible to receive.  Virginia is a prime example of how a methodical approach to integration through incremental enhancement versus wholesale replacement can also achieve real results for our programs.

I mentioned our Project Management Office.  ACF has established an Interoperability Project Management Office. It is tasked to manage the day-to-day communications with our numerous stakeholders at the Federal, State and local levels, not to mention with the private sector and advocates; as well as handle all project coordination, thus improving our interagency collaboration and cooperation.  And did I mention they actually have a plan, a project management plan!  With a schedule and all!

ACF plans to establish an Interoperability Steering Committee.  The committee will consist of stakeholders from within and outside of ACF to provide consultation, counsel, critical review and analysis, and provide support for current and future interoperability efforts. Membership would include a combination of Federal, State, and local representatives.

We are also developing a National Information Exchange Model (NIEM) that serves as a clearinghouse for commonly used human services terminology and establishes a process to identify and share essential information. The NIEM framework will also provide tools as well as training and technical assistance, and will guide our efforts at implementing information exchange services across the landscape of human services.  We are pleased to note that the Human Services Domain was recently officially recognized and officially established under NIEM. In the next few months, ACF will be posting planning documents on the NIEM website for review and comment. ACF will also establish and operate a NIEM sub-group to provide coordination with the Centers for Medicare & Medicaid Services (CMS), including its Center for Consumer Information and Insurance Oversight (CCIIO), as ACF is committed to supporting these agencies as they implement their own Health Services Domain under NIEM.

We are funding the initial creation of a National Human Services Interoperability Architecture (NHSIA) that will serve as the technical framework of interoperability.  The architecture is derived from a number of existing, successful enterprise architecture models, including the Federal Enterprise Architecture or FEA.  It is envisioned as a framework that can support common eligibility and information sharing across programs, agencies, and departments; improve the efficiency and effectiveness of service delivery across our programs; support great program integrity through enhanced identification and prevention of waste and fraud;  and in doing so, deliver better outcomes for children and families.

ACF periodically releases a compendium of interoperability documents (Interoperability Toolkit) designed to help State human services agencies connect with their health counterparts and coordinate efforts to develop modernized and interoperable systems. A revised version is being written now that will include a series of implementation scenarios; narratives that will describe for States the opportunities, steps, timeframes, and coordination needed to improve system interoperability and integration across health and human services programs.

We have ramped up our efforts at achieving greater interoperability and integration across our health and human services systems, and I think we’ll start to see the fruits of these labors in the coming year.