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What are some common goals of state HHS organizational transformation efforts?

What are some tips on how to achieve them?  

Many of our clients are state government professionals working in health and human services agencies (including the full spectrum of the human services enterprise). The article below is based on our experience working with professionals in this space.

Reading time: 10 mins

Intended readers: State HHS staff considering or designing an organizational change project.

You may have noticed a trend in recent years of state organizations hiring outside experts to come in and assess their organizational structure and processes. As more and more of our state clients seek to benefit from similar efforts, we wanted to provide some observations to help you as you consider organizational transformation projects.  Each agency will have its own unique goals, but there are a few common ones we have observed in recent years.

Article Highlights

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Goal 1  – Use a process improvement project to streamline service delivery

State organizations recognize that their service delivery is often “siloed”, with elements housed in multiple different divisions or departments. These siloes are apparent whenever overlapping benefits programs are reviewed. The recent focus on social determinants has also driven a new effort to integrate human services, and opportunities to observe these siloes have increased.

Because the delivery of services involves so many different parts of a Medicaid agency, including vendor management, provider networking enrollment systems, and quality reporting, this type of project can get complicated quickly. States realize that improving the delivery of a specific service will require a focus on broader organizational re-alignment to meet this goal.

Examples of efforts to improve service delivery using an organizational change project include:

Goal 2  – Improve alignment of Part 2 Provider Manuals policies for a specific population or service type

Streamlining benefits within a single HHS agency – An easy, early win

State organizations often have a strained oversight role given their policy and operational responsibilities for multiple different departments and a wide range of programs. The effort to keep related provider and member policy documents updated can consume an extraordinary amount of agency time. This can be especially true if a state regulatory framework includes legislative review of benefits policy changes.

While many agencies have made great progress in streamlining policy development within their own program portfolio, if yours has not, this can be a great way to energize an organizational transformation project.

Medicaid delivers benefits using categories of services that often overlap. For example, many of the billable codes for the physician’s services category can also be found in the manuals for advanced nurse practitioners. Or manuals for physician assistants. Or telehealth. Each of these programs will have different rules around prior authorization and coding (such as modifiers).

Keeping all these policies up to date and not in conflict can be challenging. The first step towards improving is to make sure you have a team lead over each major service area. For example, you can have a maternal and child health policy lead that is involved in policy development for OB services, EPSDT and your pregnancy medical home. That person can work with the policy leads for each of those programs to ensure the policies create as little obstacles for members and providers to access services as possible.

Once you have a cross-program policy lead for similar service categories, the next step is to implement a consistent method of updating policy manuals (the Part 2 provider manuals). While most agencies have certain changes that require public comment or fiscal analysis, many changes do not fall under those rules. It is important to understand how each of your policy units are making these changes, and on what schedule. Once you have a handle on this, you can work to make them as similar as possible, which will help with downstream efforts like provider education and changes to your MMIS systems.  

 Goal 3 – Improve alignment of sister agency benefits policies for a specific population or service type 

Challenges streamlining benefits policies across multiple HHS agencies- A longer term investment with big payoffs

We often see significant challenges when a single commissioner or director does not have oversight authority over all programs that deliver similar services to beneficiaries. For example, the child welfare agency will serve children in foster care, but so will the Medicaid agency.  Each agency will have it’s own detailed benefit and service manuals for physical health, behavioral health and pharmaceutical benefits for this population.

Integrated eligibility system projects have highlighted many of these conflicts and gaps. As agency staff collaborate to simplify the eligibility pathways for members, they are also having a-ha moments about overlaps in benefit packages. Streamlining eligibility is an important first step, but removing conflicting requirements in the service policy framework offers an entirely new opportunity area to maximize the delivery of human service benefits. Efforts to achieve “braided funding” across HHS agencies have also helped bring awareness to these challenges.

 Goal 4  – Improve customer experience within an agency or service line

Sometimes the biggest opportunity to improve HHS operations is by improving customer service provided to members. We have seen agencies increasingly focused on  the “citizen experience.” However, trying to align old structures with new ways of interacting with members can be difficult.

State agencies are challenged to provider members with a similar experience as they receive in the consumer marketplace more generally.  For example, Medicaid members also interact with cell phone providers, banking providers and a range of other service providers in an increasingly online environment. These models provide more and more opportunities for the customer to direct their own service and solve their own issues using AI and similar help tools. When those same customers interact with an HHS program that uses an outdated approach to customer care, the differences can be dramatic.

Transitioning more activities to self-service, rather than requiring intervention by state staff can be daunting. While this has a technical component (see also our other articles on trends in improving state website design), there is a significant “offline” transformation effort needed to move agency units that have traditionally been insulated from public-facing efforts to being more closely connected to the end user of the service.    

How You Can Address the Challenges of Improving Your Agency’s Organizational Model

We help a range of state agency clients navigate these challenges, and are happy to discuss supporting your efforts at any time.

Besides your own research into this topic, there are a few key tactics that can help you overcome some of the common challenges related to integration of behavioral health and physical health functions:

  1. First conduct a simple internal review to surface concerns your staff have about an organizational change project AND to get some great ideas for focus areasAn organizational transformation project will create anxiety for many team members. It can be helpful to begin by collecting perspectives in a more casual format first. A few starter questions include: What do your staff like about the way business units interact with each other currently? What do they not like? If they had a magic wand to improve customer service, what is the first thing they would do? How do your staff define customers?
  2. Begin with the end-user experience as your project design focus. When you take on an organizational change project for a complicated, large HHS agency, it can be easy to lose sight of the HHS members and providers you are serving. As you design your project, maintain laser-focus on the end-users: program members and the providers who serve them. Find ways to keep this focus in all your workstream analyses, policy reviews and project discussions.
  3. Identify your top 3 customer types and the top 3 services each of them get from you today- Remember you are not starting from scratch, and not everything has to be overhauled.  There are hundreds of thousands (or millions, depending on your state) of members who are receiving services from your program today. Do a high level analysis of the main categories of members and providers, and the main things they need your help with.
  4. Begin an inventory of current workflow solutions being used across your departments today– Almost all organizational change projects result in a set of new investments in workflow technologies. Go ahead and start a simple list of the major ones you are using today.
  5. Identify overlapping policy manuals within your control– Create a grid of provider types and all the different Part 2 provider manuals they can bill in. Use this grid to conduct initial planning discussions with your policy unit staff for optimization.
  6. Conduct an initial workflow mapping pilot project in a small unit– Your project will eventually get into extensive workflow mapping exercises. Pick a smaller unit that is not as connected to other units, and test out how your staff like to conduct these types of exercises. When you scale up to a larger project, you will have already enhanced your process and reduce unnecessary challenges. 

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Trends in state health and human services (HHS) website design

Many of our clients are state government professionals working on the technology side of health and human services agencies. The article below is based on our experience working with professionals in this space.

Intended reader: Government staff involved in web redesign efforts

Reading time: 7 minutes

Key Topics: Why states are revamping sites, What states are doing, Best practice examples,What scope is typically outsourced, Lessons learned and challenges

 Why are states revamping their HHS sites?

In the past few years, states have launched efforts to update their websites for a wide range of agencies. This includes public-facing functions such as employment offices, vehicle licenses, and tax collection offices. And now a trend has emerged with states updating the websites of their health and human service agencies. This includes Medicaid programs, but also child welfare, public health and mental health functions.

This trend is driven by 2 major factors:

  1. Newer technology, particularly around web architecture– This creates new opportunities for the state IT enterprise, and also creates urgency around bringing legacy systems into compliance with modern standards.
  1. An expectation by more of the general public for a streamlined service experience– Most Americans have come to expect a simple, helpful path towards getting what they need from all service providers (including public and private).

Newer technology

One of the main drivers for updating state HHS websites is the need to align legacy web technology and approaches with modern options. Many states developed their websites using older versions of Sharepoint, and those versions are no longer supported. Some state websites were designed to work best with very old versions of browsers. Most were designed before the general use of APIs. Some states are still hosting their websites on-premise, and are looking to move all operations to the cloud.

User expectations

Interacting with state HHS programs is only one small part of a members’ experience with technology systems. With the widespread use of internet-based services, members have come to expect a smooth technology experience that allows them to maximize what they can do for themselves (self-service). They also expect this experience to be simple and similar to what they experience in other areas of their digital life, like retail and banking.

What are states setting out to do?

States are focusing on several key areas, including:

  1. Enhancing the experience of users of their website (both members and program provider users)
  2. Streamlining  presentation of existing program information
  3. Porting some program offline functions to an online model
  4. Increasing agency transparency by reporting of data and sharing copies of vendor contracts  

A few best practice examples

We recently reviewed 6 state websites for a best practices scan:

  1. Arkansas
  2. Minnesota
  3. New Mexico
  4. Ohio
  5. Oklahoma
  6. Texas

Based on our review, states are using their new websites to focus on several key areas of self-service and education for providers and members. The table below provides a summary of our findings.

Functional AreaWhat Best Practice States are Doing with their Websites
Provider Enrollment & RegistrationOnline services provider enrollment and registration for Medicaid program and behavioral health service delivery programs
Licensing & CertificationOnline databases and services for board managed licensures and certifications for individuals in a variety of fields.
WICIncluding information on requirements, eligibility, and application paths for the WIC program.
Vaccinations & ImmunizationsIncluding information on required school vaccination schedules, vaccine availability, flu shot availability, vaccine registries and information for other vaccines.
Opioid AddictionIncluding educational information on opioid misuse and overdose prevention, naloxone, data on the opioid epidemic, prescription opioid disposal, prescribing guidelines and opioid treatment programs.
DiabetesIncludes diabetes prevention, diabetes management, healthy lifestyles programs, information for providers on diabetes, and diabetes research.
Hand Offs to Local Health DepartmentsIncludes food safety permits & inspections, HIV/AIDS programs and testing, children’s health services, and women’s health services.
Vital RecordsIncludes access to birth, death, marriage, and divorce records.
Prescription Drug Monitoring ProgramIncludes registration for pharmacist and prescribers, data, and legislative requirements.
Eligibility for ServicesIncludes eligibility for services under the developmental disabilities administration, behavioral health administration, and public health administration.

What scope are they outsourcing? What are they doing in house?

Overhauling a website that was likely launched 20 years ago can be an overwhelming task. Most states  choose to outsource several key components of the project, including:

  • Project management– Key efforts include managing schedules, change management, and scheduling of state resources.
  • Tech infrastructure– Key efforts include standing up a migration environment, conversion of existing code and IT assets, testing and custom development efforts.
  • Content development – Key efforts include identifying priority services and user personas to use to drive site redesign, and development of test cases to be used by development team.  

What are some of the lessons learned and challenges?

A lot can go wrong in a project like this. Based on what we have seen in recent projects, there are 2 critical areas to get right:

  1. Governance, governance, governance– Without a clear governance process, it is very challenging to move a project forward. Your project will require collaboration across many different business units. Each of those units has different goals and priorities.  There will be many times that a decision will be required, and some unit priorities will be selected over another in order to move forward. Besides the internal decision process challenge, it is important to keep in mind that the overall effort centers around moving the agency to be more public facing (via an enhanced website focused on improving the user experience). As such, there will be more complexities introduced into the decision-making process. Without a clear governance process at the outset, your project will almost certainly be late and of less quality than you want.
  2. Have a plan for what happens after go live–  So much effort goes into getting to go-live for the new site, that it is easy to miss how important the ongoing operation of the improved model is. If you do not have a plan for updating content and continuous improvement of your new site, your website will just become static and outdated again.  

How You Can Address the Challenges of Updating Your State’s HHS Website

Besides your own research into this topic, there are a few key tactics that can help you overcome the common challenges related to updating HHS websites.

Besides your own research into this topic, there are a few key tactics that can help you overcome the common challenges related to updating HHS websites. We provide this type of assistance to our government clients, and are happy to have a conversation anytime. If our services and expertise are a fit for your needs as you develop or execute your strategy, engaging with us is a simple process. If we are not the right fit, we are happy to make a referral to another firm who may be.

  1. Keep the end user experience central to your design focus. Remember, your customers are immersed in an online world outside of your website. Their online experience with social media, banking, and retail have created an expectation of self-service, speed and simplicity. In order to meet these expectations, you should engage a firm with deep expertise in the space, but that also has a practice area focused HHS website users persona development. It is critical to align technical design with real person use patterns.
  2. Include operational success in your initial planning. If you only plan for the design, development and implementation of your new website, you will fail after go-live. You must set your efforts up for successful and sustained operations from day 1.  
  3. Review and update your decision-making processes (governance) related to the effort before beginning the project. You will encounter challenging decisions early on in the planning stages of the project. Investing in a shared and relevant framework for making project decisions is one of the most important things you can do for project success.  
  4. Think about website content differently, and get assistance creating it – Most internal users (government employees) think very differently about the content that is helpful on a website compared to your external customers (members, providers, and other members of the general public). Your staff are already overtaxed with their normal duties and overall project efforts for the website redesign. Asking them to create (or repurpose) content for the site in a way that end-users will value is most likely unrealistic.

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Arkansas Legislature Passes Medicaid Expansion Program

MM Curator summary

Arkansas completed the legislative repositioning needed to make the program acceptable to the new administration.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Rep. Michelle Gray, R-Melbourne, presents Senate Bill 410 to the House.

Credit Arkansas House

The Arkansas Legislature has passed a new version of its Medicaid expansion program.

The House voted 64-34 Tuesday to pass Senate Bill 410, meaning it now goes to Gov. Asa Hutchinson, where if signed, the bill will become law.

The state’s current plan, Arkansas Works, is set to sunset, or end, this year. The new plan, entitled the Arkansas Health and Opportunity for Me or ARHOME, would retain the current private insurance model for purchasing health plans for participants. Unlike Arkansas Works, there is no work requirement.

Rep. Michelle Gray, R- Melbourne, presented the bill to the House floor.

“Even though I might disagree with some of the things that this does philosophically. Functionally, pragmatically for the state of Arkansas it makes sense for us. It works for us. We’ve had 57 hospitals between Arkansas and all our border states close in the last 10 years. Arkansas has only had had one of those 57,” Gray said.

According to Gray, the bill is not the new program itself, but rather the framework for the waiver request that the state will make to the Center for Medicare and Medicaid Services.

Rep. Mary Bentley, R-Perryville, was one of two lawmakers to speak against the legislation.

“You new guys are hearing ‘If we don’t vote for this then our small hospitals are going to shut down.’ Well you know what, there’s another bill. And Rep. [Josh] Miller, has another bill to do fee for service for everybody and let’s fix the system. Let’s raise the reimbursement rate so physicians can see our patients so we can have better health outcomes,” Bentley said.

The House also voted to suspend the current face mask requirement in the House beginning on April 1. Gov. Asa Hutchinson announced a lifting of the statewide mask mandate on Tuesday.

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