1 welcome to san diego ! napipm 2014 34 th annual education conference
TRANSCRIPT
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Welcome to San Diego!NAPIPM 2014
34th Annual Education Conference
POLICIES, PRACTICES & PEOPLE: PERFORMANCE-BASED CONVERGENCE IN ACTION
NICK MACCHIONE, FACHEDIRECTORCOUNTY OF SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY
August 19, 2014
SAN DIEGO COUNTY
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3.2 million residents
5th largest county in the U.S.
Urban & rural, from coast to mountains to desert
18 municipalities, 18 Indian Sovereign
Nations and several unincorporated
towns
2010 Census
White – 48 %
Hispanic – 32%
Asians – 11%
African-American – 5%
Native American – 1%
San Diego County is
4,200 square miles
SAN DIEGO COUNTY GOVERNMENT
Board of Supervisors – publicly elected by District
5 Major Groups Health and Human Services Agency
Created in 1998, Integrated Delivery System
Public-private partnership emphasis
$2+ billion annual budget
6,000 FTEs, 185 advisory boards
~ 1 million clients from Womb to Tomb
Land Use and Environment Group Public Safety Group Community Services Group Finance and General Government4
HEALTH AND HUMAN SERVICES AGENCY
Departments: Aging & Independence Services Behavioral Health Services
o Adult Mental Health
o Children's Mental Health
o Alcohol and Drug Services
Child Welfare Services Public Health Services Eligibility Operations Regional Operations Administration
oProgrammatic links to many County groups including:
Probation, Sheriff, Housing, Libraries
Impact the general public
(3.2M) and clients at risk and at high
risk/need (~1 M)
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Lack of Exercise Poor DietSmoking
PROBLEM
RESULT
3 4 50BEHAVIORS DISEASES PERCENT
Lea
d t
o
Re
su
lt i
n
OV
ER
No Physical ActivityPoor Diet
Tobacco Use
CancerHeart Disease & Stroke
Type 2 DiabetesLung Disease
of deaths in San Diego
GRIM OUTCOME…
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ECONOMIC IMPACT: $4.6 BILLION IN SAN DIEGO COUNTY
COST
Building Better Health
Living Safely
Thriving
SOLUTION
LWSD APPROACH
Change how service is provided to improve health and social wellbeing:
Optimize existing healthcare, public health and social service resources to innovate service delivery, reduce waste and improve outcomes
Create local accountability by all, not some Health & Safety-In-All-Policies
Promote individual responsibility
Achieve fiscal sustainability thru new payment reforms Connect the Unconnected thru modernized IT Advance evidence-based policy-making and planning
COLLABORATIVE BUSINESS MODEL
The Harvard Human Services Value Curve
Efficiency in Achieving Outcomes
Effectiveness in Achieving Outcomes
Regulative Business Model
Generative Business Model
Integrative Business Model
Collaborative Business Model
Outcome F
rontiers
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DRIVING FACTORS
We’re all in the business of serving the public.We need to work together to best leverage existing resources and meet shared goals. The management choices we make are influenced by:
Business Case – Imperatives and Visions
Economy – Budget Cuts and Accountability
Legislation and Expectations – Healthcare Reform, Title 4e, Welfare Reform
Technology Changes – Imposed and Advanced
Efficiency in Achieving Outcomes
Effectiveness in Achieving Outcomes
Regulative Business
Model
Generative Business Model
Integrative Business Model
Collaborative Business Model Outco
me
Frontiers
Human Services Value Curve, Antonio Oftelie
Children / Youth•We Can’t Wait•Positive Parenting Program
•Kickstart
Adults•Behavioral Health / Primary Care Integration Summit
•Bridges to Recovery
•In-Home Outreach Team
Older Adults•Aging Summit•Community Care Transition Program
•Passport to Healthy Aging
INTEGRATED SERVICES ACROSS THE LIFESPAN
Drivers:Vision/
StrategyService
DeliveryFinancingWorkforceP3 in Action
Behavioral
Health Services
PrimaryCare
Human Services
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How could the County of San Diego expand the
capacity of its Family Resource Centers to meet
greatly increased demand first for CalFresh (SNAP)
and then Medi-Cal Expansion?
Response:
Re-engineered Eligibility Process, including a new
state-of-the-art Access Customer Service Call Center.
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CHALLENGE
PERFORMANCE CHALLENGE
Performance Sept. 2011
Calls Handled via Self-Service 10,612
Calls Answered 32,717
Abandoned Calls 13,978
Total Calls 59,969
Calls Answered Per Work Day 1,558
% Calls Answered 76.7%
ACCESS Average Wait Time 39:02
Average Handle Time 14:52
Business Process Re-engineering
Data Analysis
Best Practices: Site visits to 211 San Diego, Orange County & San Bernardino
Call Center Vendor Consultation
“Customer” Feedback: Caller Surveys, Staff Focus Groups
PROJECT APPROACH
Staffing
• Immediate intervention
• Long term strategy
Training
• Immediate intervention
• Long term strategy
Call Center Performance
•Strategic Vision•Tactical Management•Interactive Voice Response (IVR)
ACCESS CENTER PROJECT SCOPE
ACCESS CENTER
WALLBOARD TRACKING ACTIVITY
PERFORMANCE MONITORING
Performance Comparison Sept. 2011 July 2013 July 2014
Calls Handled via Self-Service 10,612 18,909 15,081
Calls Answered* 32,717 56,694 66,440
Abandoned Calls* 13,978 13,567 12,461
Total Calls* 59,969 94,828 95,967
Calls Answered Per Work Day 1,558 2,709 3,020
% Calls Answered 76.7% 85.7% 87.0%
ACCESS Average Wait Time 39:02 15:50 13:50
Average Handle Time 14:52 14:01 15:50
*ACCESS + 211
CUSTOMER SERVICE FEEDBACK
Strongly Disagree Disagree
Neutral Strongly Agree Agree
0%
20%
40%
60% 59%
11%
30%26%
9%
64%
Sep 2011July 2014
“I am satisfied with the Call Center.”
KEY TAKE-AWAYS: IT’S ABOUT
Common Vision—Enables strategic alignment and silo-busting
Business Imperative—Innovate to adapt.
Changing the Culture from Within—We are in the wellness business.
Customer, Customer, Customer—Focus on the customer experience and pathways through the system.
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FROM “WELFARE” AND SICK CARE TO WELLNESS
Past
Transactional
Volume-Based
Competitive Advantage
Silos & Categorical
Connecting the Unconnected
Sick Care/Social Welfare
Present and FutureTransformative
Value-Based
Co-opetition
Integrated System
InterOptimibility
Wellness
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CALL TO ACTION
How do we improve
the wellness of our
communities?
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THANK YOU!
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