The agency's case management struggles are monumental. "We need to have a total picture of a client's situation in order to manage their cases properly," Elbaz explained. "But we've never had a consolidated view because the systems can't talk to one another."
Help is beginning to emerge in the form of a unique, integrated social services initiative called HHS-Connect. The project gives some city workers, like Elbaz, the capability to view data from some shared databases involving HRA and city agencies that handle services for the elderly, homeless and children. And that's just the beginning.
Eventually caseworkers -- whether they work for the city or for the many nonprofit agencies that are contracted to deliver critical services to its neediest residents -- will be able to see a client's history, family composition, and immediate and future needs. They will have the most comprehensive view of any health and human services agency in the country.
The vision for providing New York's poor with speedy and comprehensive service has existed for several years, but technology has been a major roadblock, according to Linda Gibbs, deputy mayor for Health and Human Services (HHS). "We realized we couldn't achieve the vision until we have the tools," she said. Those tools, in the form of software applications, middleware and databases, could revolutionize how government helps those in need. They could solve what Gibbs calls the "perennial problem" of getting siloed organizations to share data. Caseworkers could give families the resources to stay on their feet rather than just solve a crisis.
To reach those goals, Gibbs puts her faith in technology. She also believes in the man she chose to run HHS-Connect, CIO Kamal Bherwani.
Beginning to Connect
New York City's quest for better tools like HHS-Connect started when Gibbs was commissioner of the city's Department of Homeless Services. Reform-minded Mayor Michael Bloomberg pushed her to think beyond traditional social services delivery. She and the commissioners for other health and human services agencies realized that the road to reform was through collaboration. "Sometimes the best way to serve a family is not always with the tools within your own agency, but also with the collaboration and tools within the other agencies of your jurisdiction," she said.At the start of the mayor's second term in office, a real opportunity for change opened up when Bloomberg created the new position of deputy mayor for all of the city's health and human services. Gibbs accepted the job with the request that her responsibilities include the city's agencies for corrections, probation and juvenile justice. By including these judicial departments within her portfolio, Gibbs felt the city could offer valuable services for the first time to one of the most marginalized segments of the city's population.
Gibbs' expansive role gets to the heart of HHS-Connect: It's a way to get siloed organizations to operate effectively at both the planning level and on the front line. "How do you help the caseworker who is dealing with a homeless family connect with all the resources necessary to treat the family's situation holistically?" she asked. "It's not just about the crisis of homelessness that needs to be addressed.
It's about some of those issues further upstream that may have precipitated homelessness, including unemployment, illness and incarceration."
By working with agency commissioners, Gibbs developed a vision for more collaboration. But she soon realized those plans might go nowhere without a technological overhaul. Gibbs attacked the issue in two ways: She created a strategic road map for how the problem could be solved with the help of outside consultant Deloitte. And she brought in Bherwani to oversee technology strategy and architecture across the nine organizations that compose New York City's HHS domain.
Bherwani took on the job, not as glorified project manager, but as he described it, as a "forward-looking strategist who ensures that agency information and systems don't become siloed." He has more than 20 years' experience in the public and private sectors, most recently as CIO of the city's Department of Health and Mental Hygiene.
Bherwani's plan started with the simple proposition that the HHS needed a data-driven transformation, rather than a makeover based on computer systems. "The goal wasn't to make operations more efficient and compliant by a certain percent, but to reshape the way we think about service delivery," he said. "We also wanted to leverage our IT assets, not throw them away."
Risks and Rewards
Reshaping service delivery means not just building a client-centric approach to how work is done, but also providing better access to information and greater accountability through the use of more flexible technology. Bherwani's challenge has been to craft a strategy that would involve, to various degrees, the input of 13 city agencies -- some of which dwarf the size of many state agencies across the country.The first secret to making the project work starts with the CEO-CIO relationship between Gibbs and Bherwani. "Deputy Mayor [Gibbs] is very passionate about changing the way we do service delivery," Bherwani said. "My job is to figure out how to get that done with technology." Although that close partnership is unusual in the public sector, it has allowed HHS-Connect to move forward with speed, clarity and relatively little turbulence.
The other secret is that Bherwani and Gibbs were able to determine how to integrate everyone's thoughts into a single vision, break that down to an outcome model, set goals and use metrics to measure progress. This model gave the project a sufficient amount of transparency and accountability to silence the naysayers.
They did this through a governance structure that was set down in a series of executive orders. They required all participating agencies to share their data unless it was against the law and that all agency commissioners cooperate with the Office of the CIO for HHS. In addition, every participating commissioner was required to attend all executive-level technology meetings. No substitutes were allowed, according to Bherwani.
"We set it up this way because we felt it was important to have active involvement of all the top-level commissioners in order to structure the project for success," he explained. "Put all these steps we took together, and they help to mitigate the risk in the project."
Controlling risk was a big factor. "We took the culture of the project's team, which was very risk-averse, and got them to embrace risk. You can't pretend there won't be barriers along the way. The earlier you know about them, the more time you have to fix them before the train gets off the track."
Bherwani decided to put the project's various risk factors into what he calls a "risk register," a dashboard that tracks the probability, impact and time to impact of potential problems. With it, key stakeholders -- the commissioners -- could see exactly where issues might occur next, and which the agencies were impacting project risk.
"That kind of transparency leads to accountability
among the commissioners," Bherwani said. It also changes behavior by elevating trust between the business units that have so much at stake in the project, and the IT team that's driving the change through technology.
The other key factor was quantifying the project's value as a return on investment. Bherwani said this allowed the commissioners to see that their investments, while carrying certain risks, did generate a return. It was a value that could be measured in concrete terms, either as a societal benefit or an operational efficiency. Together, the risk-and-return equation has given the commissioners an incentive to continue investing as the project progresses.
Quick Wins
Quick wins are imperative to HHS-Connect's momentum because it's so big, involves so many players, and is spread over several years of design and implementation. In August 2008, HHS-Connect launched an online application for school meals, involving the city's Department of Education and ACCESS NYC, a Web site where residents can check federal benefits eligibility.In December 2008, HHS-Connect launched a portal called Worker Connect that gave a limited number of caseworkers access to client information -- basic demographics; a financial snapshot; address; employment history; as well as existing and historical information about a client's enrollment in food stamps, Medicaid and the Temporary Assistance for Needy Families (TANF) program. The portal will expand to include more data sources and will be available to thousands of caseworkers by early 2010.
Most important of all so far, HHS-Connect has built a common client index (CCI), which is a master registry of client links, initially, across several HHS programs: Medicaid/TANF, child care/HeadStart, homeless services, food stamps, housing and the aging. The CCI uses defined rules to match client records from different systems based on demographic data. Eventually the CCI will be bolstered by a federated document management solution that will use the agencies' underlying image repositories, containing millions of unstructured data.
These are foundation pieces for what will form the crown jewel of HHS-Connect: an enterprise case management system that will provide caseworkers with a client-centric, holistic view of a person's circumstances.
It also will help people like Nechama Stolzenberg, an administrator with the Yeled V'Yalda Early Childhood Center in Brooklyn -- one of the many small, nonprofit agencies that dispense social services to needy families. Stolzenberg administers the government-funded nutrition program for women, infants and children. With more than 7,000 participants at Yeled V'Yalda, coping with the caseload is a daily struggle. Not having access to every client's full case history just adds to the uncertainty of whether caseworkers are exhausting possibilities.
Stolzenberg said an integrated case management system will help transform how she helps her clients. Already, she's seeing some of the results, as visitors can use terminals in the center to log on to ACCESS NYC and check their eligibility for benefits in a private and dignified manner, she said.
Best Practice Model
Even though HHS-Connect is a work in progress, others are already hailing it as a best practice and model for other health and human services agencies in the public sector. John Teeter, deputy CIO of the U.S. Department of Health and Human Services, called HHS-Connect "a great initiative that starts with a foundation of best practice for data standards and data exchange."Teeter also is a member of the National Information Exchange Model, a forum founded by the U.S. Department of Justice and the Department of Homeland Security to develop and support information exchange standards among government agencies. While originally focusing on the exchange of judicial data in standardized formats, Teeter said the HHS has joined to support best practices in its field.
"Other state HHS agencies have adopted the exchange model in a broad sense, but New York City has moved further along, showing how it can be done, and in the process, become a best practice," he said.
For the city's commissioners who are investing in HHS-Connect, having a nationally recognized data exchange model is fine. But outcomes in terms of speed, accurate assessments, and satisfied customers and workers are the bottom line. Commissioner Robert Doar, who heads the Human Resources Administration -- the biggest player in the HHS -- said the agency needs HHS-Connect so that case handling is more convenient, faster, widespread and more comprehensive.
The thorniest issue he faces is the legality of exchanging certain aspects of client information between agencies. "That will be the toughest issue for all of us [involved in HHS-Connect] because there come times when one agency is holding data that we need to see ourselves," Doar said. "Navigating those legal issues will be difficult."
But that's where Gibbs' role comes into play. "Linda is there to look out over the whole picture in regards to the legal issues of sharing information and then negotiate and resolve these issues," Doar said. "She really understands how these programs interact now and how they need to interact better. She's very good at navigating."
Recession-Proof
When the initial phase of HHS-Connect started in 2007, the nation's current financial crisis was just a distant rumble. Today New York City plans to spend $86 million on the project's first phase, concurrent to the worst recession since the Great Depression. Despite the fact that every city agency has taken some capital cuts, HHS-Connect has remained largely unscathed so far, according to Gibbs.One reason for such stability is that the project has strong support from New York City CIO Paul Cosgrave. The city's Office of Management and Budget also has been a big champion consolidating siloed systems to generate long-term savings.
Gibbs also thinks that by splitting the initiative into multiple phases, each with its own competitive procurement process, the project builds incrementally. Gibbs is quick to credit Bherwani for ensuring that the city gets the best deals for technology investments required by HHS-Connect.
But the real story remains the benefits that HHS-Connect will deliver to clients and caseworkers. Gibbs recalled that her old agency, the Department of Homeless Services, had approximately 60 stand-alone data systems that couldn't exchange information with one another, let alone other city agencies. By removing what were once thought to be insurmountable barriers to data exchange and making it more portable across many systems, the city is quickly reaching a point where city caseworkers and nonprofit organizations, such as Yeled V'Yalda, can form relationships with clients that are simpler and more supportive.
"The wild goose chases for information will be over," Gibbs said.
