Case Study: A Mid-Atlantic State Taps the Web to Set New Standards for Public Welfare
When this state’s Department of Public Welfare’s (DPW's) Office of Mental Retardation (OMR) needed an enterprise-level information management system, Deloitte Consulting LLP (Deloitte Consulting) understood it wasn't looking just for a technical solution. It needed to address business processes issues that would affect the solution and all intended users. We helped it design a time- and money-saving system that met everyone’s needs.
Like its counterparts in many states, this mid-Atlantic state's DPW OMR was awash in paper records and saddled with countless duplicate data entries. In addition, the state's auditor general was asking tough questions about the OMR’s quality of community-based services, and the organization was in danger of noncompliance with federal care guidelines. State officials were struggling to fulfill promises made to the OMR’s many stakeholders about improvements in service.
And what an assortment of stakeholders! Not simply the state's growing population, but also 47 counties that administer OMR services, 158 case management entities, and 1,035 care providers across thousands of locations – all with their own ways of dealing with individuals’ needs.
The OMR, which is responsible for the well-being of almost 70,000 people, set out to build an enterprise information system, called the Home and Community Based Information System (HCSIS), that would address its growing challenges.
We realized that this was not simply a technology problem; business process issues had to be considered before we embarked on a solution.
First, a plan for communication was critical. Many of the state’s agencies worried about what the project would mean for them and their funding. And advocacy groups were poised to blow whistles if they saw any reductions in the quality of service for families.
Our collaborative approach to the project meant involving stakeholders from the outset:
As there was no software package available to support the HCSIS initiative – not within OMR, not within the DPW as a whole and not in the marketplace – we set out, with the OMR developers, to build an infrastructure from scratch.
Needed: Input from Everyone The Deloitte Consulting team polled OMR managers on the office’s business processes. Follow-up focus groups with OMR stakeholders soon isolated the processes that mattered most. HCSIS had to be easily accessible around the clock by state citizens, support agencies, health care providers, and federal and state employees.
From there, the team began development of a large-scale Web-based tiered application. The data, business and presentation tiers were structured so that changes in one layer would not affect the others, reducing the cost of enhancements required by future changes in policies. Deloitte Consulting expedited software development by providing the state with its proven and tested foundational program code framework free of charge.
The application architecture was designed to create a common look and feel; it had to be very easy to use and it had to guard individual privacy – the Health Insurance Portability and Accountability Act (HIPAA) was en route to becoming law – using robust security rules. The technical architecture had to be scalable, flexible, developed with little capital investment by the stakeholders and integrated with legacy systems to tap existing functionality. Internet access was all that was needed for any user, anywhere in the state, to be able to use the HCSIS’ many functions. (Access depends on the individual’s security clearance levels.)
Deloitte Consulting and the DPW then began a big recruitment effort to involve every stakeholder group in drafting detailed system requirements for the HCSIS. With so many stakeholders to consider, the project involved dimensions beyond the intersection of IT and business needs. Fortunately, the team was able to draw on other Deloitte Consulting resources with in-depth experience in technology and in human capital management.
The outcome was a three-phase approach, beginning with a focus on quality initiatives, such as incident reporting and management. The second phase included the main business processes that affect individuals receiving home-and community-based services, including intake, individual planning and budgeting, and case management. The third phase incorporated financial management processes for activities such as allocating funds by county. All three phases were delivered within budget and on time.
To date, the HCSIS has saved about 20,000 hours/year (most of that among formerly disparate county programs) and avoided the creation of 47 local IT systems in the counties. That translates into estimated savings of $50 million – a one-year return on investment in IT infrastructure and productivity gains alone. The state's citizens now have an easy-to-use Web site that gives them considerable control over their health care choices. A standard registration process automates data collection; one benefit is that individuals transferred to another county no longer have to reregister. The support coordinators now use a standardized Web-based tool to work with the consumer and family, and they keep all their case notes organized within the HCSIS. In effect, the HCSIS provides OMR’s stakeholders with a kind of “yellow pages”– the difference being that they can continually input information, analyze it and access it from anywhere using the Internet.
Each county has access to the information its employees need to make key decisions about the service and support they offer; the HCSIS conveys the same expectations from county to county. The HCSIS quality initiative gives the state the information required to properly monitor consumer satisfaction and compliance with all guidelines. It allows users to report and track incidents via the Internet; the wealth of data captured by the system also offers unprecedented opportunities to analyze trends. And, the OMR now has the financial management tools to track factors such as the “burn rate” of allocated funds as consumers use its services.
The success of the project has led the DPW to extend the project’s scope to other offices. The Office of Social Programs is just one example: The HCSIS is being rolled out as the state’s information system for management of all Medicaid waivers. Other state departments, such as the Department of Health, are identifying programs that could adopt the HCSIS. But the real signal of the HCSIS’ achievement is the attention it has been getting from administrators from other states. It has become something of a gold standard. The program recently won "CIO Magazine’s" prestigious “2005 Enterprise Value Award,” and it has been a key attraction at state administrators’ conferences.