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5 Trends Driving the Future of Human Services

April 1, 2013 By Tracy Wareing, executive director of the American Public Human Services Association and Howard H. Hendrick, director of Human Services Business Strategy for Accenture and former director of Oklahoma’s Department of Human Services

Henry Ford unveiled the Model T in 1908 in a defining moment that changed travel and manufacturing—and influenced American life for years. Ford’s innovation and others like it—the airplane, the television, the Internet and the mobile phone—shattered the status quo, introducing the next frontier in how people live and work. While it’s not the stuff of history books, human services innovation is equally powerful. It’s happening now, fueled by trends that help agencies deliver outcomes today while preparing for tomorrow. 

Today’s do-more-with-less environment is more the rule than the exception. The political pressure to avoid displaying material reductions in service while costs increase and revenues fall is driving change in human services. Leaders know that processes, technologies and cultures must all be part of the change equation to deliver high-quality, cost-effective services. A recent survey of 2012 Human Services Summit attendees revealed a consensus around the value of progressing along the Human Services Value Curve (a framework developed by Antonio Oftelie at Harvard University), citing it as a high priority. Yet respondents acknowledged that moving their organizations to greater levels of maturity is a significant challenge. 

How can agencies move through the challenges of change? What today’s pragmatic human services leaders understand is that innovation does not have to be an all-or-nothing proposition—and that it is never a one-size-fits-all proposition. Innovation can be about bold moves or subtle shifts, and it can occur all at once at scale or incrementally in pockets and across functional areas.

Whatever the future of human services innovation looks like, the key for organizations lies in making the most of the forces of change in alignment with their unique circumstances. It’s about harnessing burgeoning ideas, trends and innovations that can bring about outcomes and impact in the short term—and hold strong potential for continued progress five or even ten years from now. So what are the most promising trends in human services? And how can organizations take advantage of them to move to greater levels of outcomes and impact for the people they serve? 

Human services organizations sometimes have entrenched ways of working. It is not uncommon for service delivery functions within a single agency to be isolated from one another, despite redundancies that mean higher costs and lower-quality services. Government agencies and nonprofit community-based organizations often work in parallel, but rarely with explicitly common goals and practices. 

Recognizing the need to maximize resource use and offer fresh ideas, some human services organizations are breaking through longstanding barriers and exploring nontraditional partnerships with each other—both nonprofits and the private sector. The result is a new human services ecosystem where organizations forge interactive and interdependent relationships that are mutually beneficial and directed toward a common goal. 

This mix of new people and resources creates important advantages. Working together broadens the discussion around the role of human services with other state and community services. It forces every contributing organization to consider core competencies and determine how the collective can best function for greater, system-wide impact at less cost. It adds a client and community-centered approach to program-centered accountabilities, and creates stronger social services through collaboration. 

The relationship between the Arizona Commerce Authority and the Arizona Department of Economic Security reflects the potential of nontraditional collaboration. Once operating in isolation, the state’s job generation mechanism and its human services system are finding ways to come together to meet their distinct missions while seizing the potential for collaboration where clear intersections exist. 

If this trend continues over the next five years, human services delivery could change dramatically. Broad coalitions of organizations with the right skills and resources led by human services agencies would jointly provide coordinated, cradle-to-grave human services with a shared emphasis on work, higher paying jobs with skill-ready workers and early intervention—minimizing the need for deeper-end government services.

An extension of this partnership climate, pay-for-success contracts are gaining traction as an alternative funding mechanism for human services programs that pays providers of goods or services when outcomes are met. These arrangements take on a variety of forms, and social financing is one of them. The basic principle is to encourage outside investment in preventive social interventions that ultimately benefit the common good—and reduce the need for costly future remediation for which taxpayers will have to pay. 

In social financing, foundations or other non-government entities infuse capital for a specific intervention and, if a predefined social outcome is achieved, funders recoup their investment plus a reasonable rate of return. Prison recidivism programs in the United Kingdom and New York City number among those that have been funded via social financing. Similarly, Dakota County (Minnesota) Community Services, supported by the Bush Foundation, has explored the business case for its Re-entry Assistance Program, developed an outcomes measurement framework, and a re-investment design to support social investment funding. 

Not only do such pay-for-success models align incentives across sectors and promote the wise use of precious taxpayer dollars, they are rooted in a strong outcomes focus. To monetize social outcomes, value must be inherently data-driven and outcomes-based. This drives discussion on measurable impact and emphasizes return on social investment in an entirely new way. Non-government funding opportunities also tend to increase tolerance for the risks that accompany innovation. Continued momentum here could mean that, as soon as five years from now, agencies could regularly pay providers only when social outcomes are met or exceeded. 

The proliferation of data and the sophistication of technology to draw insights from it is a double-edged sword for many human services organizations. While today’s data-rich environment has brought an ability to measure outputs and some outcomes, it can also create a swirl of complex questions without easy answers. What data do we have? What data should we be collecting? How do we protect our data’s integrity? 

Descriptive and predictive analytics are at the heart of the information boon as organizations work to make data insight actionable. Human services agencies using analytics today are most often using descriptive analytics for simple reporting or to detect and correct non-compliance after transactions are completed. The more exciting promise of analytics lies in a more proactive application. Predictive analytics can increase understanding of the relative effectiveness of different programs so that interventions—and resources—can be smartly targeted for better outcomes. As one 2012 Human Services Summit attendee explained: “Analytics is the way we are going to be able to figure out where to target our resources.” 

There is also tremendous potential for organizations to deepen analytics insight to develop preventive interventions that stave off later traumas and future reliance on the social safety net among specific populations. Consider the story of the Hillside Work-Scholarship Connection, a public-private partnership focused on reducing dropout rates among at-risk youth, so they are ready for a productive life after high school. 

Working in the Rochester, New York school district, Hillside used predictive analytics to understand the relationship of specific risk factors—attendance, suspensions and standardized test scores among them—to graduation rates. Hillside understood that some students would graduate without their intervention, and other students would not graduate even with it. The organization developed a data-driven recruitment strategy based on which students would be the most likely to benefit from the program. It’s an approach that improves return on investment for participants and funders alike. 

As the use of analytics matures in the coming years, this success points to a future where key decisions, including resource allocation and service provisioning, are based on known impact and proven results in all aspects of human services delivery.

While public human services delivery is unlike anything in the private sector, this does not mean that agencies have nothing to learn from commercial practices. Even before Henry Ford’s day, the private sector had an R&D model where innovation was valued. 

The opportunity here is for human services leaders to fearlessly challenge “insider” mindsets that see only differences and inconsistencies between private sector and public sector services—and consider the potential of “outsider” innovations. The advantage lies in lower-risk innovation that aligns with consumers’ service delivery expectations. Agencies should consider the example of customer-centered organizations that use multichannel touch points, customer and product segmentation, targeted promotions and self-service options. Translated to the human services environment, such approaches could mean quicker access to jobs, job skill development, eligibility determination and other services, so that people can experience economic recovery faster.

Looking to service delivery innovators in retail, financial services, telecommunications and insurance, the Australia Department of Human Services is reaching people in new ways through service center experiences, self-managed channels and online and mobile options. Targeting students receiving stipends, the Department launched its first mobile app, which allows them to conduct a number of tasks from their smartphones. The Department reports that users are conducting an average of 40,000 transactions per week, which eases pressures on service centers.

As other human services agencies begin to explore such “outsider” practices, what’s business-as-usual in other industries may increasingly define the new face of human services delivery. 

Serving the whole individual, a tenet of human services transformation, is impossible without health and human services integration—from strategic vision through tactical implementation. A 2012 Human Services Summit attendee explained the vision, “The challenge is sustaining a long term strategy to be able to view our customers from eligibility determination through delivery of services and assess health outcomes of the overall populations.”

In recent years, there has been increasing momentum around the connection between these areas, some of it spurred by the requirements of the Affordable Care Act (ACA). Opportunities for coordinated service delivery and holistic planning and economies of scale for infrastructure investments should create positive value where planned vision exists at the start. 

As the mechanisms for paying for and delivering healthcare change post-ACA, it is an optimal time to come together and refocus on measuring the right kind of outcomes. This provides a richer understanding of how overall population health is often an indicator of the effectiveness of specific social programs, revealing “hot spots” for integration. 

Consider the Home and Healthy for Good program in Massachusetts. It provides housing to homeless individuals as a first priority and then focuses on health issues. Data have shown a significant drop in participants’ Medicaid costs, revealing a link between housing and healthcare costs, and highlighting a place where continued and even broader interoperability would likely bring additional value.

As states integrate health and human services, the future vision is one where the distinction between health and human services fades, both in theory and in operation, and wellness is defined holistically as a function of a person’s social, economic, physical and mental state.

Henry Ford’s use of assembly line manufacturing and interchangeable parts helped make the Model T affordable to the common man. While human services organizations share common ground around the need for change, the paths to change are varied. Different organizations will be ripe for different trends. Some jurisdictions are already rich in an entrepreneurial atmosphere, while others may need legislative action as a first step to incubating change. 

Yet for all, success will require adaptive leadership and a pragmatic approach that never lets the perfect be the enemy of the good. The search for improvement is continual, and reaching the next frontier requires the courage to lead. 

This article was published previously in Policy & Practice, the journal of the American Public Human Service Association.

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The future of the Semantic Web: cultural heritage and privacy

By Dr. Heather Packer, Research fellow, the University of Southampton.


After attending both the International Semantic Web Conference (ISWC) and the Joint International Semantic Technology Conference (JIST), I considered what this meant for research and development in this exciting area.


Some of the most interesting work presented at ISWC and JIST were in the areas of cultural heritage, such as the recording of personal stories, and integrating historic maps with new timelines. This was highlighted in the opening keynote at JIST, which was given by Eero Hyvönen of Aalto University in Finland, presenting its work on using Semantic Web technologies to preserve Finnish cultural heritage.


These included the preservation of ancient shoemaking methods, through the digitisation and documentation using Semantic Web metadata with multimedia, interviews and written sources. Secondly, the complete transcription of the Finnish national epic, the Kalevala, into a Semantic narrative, and the process by which topics are linked from their own ontology portal, so that topical connections in the Kalevala narrative can be made with other Finnish cultural heritage work.


Aalto University’s work shows that Semantic Web technologies, such as its Cultural Sampo ontology portal, allow cultural heritage artefacts and narratives from multiple sources to be brought together and automatically cross-referenced. Examples were shown where the cross-linking between sources has already benefitted researchers, with technical barriers easily overcome.


In the future, I am aiming to work towards a Semantic Web which will allow narratives to share workflows and stories about companies, as opposed to more traditional methods like statistics calculated from databases. These narratives can be used to explain things based on people’s past experiences and their interests (taken from their actions on the web), to make them both more useful and engaging.


One problem, however, arises from where is it acceptable to gather and use data. Many of the people I have spoken to in academia and industry have said that information taken from their emails is too intrusive and people as a whole are unwilling to use such a system. However, people are more willing to adopt systems that use information from social networks where they can freely censor information about themselves.


Yet in my experience the most useful information is often to be found precisely in private online places such as email and calendars. In the future I would like the Semantic Web to allow me to attend a conference in another country, and automatically (with optional and minimal input) handle my flights, hotels, conference registrations and restaurant recommendations based on preferences that I had made in the past, such as price range and hotel recommendations and amenities.


In addition to academic research, the Semantic Web also has applications for business and handling personal data. The latter, in particular, has recently seen its research spurred on by a number of initiatives, including the midata initiative from the UK government’s Department for Business, Innovation and Skills (BIS). The initiative, which is due to start in 2013, mandates that companies must supply data they hold about a person back to that person in a machine readable format, and under an open licence.


The Semantic Web provides an obvious framework for enabling this at low cost to businesses – there are already numerous examples of marking up personal data under appropriate licenses such as the Open Government license used on data.gov.uk. Semantic Web technologies would therefore enable businesses to comply with new data protection legislation in a cost-effective manner. End-users that receive their data will also benefit, because there are numerous analysis, visualisation and storage mechanisms which already work with Semantic Web data.


The need for storing, managing, using and sharing personal data continues to grow. In response, numerous business startups which focus on providing such services have been launched. Meanwhile groups such as the W3C Read Write Web community group are discussing approaches to using Semantic Web techniques for publishing, receiving and sharing private data. For users this means that it will be easier to make their data work for them, including sites that use your data to help you save money, such as Bill Monitor, which analyses your mobile phone bill to find out how much you can save by getting a new phone contract. It is very likely that similar services will exist in the future for other utilities, such as electricity, gas, and broadband.


The future of the Semantic Web is making it easier to access increasingly richer presentations of our history and heritage, and also publish, and thus increase the amount of cultural heritage material being preserved and made available online. The future of personal data is also one which is expanding rapidly, towards the goal of helping people to make more financially beneficial purchases, and to better manage their private data.



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Health Insurance Exchanges Are the Future

Over the past two years, many Republican governors held off taking steps to create a health insurance exchange (HIX) in the hopes that Mitt Romney would win the 2012 presidential election and repeal the Affordable Care Act.

And now, some states, particularly those run by Republican governors, are faced with less time to make a big decision — though the federal government did extend the deadline for states to decide whether to establish and operate their own HIXs.

States have three options for an exchange, as dictated by the Affordable Care Act:

States can run their own exchanges, with 100 percent funding from the federal government (though states will likely face costs in updating legacy systems to integrate with the exchange system);An exchange that is state-federal partnership can be established; orStates that choose not to participate in the development of an exchange will have an exchange established and run for them by the federal government.

And it seems the third option may be what will happen in several red states.

Some governors, like Maine Gov. Paul LePage, have completely checked out of the HIX discussion, refusing to participate in any way. “I’m not lifting a finger,” LePage told Bloomberg. LePage returned a $5.8 million federal grant that would have helped his state pay for setting up a partnership exchange.

Other Republican governors that have firmly opposed participation in the program include Florida’s Rick Scott, Louisiana’s Bobby Jindal, Kansas’ Sam Brownback, Texas’ Rick Perry, South Carolina’s Nikki Haley, Georgia’s Nathan Deal, Virginia’s Robert McDonnell, Alabama’s Robert Bentley, Nebraska’s Dave Heineman and Alaska’s Sean Parnell.

While some say that not participating in establishing and operating a HIX will rob states of the opportunity to negotiate the best rates with insurers, some Republicans have argued that they are not prepared to foot a large bill for a program they do not necessarily support. Now faced with the reality of four more years of an Obama administration, other Republican governors are working with the federal government’s deadline extensions to run their own exchange.

Enrollment in health-care plans is scheduled to begin in October 2013, as all Americans are required to be enrolled in a health-care plan by Jan. 1, 2014. But with some Republican leaders dragging their feet and the federal government seemingly willing to offer states flexibility, that timeline could change.

The deadline for states was extended in response to direct requests from some states that wanted more time, according to a spokesperson from the Centers for Medicare and Medicaid. “Our preference is for each state to establish its own exchange because a state-based exchange (SBE) provides states with the most amount of flexibility,” a spokesperson said via email. “There is no one-size-fits-all approach, and an SBE allows a state to structure its exchange in its own way that works for its citizens. For example, a state with its own exchange will be able to make needed changes to enrollment and eligibility, determine how to select plans to participate and how to subsequently manage those plans directly, and how best to educate consumers about the exchange.”

The deadline extensions are a further demonstration of the federal government’s intent to allow states to participate in not only the final rules of their exchanges, but also to be active participants in the whole process, said Gartner Research Director Rick Howard. While the practical effect of the deadline extension may not be to persuade stout opponents of the program to participate, it’s a “good-faith effort” by the federal government to encourage participation, he said.

Florida, Ohio and Missouri seem to be reconsidering some level of involvement in running their own program, Howard said, and Arizona, Utah and Pennsylvania may also find a way to meet the new deadlines. “I think that those governors who have resisted the exchange are doing so on the idea that they’ve seen some price tags that seem to be pretty expensive,” Howard said, adding that Republican governors may just be managing risk conservatively, and many of those now opposed to state-based exchanges may adopt an exchange once real-world models have been developed and demonstrated by other states.

Ultimately, Howard said, exchanges are the future, no matter who is in the White House. “You can wish away the Affordable Care Act, but that’s not going to change the underlying dynamics of the marketplace,” he said. “We’re seeing through merger and acquisitions activities that that’s being borne out. Health plans are looking to survive in a much more consumer-oriented marketplace that they just haven’t had to face before.”

Commercial health care was already headed toward a side-by-side comparison model because the advancement of technology has led consumers to expect more options while shopping, he said, and the Obama administration is trying to bring government up to speed with the marketplace.

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Can Technology ‘Cure’ Health Care’s Future?

Aneesh Chopra, senior adviser of health-care technology strategy at the Advisory Board Co., envisions a scenario where once a doctor has all necessary patient data, she could begin to look at how to best engage the patient in newer ways to improve his overall health outcomes. Photo courtesy of shutterstock.com.

One day soon, patients will routinely interact with doctors via remote telepresence. It’ll be common for people to take digital photographs of medical conditions and send them to health-care professionals for evaluation. And improvements in data capture and analysis will lead the way toward better, more cost-effective medical care.

These are just a few predictions for how health care will evolve over the next 25 years. But the future of health care is cloudy at best, given the broad array of changes that will take place in the health-care system over the next several years. What’s clear is that technology will play a vital role in improving health care for Americans and making the system more sustainable. Whether it’s used to help ease the Medicaid burden on states or to enable patients to be diagnosed more quickly and easily, technology has huge implications for the future of health care … whatever that future may bring. 

In 2009, Medicaid costs accounted for an average of 15.7 percent of states’ general fund spending, according to Medicaid and State Budgets: Looking at the Facts, a publication of the Center for Children and Families. By 2011, that amount had risen to 16.8 percent, with no sign of slowing in sight. Medicaid as it exists today is simply not sustainable. A new model that meets the needs of an aging population is necessary. The Affordable Care Act (ACA) requires states to take a number of steps over the next several years to reform the system. And while the ACA’s future also is in question (Gov. Mitt Romney has promised to repeal all or part of it if he’s elected president), the need for significant reform still is evident, and technology will likely play a role in a number of areas, including enrollment and eligibility, pay-for-performance and electronic medical records.

Cheryl Camillo is a senior researcher with Mathematica Policy Research, a Princeton, N.J.-based research organization. Camillo focuses on ACA and Medicaid and is also the former executive director of the Maryland Office of Eligibility Services. Camillo said the ACA is motivating states to use technology to change the future of Medicaid application and enrollment processes.

“From 2014 through 2019 there will be a substantial transformation of Medicaid due to ACA,” said Camillo. “If it all works out, the Medicaid program in 2020 will be very different than it is today, especially in the eligibility and enrollment areas. The use of IT systems will be a significant part of that.”

Rather than apply to numerous programs to determine eligibility, future applicants would fill out one electronic application and be automatically routed to the most appropriate program with minimal interaction and paperwork — a scenario dramatically different than today’s complex, paper-driven process.

“Information technology is essential to making that happen,” Camillo said. “It will allow people to apply electronically, and the systems will interface behind the scenes. The data needed to determine eligibility would be pulled from sources where it already exists electronically.”

Technology could also play a significant role in changing how providers interact with and manage chronic care patients. According to Alain Enthoven, professor of public and private management at Stanford University and a founder of the Jackson Hole Group, a national think-tank on health-care policy, Medicaid’s open-ended, fee-for-service payment system is a major contributor to the high level and rapid growth of spending. In 2009, the Massachusetts Special Commission on the Health Care Payment System said that fee for service “rewards overuse of services, does not encourage consideration of resource use, and thus cannot build in limitations on cost growth.”

Moving to a fee-for-performance scenario would change how doctors are rewarded while also promoting better outcomes. “Medicaid as we know it is a 1950s-era concept based on acute, episodic care and built around a doctor making a living,” Enthoven said. “In the future it will be more about doctor performance, actually helping improve health, and reducing patient dependence on the doctor. Coaching and electronic exchange of information would replace many in-person visits, and patients would be encouraged to manage their own health.”

Aneesh Chopra, senior adviser of health-care technology strategy at the Advisory Board Co., envisions a similar scenario. “Once a doctor has all the data they need, they could begin to look at how to best engage the patient in newer ways to improve their overall health outcomes. Technology tools could be used to collect patient monitoring data, and doctors could text or call patients instead of having them travel to the office,” Chopra said. “I envision an iPhone App Store scenario where patients download and use tech tools that support behavior change and help them make better health decisions.”

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