Zachary Tumin is the Associate Director for Programs in Technology, Networks and Governance at the Ash Institute of Harvard Universitty's John F. Kennedy School of Government.E-mail: email@example.com
New York's HHS-Connect: IT Crosses Boundaries in a Shared-Mission World
A new initiative is underway in New York City that will boldly, literally, go where social services has never gone before.
Under the leadership of Deputy Mayor for Health and Human Services Linda Gibbs and her chief information officer, Kamal Bherwani, HHS-Connect is stitching together the information operations of the nine agencies comprising the City's sprawling health and human services domain.
That domain needs to sprawl. New York City is big - the 4th largest government in the United States, and the 16th in the world. Home to eight million people, employing about a quarter million. Health and Human services itself serves about two million people with services ranging from corrections and probation, to health, mental hygiene, and public hospitals, to Medicaid, Medicare, child protective services and services to the aging.
The City's health and human services chiefs all acknowledge a shared mission - self-sufficiency for their clients, safety for citizens, economy for the City. They also pursue 1200 diverse operational missions -- from birth certificates to Medicaid reimbursements, to incarcerations and release.
How can anyone assure that the sum of 1200 operational missions floats the city's own boat highest - achieves those shared goals "better, faster, cheaper" as MIT's Steven Spear puts it in Chasing the Rabbit, his recent book on boundary-spanning organizations, "managing the pieces for the whole"?
The inspiration for HHS-Connect came from an elevator introduction and lunch at a local restaurant eight years ago, between two then-new New York City Commissioners. Linda Gibbs was Commissioner of the Department of Homeless Services. Her offices shared a building with Martin F. Horn's, then and now Commissioner of Probation and Corrections.
"Marty's job was to keep them locked up," Gibbs told a recent Harvard audience. "Marty went beyond the mission. He said, 'Yes, that's my job, but I care about the outcomes for these guys. I want to see them not being re-arrested.' He knew from research that the most likely to be re-arrested were those with histories of homelessness who left jail without a place to go, and were in shelter."
Gibbs' job was to make sure that all homeless people in New York had a bed to sleep in, food, and were well-cared for. "But I very much wanted the job not to continue to be to supervise 40,000 homeless people, but to see if we could actually reduce homelessness in the city."
Gibbs and Horn talked about how they could collaborate to bring their resources and efforts together - how they might have more mission success if they did than either could accomplish alone.
In a shared-mission environment, they realized, no one can go it alone. Collaboration was the key to their individual success, and the City's.
The conversation expanded to include other commissioners. Initially focused on business practices, policies and programs, the commissioners ultimately confronted the 800-pound gorilla in the room.
"We were constantly plagued with this challenge that it was impossible to get our systems to talk to each other," Gibbs recalled.
Today, HHS-Connect is the lynchpin of the City's strategy for cross-boundary reform of the social services domain. It is focused on a better experience for the client, for the worker, and for the City. Bherwani co-chairs an Executive Steering Committee, which includes the nine agency chiefs, OMB, and NYC Chief Information Officer Paul Cosgrave.
As an IT professional, Kamal Bherwani describes HHS-Connect as an integration platform that is architected to achieve a specific purpose. Like a Ferrari that is architected to go fast, or alpine systems that help humans climb mountains, or lunar missions that support voyage and exploration, HHS-Connect is the platform that architects for safety, self-sufficiency and economy in the provisioning of the city's health and human services.
In a cross-boundary operation, that's huge: how to optimize for safety, security and stability of a family in crisis, for example, challenges every social service organization. Pull too hard on the safety oar, and the family can be broken apart. Pull too hard on the stability oar and you can expose vulnerable children to awful risk. Each strategy has human and financial costs.
Typically, most agencies throw either a bevy or a shortage of resources at problems, hoping something sticks. Hit or miss, over- or under-resourced: New York was no different.
"Early on," Gibbs said, "we found a 60 percent overlap of the clients. On average five agencies would be involved with a single family - but they didn't know about each others' presence in the household. They didn't know when it started. They didn't know when it stopped. They didn't know what happened. They didn't know what information was gathered."
The clients fared no better. "You could be standing on line with twenty people behind you and we would say, 'Go get your birth certificate,' when we - the City - had already asked you for it a dozen times before."
Gibbs' plan is to use HHS-Connect as a management information system which supports overall City performance management and budget decisions. More than that, by linking all the nine agency's data together, HHS-Connect also provides the opportunity for workers to do one-stop shopping for data via what is known as the Worker Portal, and for clients to do one-stop shopping via the Client Portal.
All three capabilities are vital - potentially enabling customer service or cash flow gains from reduced waiting times for services at City hospitals, for example; faster Medicaid reimbursements to the City; and more robust support services for prisoners when released.
Each of those is part of the HHS-Connect business case. HHS-Connect is being built upon an astounding analytic foundation. The city has invested heavily in the "prep" work - linking 600 operational measures to a series of overall outcome measures, for example. As 600 individual indicators move, so will the needles on the overall outcome measures.
Stitching it all together, the HHS-Connect development team built a common client index so that clients now have a unique identifier no matter whose system they're in. Seasoned analytic professionals like Accenture's Marc Marin, who has worked New York's state and local social services beat for years now, helped lay this foundation.
The platform also keeps everyone's eye focused on the outcome measures, and the impact - not just on operational effectiveness, but overall mission. When fully implemented, Bherwani believes, this framework will help guard against either over-or under-investment in new capabilities.
That's important, as the City commissioners have all invested time, budget and staff in HHS Connect. For Bherwani, he's on the spot to show return, and earn new investment.
With such massive builds underway and ahead, Bherwani manages that risk by parsing the rollout into spirals, or stages; managing the risk and return to each; and stitching all together in a "net present value" scheme.
"We don't have a master plan from day one all the way to the top, because we can't see that far," Bherwani said. "We break it down to little milestones, and measure the value of those milestones combined."
Key to this are quick wins that demonstrate value, build trust, and encourage taking the next step.
"With the client portal people can log in, do pre-screening eligibility checking across lots of different programs at City, State, and Federal levels - 35 of them in seven languages- put the information in once, and get an answer that says, 'We think you might be eligible for these 10 things.' Historically, these clients have had to go around to different agencies, apply, find out if they're eligible. It made them waste a lot of time and money. It made the agencies waste a lot of time and money for people who clearly weren't eligible but who would be applying anyway."
What capabilities should HHS-Connect build next? Bherwani uses a net present value scheme borrowed from financial investments to compare the value of competing alternatives.
"We try to think like investors, not accountants," Bherwani told a recent Harvard audience. "Accountants see IT as a cost. We treat IT cost as an investment with expected returns. We manage those investments for their risk, and assure the return."
"Someone suggests, for example, improved homeless outreach, and integration of Department of Homeless Services into HHS-Connect," Bherwani said. "We say, 'Okay, well, let's see.' We sit down with Commissioner and say, "What do you think that return would be to mission effectiveness?" He says, "I don't know -we probably save 20 lives of people who are homeless, freezing in the cold if we have better information about where they are, so we can deploy our people there and try to intervene."
"We're not trying to put a value to a life," Bherwani said. "But we're asking, 'How much investment do we have to make to have a change in that number that we think is positive, and do we think it is worth putting our money there or someplace else next?'"
Taking account of mission-impact of potential next moves in a consistent way helps Bherwani compare value across competing next steps. It's not bloodless and its not rocket science, but it forces forward thinking, permits some rigorous comparison among competing alternatives, and makes it transparent. That builds trust.
"We realized early on that if we didn't communicate well, we wouldn't have trust," Bherwani recently told a Harvard audience. "And if we didn't have trust, they wouldn't participate even if they said they would. So we start with probability, impact, and time to impact as a kind of a methodology."
HHS-Connect is poised for a next stage expansion. A cross-boundary vision, an architecture to deliver on it, and an approach as an investor smartly managing risk has brought the City to this gate. The next moves will be all the more compelling to watch.
Zachary Tumin is the Associate Director for Programs in Technology, Networks and Governance at the Ash Institute of Harvard University's John F. Kennedy School of Government. He is also the contributing editor, technology, for the Better, Faster, Cheaper site. "Collaborate or Perish!" by William J. Bratton and Zachary Tumin will be published by Crown/Broadway Business, a division of Random House, in 2011.