State and County Health and Human Services Agencies Use Technology to Break Down Silos and to Better Serve Citizens

From cross-department data sharing to software analytics to services integration, state and local agencies are making connections and using IT to improve the delivery of vital citizen services.

by / August 30, 2010
HHS Fish Sept. 2010 feature design

Give a man a fish and you feed him for a day; teach a man how to fish and you feed him for a lifetime. Though the Chinese philosopher Lao Tzu imparted this wisdom around the sixth century B.C., it's relevant today as governments not only grapple with the unbending truth of limited resources, but also seek to include others in their solutions, dipping into almost limitless possibilities by connecting with and relying on clients, communities and vendors.

Perhaps nowhere is it more imperative to be resourceful than county health and human services agencies, which strive to meet citizens' most basic needs. Compare notes with such agencies and you'll be met with dizzying mandates: improve client outcomes; meet federal directives; chip away at fraud; track regulatory changes; confront duplication and inefficiency; plug gaps; and deal with disparate systems and technologies while encouraging workers to adopt new business processes meant to help alleviate those challenges, but instead add to them.

Adding more cases to the load isn't a good option -- some workers in Alameda County, Calif., already have 600 at one time.

Counties and states are instead looking at new technologies to help them find and pick the lowest-hanging fruit, boost efficiency and ultimately remit some of the work and control to people who use their services -- involving them in the process, instead of just feeding them.

Collaborative Vision

In Scott County, Minn., the aptly named organization FISH (Families and Individuals Sharing Hope) was formed to improve connections between county government, faith-based and service groups, nonprofits, and businesses to fill resources gaps. While the county government dreamed up the arrangement and started the process, each sector is a spoke in the wheel, working independently but also together to meet community needs.

"It's a community-based response rather than a government agency or nonprofit agency response," said Tim Walsh, community services director of Scott County. "You have people in these various communities and a lot of people who just want to do good. They don't know how to organize together necessarily, they can't do it all by themselves, they don't know who else is interested in doing that. We want to provide tools for them."

Walsh explained FISH's two elements: a leadership council of about 100 leaders, and a relational network that organizes resources and individuals by what they're offering. Resource requests are taken from members of the relational network and brought to leaders who work to find solutions. While organizing a simple group e-mail has helped FISH meet the needs of more than 70 families (in one instance, installing a wheelchair ramp), Walsh said the organization has a grander vision for its Internet portal, which is still in its infancy.

The county worked with High Monkey Consulting and Insightformation Inc. to build the first iteration of its portal with Microsoft SharePoint 2007 as the platform and framework, hosting the site on the county's existing SharePoint servers. The site enables the leadership team, and soon the larger service community, to log on and communicate, said Perry Mulcrone, the county's deputy IT director.

FISH also is developing an e-citizen portal, Mulcrone said. As it's imagined, FISH's website will be an area to give -- to donate money or time -- and to receive -- to find a resource or log a need and have a network member who has access to the extended collaboration site guide them, Walsh said. The website also will offer access to the Broader Needs Assessment (BNA) application engineered by neighboring Hennepin County. The tool searches the state's existing resources database and presents services based on clients' needs, said Jennifer Castillo, the business-side lead for the BNA and principal planning analyst for the Hennepin County Human Services and Public Health Department.

Mulcrone said FISH also plans for improved discussion boards,

a cell phone interface, and mash-up capabilities with Facebook and Craigslist for greater access to resources. "We want the external website to be like a front door to involvement with this overall FISH network," Walsh said.

The FISH collaboration began three years ago when Scott County's nonprofit and faith-based communities faced big budget reductions that laid bare their vulnerabilities: They had few volunteer channels and little cross-sector support. A need to pull resources together became clear.

"The interest was to serve people better, to reduce duplication, to reduce redundancy in the system, to increase the sharing of volunteers and resources ... and over time, to develop that network," Walsh said.

With the vote of confidence from the county commissioners, the county board formalized the goal two years ago and one year later formed the leadership council and plans for a collaborative networking site.

The point of FISH isn't to erect another government bureaucracy, but to allow government to step into a secondary, facilitative role, he said.

Walsh said FISH's success during the country's recession gives him hope. "I think it's awe-inspiring and hope-inspiring to see how people are stepping up to do their part to meet these needs," he said.

Alameda Analytics

Another spot of sunshine -- in a land of even deeper budget cuts -- has been Alameda County, Calif., east of San Francisco. The county has found a tool that saves money and improves services by empowering caseworkers with all the right information.

The county uses a public-sector analytics framework that combines an IBM data warehouse with analytics technology to enable county workers to speed up the eligibility process and identify fraud.

The secure database downloads information daily from the county's six benefits systems, and the analytics system organizes and presents the information in a single dashboard and alerts workers who can go straight to cases that need attention.

"That's the beauty of [the data warehouse]: to bring in information and provide information and to do it in a very secure and confidential way," said Don Edwards, the project's lead and assistant director of administration and finance for the Alameda County Social Services Agency.

The analytics component works with the agency's existing interactive voice response technology to call clients' homes and warn of possible changes to benefits pending an action. In some cases, the system can take action, such as discontinue benefits, without human intervention.

"The brain of the system is very intelligent, it's proactive. But like any machine, you have to tell it what to look for," said Edwards.

One unexpected savings from the data warehouse came when Alameda County discovered that its old service for reporting data about welfare-to-work clients had provided information up to 45 days late and at times was completely inaccurate. The county saved $75,000 by eliminating the old service, and now uses the raw data piped in from the data warehouse to find the true welfare-to-work participation rate.

With this information, the county will have a better chance to meet federal tracking requirements by identifying clients who had previously fallen through the cracks. Through fraud detection and system improvement and efficiency, the county estimates that it can recover $11 million, Edwards said.

The data warehouse and analytics system were up and running within six months. "We could see in the very beginning, in January [2009], how clients are associated with one another," he said. "We could see in one glance the entire life cycle of a client." For instance, the agency witnessed multiple clients with the same Social Security numbers and clients both receiving state welfare benefits and serving as care providers in the adult and aging system -- suspicious events that call for investigation.

The agency now wants to bring the technology into other

government realms like law enforcement and education. Edwards said the agency is working with the county Sheriff's Office to pull incarceration data and chart it against those receiving county benefits. The agency also is determined to work with the 17 county school districts to share up-to-date information on children in the foster care system.

Back in 2003, Edwards was looking to build a network linking disparate systems in a user-accessible way. He wanted workers to have a holistic view of each case and be alerted in real time of the next actions to take. But the risk inherent in building a data warehouse in a public environment kept the project on the back burner for some time. "The big challenge is that data warehouses can often be big sinkholes for cash," he said.

In the end, why did the county make the leap? Alameda had many drivers, among them, a desire to meet a 2005 federal law that mandated that half of all welfare clients participate in work activities or the county would face cuts in funding.

Alameda's analytics software runs on a Linux operating system. The county uses IBM's Cognos business intelligence software to provide reporting and dashboards. The initial investment in the IBM technology was $1.3 million, which Edwards believes will be more than realized in savings. But he added: "The real benefit of the system is how well the agency will serve its public as a result of the collaboration."

Power of PEAK

Colorado also had its clients in mind when in late 2009 it unveiled a self-service, Web-enabled application for public benefits called the Program Eligibility Application Kit (PEAK).

PEAK empowers citizens to check through a simple interface if they're eligible for food, medical or cash assistance from five different government programs, and also to log on to check their benefits or apply for benefits using an electronic application. PEAK is part of a series of improvements and updates that Colorado is making to its existing Colorado Benefits Management System (CBMS).

"This will be a huge efficiency improvement for our clients because it allows them not to have to print out a paper application and stand in line, and it reduces data verification and data entry errors, improving the overall application process and timeline," said William Browning, president of Colorado-based Rebound Solutions, who served for eight months as interim director of the CBMS to oversee improvements to the system.

Under the "Am I Eligible" area, clients submit basic demographic, income and other information to get an eligibility picture. The site also offers computer skills and navigation tutorials. Although PEAK cannot guarantee the accuracy of its benefits eligibility determination, Browning said the application is a good way to screen clients before they take time to visit workers.

"We've all seen clients who don't need to apply because they aren't qualified," Browning said. "People don't realize how poor you have to be to be eligible for food assistance."

When clients decide they want to apply, electronic application forms are intuitive and collect information based on what the client is applying for, Browning said.

On the intake side, the state also will be implementing the Intelligent Data Entry (IDE) project to smooth processing by improving the interface, Browning said. The improvements, which will help the state and counties avoid federal sanctions by speeding up processing time, are a result of a state collaboration with Deloitte Consulting and county caseworker representatives. The IDE functions will be released progressively through 2012.

While the initial 2004 CBMS rollout was a disaster -- the system was slow, immature and underfunded -- Browning said that the CBMS has been stable for two years. And with Deloitte now on board, the state has instituted an improved quality assurance process and is upgrading key servers and storage components. "The

focus is on improving efficiencies for our clients; and now with a stabler system and high client demand, the time is right to make these investments," Browning said.

Former Colorado CIO Mike Locatis said focusing on the needs of the state's 64 counties was extremely important because the counties are the state's clients. "The state has that kind of middle-person role because these programs are federally mandated and funded," Locatis said, "the state is the custodian of the larger systems and processes and making sure we comply with statute and so forth. The county offices end up delivering from that hosting state's systems and processes."

Counties have been engaged since the inception in helping build and test PEAK, Browning said.

Similarly FISH's Walsh thinks county-level ideas in Minnesota could be adopted statewide. "We're starting to talk to the state about whether they'd be willing to host county solutions like this one so that we can freely share these solutions across local governments."

FISH's long-term vision is to share ideas much like its neighboring counties have. Building bridges over communication barriers and including others where they weren't included before has already caught FISH some success.

Jessica Hughes Contributing Writer

Jessica Hughes is a regular contributor to Government Technology and Emergency Management magazines.

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