Deloitte Consulting leader responds to recently-published Integrated Eligibility Systems report
Dr. Horn is a director with Deloitte Consulting LLP’s public sector practice, where he is a key advisor to health and human services clients of Deloitte Consulting's state government practice. Dr. Horn, also Deloitte’s Public Sector Health and Human Services Integrated Eligibility Leader, provided the following response to Deltek’s recently-released report, State Integrated Eligibility Systems. For more information on Dr. Horn, click here.
Dr. Horn writes:
For those of us who have spent much of our careers advocating for integrating services across health and human service (HHS) silos, this report is quite correct that never before have states been provided with the funding and the flexibility to do so. Yet, integration will still not be easy.
One integration challenge often sited is that individual HHS programs often have real – or perceived – restrictions concerning the sharing of information with other programs. Chief among these concerns are: privacy – the obligation of government programs to keep secure personally identifiable information; confidentiality – the obligation of government programs to keep confidential information gathered in the course of working with a client unless authorized to share that information with other individuals or programs; and security – the obligation of government programs to ensure that information obtained from clients is not vulnerable to access by unauthorized persons. In addition, some raise the specter of the Health Insurance Portability and Accountability Act of 1996 (HIPPA) as a barrier to sharing information across agencies.
All of these are important concerns, but far from insurmountable. Take, for example, HIPPA. Contrary to popular misunderstanding, HIPPA allows for the exchange of information if doing so is necessary for “treatment, payment and operations.” Secondly, HIPPA does not prevent sharing of information if the client consents to doing so.
Another challenge to creating integrated systems is that it requires fundamental organizational change – so that service providers no longer think of themselves as providers of individual benefits, such as Temporary Assistance for Needy Families (TANF), Medicaid or the Supplemental Nutrition Assistance Program (SNAP), but as providers of a range of benefits and services. This is, perhaps, the hardest task, requiring a focus not just on the IT challenge, but also on change management up and down the programmatic chain of command.
A final challenge is that not all government services and benefits share a common goal. Some are designed to move individuals and families toward self-sufficiency – that is, to a point where they are no longer in need of that service or benefit. The best example is TANF. Others, however, are designed to improve the current circumstances or the quality of life of an individual or family rather than moving the client toward self-sufficiency. We don’t, for example, expect Social Security to move the elderly into paid employment. Still, others attempt to intervene in ways that improve the long-term prospects of the client without providing direct services that would lead to self-sufficiency, such as is the case with services and benefits for children. We don’t, for example, provide job training for children enrolled in the Head Start program, but do expect that Head Start will significantly improve a child’s long-term economic prospects.
So, what's the solution? I believe the solution is for case managers to organize services around people, and not people around services. That is, rather than asking, “How many services or benefits can I enroll this person in?", the case manager would ask the question, “What is the goal for this individual or family, and which services and benefits would most likely help that individual or family achieve that goal?”
Dr. Horn brings up a valuable point, in that not only is the integration of disconnected IT systems a great challenge in itself, but add to that the task of transforming the way in which case workers think about how and why services are delivered, and we have an even greater, and perhaps more important challenge to overcome. While integrated IT systems can only assist in making this organizational change, caseworkers must embrace integrated systems and other technological advances (mobile applications, for example) in order for these changes to be most effective and valuable to the population in need. It is the hope of government officials, policy-makers, case managers, IT vendors, beneficiaries, and others that these challenges can be overcome both alongside and with the help of health and human services IT systems’ integration.
Thank you to Dr. Horn for contributing valuable insight and opinions regarding integrated health and human services systems.
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