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Transforming Social Services

Getting started on your cloud journey

Hand protecting family on wood table. Healthcare and life insurance concept
Health and human services (HHS) agencies have an immediate opportunity to transform operations and improve outcomes for the people they serve. Pandemic-related funding, the infrastructure bill, emerging technologies such as AI and machine learning, and the proven success of cloud-based solutions during the pandemic have all created fertile ground for moving forward with modernization.

Cloud-based solutions have become central to many agencies’ strategy for modernization, enabling organizations to deploy within days secure, stable, and instantly scalable systems and solutions that would take years with legacy or on-premises technologies. The cloud also simplifies data integration, consolidation, and sharing, which enables organizations to move toward a whole-person model of service that takes a broader view of a beneficiary’s circumstances and works to address issues across multiple programs rather than in programmatic silos.

Despite the many advantages of using cloud-based solutions to modernize legacy systems, technology alone is not enough to assure the success of HHS transformation initiatives. Organizations must start with the proper foundation for transformation, adopt modern approaches to data integration and analytics, and improve the user experience.

Building a foundation for modernization

Although project teams tend to think of technology first when they consider HHS modernization, they should only make technology choices after they work through issues related to people, processes, and governance.

“We go through a very thoughtful process to uncover what the true problems are and then work methodically on how to potentially solve those problems,” said Jason McNamara, who is the Health and Human Services Leader for Amazon Web Services (AWS), on a recent Government Technology webinar.

The following strategies help HHS agencies build a strong foundation for modernization.

Identify an important business problem. “I would urge folks to find a significant pain point that’s impacting client outcomes, worker experience, or customer experience and solve for that,” said Stuart Venzke, Leader of SLG Human Services and Labor for AWS. Besides alleviating pain points, this approach creates visible wins that encourage buy-in for modernization — especially when people have seen past modernization initiatives fail or never materialize.

Work backwards from the problem. “In a recent meeting, a senior medical director had mapped the scope of the problem and it was infinitely large. There were a million people in the program. The conversation was less about the technical approach and more about identifying the starting point. To do that, we used a user-centric process called working backwards, where we work backwards from the beneficiary’s perspective,” said Casey Burns, who is the Lead for U.S. State and Local Government Verticals and Strategy for AWS on a recent Government Technology webinar.

Working backwards also gives organizations an opportunity to disrupt internal operational workflows in a positive way. It includes clarifying who the organization’s internal and/or external customers are (e.g., employees, HHS clients, or other agencies), thoroughly documenting workflows, and rethinking how to serve customers.

“A state agency in the Midwest has been working on a very complicated analytics challenge for three years. When we came on board, we said, ‘Let’s see what’s working well and accelerate that. And let’s look at what isn’t working well and see how we can promote some solutions, technologies, and workflows to help you get there.’ When agencies can think differently about their problems with people and processes, and then bring in the cloud to scale their solution, they can often achieve their goals in a matter of months rather than years,” said McNamara.

Start small. Instead of trying to develop a comprehensive solution, start with a “minimum viable product” that meets a specific need. Avoid adding on “bells and whistles” until the basics are in place. This approach keeps project teams on task and allows the organization to test and refine technology implementations, processes, and modernization strategies as they go. Starting with a small, low-cost proof of concept also helps people more easily understand and accept risk. “If they can fail fast and do so in a very methodical way, while accepting a very small risk, they can slowly build an appetite for risk and embark on bigger and bolder things,” said McNamara.

Modernize incrementally. By making incremental improvements to functionality, agencies gain immediate business benefits while replacing legacy technology and modernizing systems over time.

“A key element of an incremental modernization strategy is to leverage the things that are already working and replace or enhance the things that aren’t working. Some project teams are reluctant to invest in short-term, transitional enhancements to their legacy system because they view those enhancements as a waste of time and money. However, if you can actually improve outcomes or the user experience for three or four years while you’re waiting for a new system to come online, that’s incredibly valuable,” said Venzke.

Adopting modern approaches to HHS data integration and analytics

Data-driven insights enable HHS agencies to make better decisions about programs, advocate more effectively for policy changes, and better serve their clients.

“When I was director for the Department of Healthcare Services in California, our data analytics and research division could answer practically any question we dreamt up,” said Jennifer Kent, a Senior Fellow for the Center for Digital Government, on a recent Government Technology webinar. “When I asked who the most expensive patient in our program was — at that point, we had 13 million beneficiaries — they were able to identify that person and the top cohort. They had done all this great analysis by linking a lot of different data sets. It really helped administrators make good policy decisions.”

Cloud-based data lakes, which pool raw or processed data from disparate silos, are integral to transforming the way agencies consolidate, analyze, and share data. Newer, more user-friendly tools are also making data analytics easier by allowing business users to type a search phrase such as “find my highest-cost claimants in Medicaid” when they want information. However, when it comes to working across multiple programs and organizations and innovating in areas such as data sharing, the main challenges are usually related to people, policy, or culture.

The following practices help project teams overcome these hurdles.

Obtain leadership alignment. “It’s really easy in the governance space to be risk averse when leadership alignment is not there. That creates the opening for the project to become a lower priority,” said Betsy Baker, Modernization Lead at AWS, on a Government Technology webinar.

To keep IT, legal, compliance, risk, business, and other functions working toward the same purposes, the project team must ensure these leaders align on the project vision, goals, and expectations for HHS modernization.

Establish aggressive top-down goals. Some states and localities establish entire offices or agencies to address things like data governance or health equity. Aggressive goals from the executive level keep people motivated to work together and move faster than would be possible organically.

Get people comfortable with change. As an example, people who don’t fully understand the regulations or the ways data may be shared might use the need to comply with the Health Insurance Portability and Accountability Act (HIPAA) to block information sharing. “We have to get people comfortable with the details and empower them to try to avoid that snowball effect of, ‘we can’t’ because of HIPAA, high trust, or some other can’t,” said Baker. Doing so requires training, trust, and strong leadership to pave the way.

Don’t let perfect be the enemy of good. When it comes to things like master patient indexes (MPIs) and matching multiple records, it’s important to remember the whole picture and avoid getting bogged down in the details. “Start with a small cohort or look at a specific problem and target a cohort that is associated with that problem. Figure out what’s good enough, and then apply it to a broader audience,” said Baker. Improving the user experience and client outcomes Improving service delivery and the user experience leads to better outcomes for individuals, their families, and their communities. To improve the user experience and free up contact center agents and other workers for more complex issues, agencies are using self-service portals, mobile device applications, natural language processing for voice and text calls, and other cloud-based services.

The following practices help agencies improve service delivery and the user experience.

Learn what customers need. “In terms of our working backwards process, one of the first things we do is define the customer personas in detail,” said Venzke on a Government Technology webinar. These personas go beyond identifying a role such as caseworker or Medicaid recipient. They document the whole story or journey associated with a role so the organization can understand the user’s challenges and think through potential solutions.

Focus groups and surveys are traditional ways of gaining insight into customer needs and pain points. A less obvious route is to look at program appeals. “You get insight into where things do and don’t work in your process, because those things are often driving appeals and appeal decisions,” said Venzke. Frontline workers are another source of valuable information because they usually have a good sense of their clients’ needs and challenges.

Focus on making life easier for the applicant, beneficiary, or claimant. While this tenet may seem obvious, many processes center around what’s needed on the back end. “We’ve found that most of these systems, regardless of the program, have been designed to emphasize compliance with a set of rules rather than to simplify the customer experience,” said Venzke. One way to make life easier is to provide visibility or notification when online applications or claims for things like unemployment insurance are received and accepted.

Empower the public by enabling them to opt in to data sharing. Once a person consents to their information being shared with other programs, agencies can begin to assess additional needs and their clients’ eligibility for other programs.

Empower the workforce that serves beneficiaries. Recruiting, training, and retaining workers in child welfare, eligibility programs, and other HHS services is a difficult task. Many workers are retiring and staff sizes are shrinking. User-friendly tools and intelligent automation can alleviate pressure and help staff more easily find the best solutions for their clients.

“We’ve got to make sure we’re giving people the tools they need to do the highest impact work — that we don’t make them click between 17 screens or answer calls to reset a password or validate something that we could have had a machine do. These people are superheroes; let’s help them do superhero work,” said Burns.

Success is a journey not a destination

As agencies embark on HHS modernization, building a strong foundation, adopting cloud-based approaches to data integration and analytics, and improving the user experience will help ensure the success of their modernization investments. In addition, using an incremental modernization strategy will ensure solutions remain relevant and sustainable as the landscape changes and agencies move toward their goals. At the core of this strategy is the ability to see success as a journey and not a destination.

“A lot of us tend to think if we get to a certain place sometime in the future, we’re done. It’s really important to embrace the idea that success will change along the way, and that success is also something to be celebrated along the way,” said McNamara.