A Better Way to Build Modern Safety-Net Systems

There are both benefits and challenges to a modular, agile approach to modernizing health and human services technology.
December 22, 2016
By David Hansell  |  Contributor
Leader of KPMG's Health and Human Services Center of Excellence

Driven largely by federal policy direction and financial incentives, the past several years have seen a wave of efforts to modernize state health and human services systems, some of which were built as long ago as the 1970s and '80s. The recent federal initiatives have spurred states to act on long-held visions for replacing outdated systems that support core safety-net programs with more efficient, streamlined, businesslike ones.

This surge has also led to an important re-examination of the way such systems are procured and implemented as agencies navigate the shift from the traditional slow, monolithic approach to modular, agile alternatives. At the same time, agencies are looking toward integrated operations to better meet the evolving needs of both caseworkers (who want mobile solutions that allow for easier information sharing and access to critical data) and clients (who often seek services from multiple agencies, with none able to get a full picture of their needs).

States are increasingly looking to build new technology with development processes that have become well established and proven in the commercial world. As they seek to evolve their modernization projects from a traditional, monolithic approach to a more flexible one, there is much to be learned from recent projects about potential benefits and challenges.

The traditional "big bang" approach is increasingly seen as high-risk and as too slow and cumbersome to deliver optimal results. One benefit of the modular approach is that it breaks down large and complex projects into smaller increments, making the overall effort more manageable. Take, for example, the experience of Texas' Department of Family and Protective Services. In modernizing its child welfare case-management system, the agency initiated component projects when funding was secured, requirements were well established and the organization was ready. It was a successful and cost-effective strategy.

Another benefit is that adopting a modular approach allows public-sector agencies to utilize techniques that have worked well in the private sector, including iterative development, rapid sprint cycles and continuous, user- tested adjustments. And breaking large systems down into separate capabilities gives agencies the flexibility to select the most qualified contractor for each module.

But while the benefits are clear, so are the challenges. While regular component-product rollouts and upgrades are facilitated, it is essential that all phases of a project ultimately merge into a singular functioning system. Establishing an overarching vision of what the final product is intended to do is a critical aspect of modular modernization; it's also something organizations struggle with.

To address that issue, leaders should insist on a "problem first" approach -- pinpointing issues, crafting appropriate solutions and developing a long-range strategy for addressing gaps that are identified. Only then should leaders progress to the IT procurement and development phases. Effectively utilizing the agile method depends ultimately on project management and governance structures that facilitate collaboration across multiple stakeholder groups. One simple, yet effective approach comes from New Jersey's Office of Information Technology, which created a workgroup of IT project-management officers who meet regularly to share tools and best practices.

But addressing IT needs is only half the battle. Leaders must also plan for managing and communicating the change, as well as training staff and monitoring implementation. Some states are moving away from classroom training, turning instead to e-learning approaches that are more accessible to all.

IT modernization is a colossal undertaking, and the shift to a more agile approach to IT procurement will continue to present both opportunities and challenges. But agencies that are able to successfully manage this shift will be in the best position to deliver services to the children and families who need them most in an efficient, cost-effective manner. And that's really the ultimate goal.