Tackling complex Dependency: Lessons From...

Tackling complex Dependency: Lessons From NYC

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1© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. 1

Why Focus on Breaking Down Information Silos? 11.30

How did NYC Disrupt Barriers and Share Information? 11.35

What Lessons Can We Apply? 12.00

Questions 12.10

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END

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2© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.

Why Focus on Breaking Down Information Silos?

New devolved powers from central government to commission better care to residents, along with ground breaking plans to integrate health and social care with the NHS and Police, present a once in a generation opportunity to transform and remodel its services, improve outcomes for residents and reduce costs. The ability to access timely accurate information across public services will be fundamentally at the heart of this transformation and the ability to better serve our complex dependent population.

Once in a generation opportunity

Establishing a information sharing and coordination capacity is essential for serving those most in need whilst reducing the cost of delivery with shrinking budgets. Without an ability to see its residents holistically, Authorities cannot understand the complex problems and circumstances shared by its most troubled residents that consume the highest percentage of resources as well as eliminate any duplication in the system.

Information Sharing is a critical foundation for tackling complex dependency

The Biggest Barriers are Leadership, Governance, and Trust NotTechnology

Lack of Leadership and Mandate for Sharing Information

Absence of Common Governance Processes

Perceived or Actual Legal and Policy Barriers or Complexity

Not Enough Stakeholder Engagement and Participation



Breaking Down Silos: Turning Data into Insight and Intelligence

1) Earlier Access to the Right Services2) Quicker Decision Making3) Coordinated Care through Transitions and Issues4) Decreased Recidivism

1) Lower Cost of Service2) Reduced Fraud, Waste, and Error3) Improved Productivity and Collaboration4) Enabled mobile resident and worker self-service

1) Real-time Holistic View of Individuals and Families2) Situation/Event-based Awareness3) Population Based Insight over Time4) Pattern Recognition and Prediction

Better Outcomes

Improved Efficiency

More Insight

Tackling Complex Dependency

More Insight from Data is a critical enabler of the Combined Authority; it will:

• Make new collaboration and service models possible;

• Create economic efficiency and savings that can be reinvested in care; and

• Drive better outcomes for residents across Greater Manchester.

Data is a Resource and Asset:



The New York Story



Health and Social Care agencies were limited in their ability to share information, which constrains their ability to improve service delivery and associated decision making. Specific limitations include:

THE PROBLEM

Limited resident-centric approach to service delivery reduces accessibility to services, transparency in government procedures and accountability for outcomes of shared residents

Inadequate data sharing capabilities decrease the ability of City agencies to view residents holistically, tailor services to their specific needs and identify persons at-risk in a timely fashion

Manual and/or redundant business processes for key activities such as data entry, data matching and application processing result in increased cost per transaction and slow service delivery which in turn make for low resident satisfaction and poor worker morale

No common standards and complex policies across agencies for critical areas such as Information governance, IT security, data confidentiality, etc. make it difficult for agencies to feel confident about sharing information with other agencies

No self service and mobile options for residents; an inability to meet their expectations of self service

Budget constraints and mandated efficiency and savings target

Rising caseloads; constrained resources to serve those caseloads

● The NYC Human Resources Administration has 14,000 employees and serves over 3 million people

● Spends $58bn annually, $1-2bn on IT

● A network of NYC agencies that serve over 4.5 million people

● Home to 8 million

● Employs 250,000

NYC Scale



Eight Agencies in one Domain



NEW YORK CITY’S JOURNEY: HEALTH AND HUMAN SERVICES CONNECT

Providing Better Client Service

Reducing Cost and Creating Efficiency

Breaking Down Information Silos

Improving Worker Experience

Creating a Health and Social Care Enterprise



NYC HHS-CONNECT VISION

To break information silos through the use of modernized technology and coordinated agency practices to more efficiently and effectively provide Health and Human Services to clients.

VISION

GUIDING PRINCIPLES

Establish a Client-Centric Approach

Increase and Manage Accessibility of Information

Improve Accountability

Utilize Modern and Flexible Technology

OBJECTIVES

Provide a 360 view of client and the services they receive

Facilitate information sharing and collaboration between City, State and providers

Allow clients to provide information once

Have clients interact with the City versusmultiple Agency stovepipes



How did NYC Disrupt Barriers and Share Information?



CREATING A PROGRAMME AND BRAND

In March 2008, with the signing of Executive Order 114, Mayor Bloomberg established the HHS-Connect program

Data Sharing as a mission Its own space and team

Since then, the HHS-Connect governance structure and process have provided effective direction and oversight in all strategic, policy, legal, and operational matters related to cross-agency data sharing.

A separate programme and brand “to consider all data for data sharing, while ensuring compliance with federal, state, and local laws and regulations.”

Executive Order 114 stipulates that: § 3. Data Sharing. For the purposes of HHS-Connect, agencies shall consider all data for data sharing while ensuring compliance with all applicable Federal, State and local laws and regulations. To facilitate datasharing, agencies shall work with the HHS-Connect team to identify data sharing needs, as well as sources and types of data. Data sharing shall occur in a timely fashion and agencies shall facilitate real-time data exchanges whenever possible, as set forth by the HHS-Connect data sharing strategy.



Vision to Action: HHS-Connect

FoundationalInitiatives

KeyCapabilitiesImplemented Access NYC

(client portal)

Worker Connect(workerportal)

EnterpriseCase

Management

CommonClientIndex

DocumentManagement

Momentum and trust built using achievement of Quick Wins

Governance Enterprise architecture

Outcomemodel

Net presentvalue model

Federated data sharingarchitecture

Informationexchangestandards

Enterprisesecurity

Policy & legal



A Use Case Driven Process

Use Case Creation

Permissible in Law

Economic Impact

Human Impact

Rigorously Documented

• Basis in Law• Privacy• Consent• Sharing

Agreement(s)

Collaborative Challenge

• Duty to share• Duty to protect• Duty to balance

Automated and Reusable

• Automatesharing rules & documentation

• Reuse patterns and tools for sharing

Outcome Based

• Human and economic impact first

• Linked to a measurable benefit



FACILITATING CROSS-AGENCY SERVICE COORDINATION

Cross-agency collaborationHelp agencies focus on case / client life events and cross-agency service planning.

● Case Event Notification

● Client Calendar

● “Virtual” case management – assessment, planning, linkage



A KEY ACCELERATOR: FEDERATED APPROACH

What Lessons can We Apply?



Lessons for Devolved Data Sharing

Lesson Description

Creating an organisation and mandate to for data sharing

■ Establishment of clear mandate and accountability for cross authority data sharing

■ Governance with inclusive involvement and clear sponsorship

■ Drive empowered decision making downward

Build a robust information governance and decision making function

Programme should be business led and focused on its stakeholders

Place the right delivery and technology bets

■ Create an authority wide information governance function that starts with the duty to share

■ Framework to evaluate, prioritise, and track initiatives based on benefits and feasibility

■ Invest in a cross authority stakeholder engagement function to foster partnership and participation

■ Include a training and communication capability to share vision, provide knowledge, and create confidence

■ Establish programme momentum with incremental quick wins

■ Invest in federated data sharing, data standards, and a common resident index

■ A flexible programme that expects to learn from experience

© 2015 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.

The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks of KPMG International.

Produced by Create Graphics/Document number: CRT041541G

If you have any questions or would like further information in relation to the proposal please contact:

Eric ApplewhiteDirectorKPMG LLPMobile: +44 (0)7796 937808

Katie JohnstonDirectorKPMG LLPMobile: +44 (0)7917 050438

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