Medicaid outcomes, measures, and metrics are here to stay

This October, my colleagues and I attended the National Association of Health Data Organizations (NAHDO) annual meeting in Park City, Utah. NAHDO is a national non-profit membership and educational association dedicated to improving healthcare data collection and use. NAHDO is also a co-founder and member of the All-Payer Claims Database (APCD) Council, which provides leadership and technical assistance to states implementing APCDs. For more on the history of NAHDO, click here.

This year’s conference centered on balancing transparency, privacy, and quality in an age of enhanced reporting on public health information. As a follow-up to the annual meeting, I wanted to share with you some of the key takeaways:

1. Stakeholder engagement is key to achieving increased data transparency. As state agencies, hospitals, researchers, and other health data representatives embark on data transparency-related initiatives, representatives from Colorado, Maine, New Hampshire, and Washington made clear the importance of having the right stakeholders involved from the start. To NAHDO attendees these stakeholders include attorneys, providers, members, state agency representatives, legislators, payers, and others with the subject matter expertise and experience to integrate and publicly share health information data.
2. Collaboration maximizes cost transparency. Collecting cost-related information from providers, and making the information accessible to health data consumers, remains a difficult task for many organizations. Although several states have worked diligently with legislators to mandate that providers supply cost-related information to state health agencies, several other states have partnered with their member, provider, and insurance communities to form work groups that collaborate in the name of making healthcare more accessible and affordable.
3. If you build it, they may not come. Building treasure troves of information for health data consumers is only beneficial if the consumers know the information exists, and are interested in using it. To help spread the word about new web-based platforms and/or tools, organizations across the nation are leveraging creative marketing strategies via Google AdWords and Facebook. Colleagues from Colorado’s Shop for Care, Maine’s CompareMaine, New Hampshire’s HealthCost, New York’s FAIR Health, and Washington’s HealthCareCompare shared their successes and challenges in making the public aware of critical healthcare information. In support of this takeaway, Andrea Clark, BerryDunn’s Senior Analytics Manager, joined colleagues from the Center for Improving Value in Health Care, Washington State, and FAIR Health to speak about BerryDunn’s work helping clients develop enhanced public use healthcare data products. You can read more about that here.

Rally behind “The Year of Data Quality.” During the recent Medicaid Enterprise Systems Conference (MESC) in Portland, Oregon, Julie Boughn—Director of CMS’ Data and Systems Group—named 2018 “The Year of Data Quality.” NAHDO attendees, in support of this mission, highlighted that consistent nation-wide file layouts, coupled with consistent field definitions across databases, could go a long way in improving data quality in health IT solutions, such as APCDs.

In sum, the annual meeting was an excellent venue for hearing from data gurus, state health information officials, and those passionate about affecting change through health data solutions. As the conference in years past was attended mostly by APCD gurus, the stakeholder audience continues to broaden to include all those who have a hand in improving citizens’ health and well-being.

Are you struggling to improve business outcomes through modifications to your software solutions? If so, then you have no doubt tried — or are trying — traditional software implementation approaches. Yet, these methods can overwhelm staff, require strong project management, and consume countless hours (and dollars).

It may be time for your organization to consider the DevOps (Development and Operations) implementation model — a software implementation approach that uses agile methodologies.

The DevOps implementation model — proven to be effective in upgrading large software solutions such as Integrated Eligibility and Enrollment — increases organizational flexibility with frequent prioritization of business problems.

An alternative approach
In contrast to traditional software implementation approaches, the DevOps implementation model features continuous collaboration by the development and operations teams in breaking down, prioritizing, and implementing solution fixes in small release packages. Positive results include improved business prioritization through collaboration, better management of the backlog of software requests, focused development staff efforts, and high-velocity implementation of each release — leading to an improved software solution.

Here are seven essential implementation steps for adopting the DevOps implementation model:

Step 1: Define your software solution’s backlog of outstanding business problems — Understanding the business problems is the first step towards solving them.

Step 2: Prioritize the business backlog using such factors as:

• Operational impact
• Priority and severity levels
• Development level of effort
• Infrastructure considerations

Step 3: Schedule regular team meetings to address the status, prioritization, and resolution of the software solution’s business backlog — keeping the team focused and coordinated increases your efficiency towards resolution.

Step 4: Group prioritized items into small work packages that you can release through the software development life cycle (SDLC) in two- to three-week efforts —helping to keep work packages in small, organized, and manageable packages.

Step 5: Cycle each release through the various stages of the SDLC, utilizing an implementation approach that is defined, documented, and approved by all key stakeholders —providing a predictable and repeatable process for simultaneous development of multiple work packages.

Step 6: Schedule work package releases for implementation to help coordination and planning activities with stakeholders prior to implementation.

Step 7: Implement and integrate the software solution into operations. Making sure stakeholders are aware of release changes is critical for the success of a release. Be sure staff are trained ahead of the release, and that changes are communicated to all appropriate audiences.

You can pair DevOps with other methodologies. This allows you to address smaller components of functionality through DevOps while leaving larger components of functionality to traditional methodologies.

Other considerations:

• Once you resolve the business problem, monitor the solution to make sure the release did not negatively impact other areas of your software solution.
• Ensure the software solution is supported by management plans (e.g., change, configuration, and issue management plans) that are thorough and approved by the key stakeholders. This will help ensure expectations of processes and procedures are agreed upon.
• Maintain the list of business problems in a location accessible to all key stakeholders for awareness, accessibility, and accountability purposes.
• Communicate, report, and manage the status, definition, and/or resolution of issues and/or defects in a consistent, concise, and clear manner to assist in efficiently prioritizing and addressing your business problems.
• Begin communicating the impact of the issue and/or defect as soon as possible–the sooner the issue and/or defect is known; the quicker the team can begin down the path towards resolution.
• Develop materials to train affected staff. Clear and concise training materials will help educate and communicate updated processes to stakeholders.

Improving your software solution
Finding a way to improve your software solution does not always mean using traditional software implementation approaches. Based on our experience, we’ve learned that collaboration between the development and operations teams, and continuously repeating the seven steps of the DevOps implementation model, allows organizations to efficiently address software solution problems.

Interested in learning more about how the DevOps implementation model could work for your organization? Please contact Zachary Rioux.

There’s a good chance that your organization is in the position of needing to do more with less under the strain of staffing constraints and competing initiatives. With fewer resources to work with, you’ll need to be persuasive to get the green light on new enterprise technology initiatives. To do that, you need to present decision makers with well-thought-out and targeted business cases that show your initiative will have impact and will be successful. Yet developing such a business case is no walk in the park. Perhaps because our firm has its roots in New England, we sometimes compare this process to leading a hiking trip into the woods—into the wild. 

Just as in hiking, success in developing a business case for a new initiative boils down to planning, preparation, and applying a few key concepts we’ve learned from our travels. 

Consensus is critical when planning new technology initiatives

Before you can start the hike, everyone has to agree on some fundamentals: 

Who's going? 

Where are we going? 

When do we go and for how long? 

Getting everyone to agree requires clear communication and, yes, even a little salesmanship: “Trust me. The bears aren’t bad this time of year.” The same principle applies in proposing new technology initiatives; making sure everyone has bought into the basic framework of the initiative is critical to success.

Although many hiking trips involve groups of people similar in age, ability, and whereabouts, for your business initiative you need to communicate with diverse groups of colleagues at every level of the organization. Gaining consensus among people who bring a wide variety of skills and perspectives to the project can be complex.

To gain consensus, consider the intended audiences of your message and target the content to what will work for them. It should provide enough information for executive-level stakeholders to quickly understand the initiative and the path forward. It should give people responsible for implementation or who will provide specific skills substantive information to implement the plan. And remember: one of the most common reasons projects struggle to meet their stated objectives (and why some projects never materialize to begin with), is a lack of sponsorship and buy-in. The goal of a business case is to gain buy-in before project initiation, so your sponsors will actively support the project during implementation. 

Set clear goals for your enterprise technology project 

It’s refreshing to take the first steps, to feel that initial sense of freedom as you set off down the trail. Yet few people truly enjoy wandering around aimlessly in the wilderness for an extended period of time. Hikers need goals, like reaching a mountain peak or seeing famous landmarks, or hiking a predetermined number of miles per day. And having a trail guide is key in meeting those goals. 

For a new initiative, clearly define goals and objectives, as well as pain points your organization wishes to address. This is critical to ensuring that the project’s sponsors and implementation team are all on the same page. Identifying specific benefits of completing your initiative can help people keep their “eyes on the prize” when the project feels like an uphill climb.

Timelines provide additional detail and direction—and demonstrate to decision makers that you have considered multiple facets of the project, including any constraints, resource limitations, or scheduling conflicts. Identifying best practices to incorporate throughout the initiative enhances the value of a business case proposition, and positions the organization for success. By leveraging lessons learned on previous projects, and planning for and mitigating risk, the organization will begin to clear the path for a successful endeavor. 

Don’t compromise on the right equipment

Hiking can be an expensive, time-consuming hobby. While the quality of your equipment and the accuracy of your maps are crucial, you can do things with limited resources if you’re careful. Taking the time to research and purchase the right equipment, (like the right hiking boots), keeps your fun expedition from becoming a tortuous slog. 

Similarly, in developing a business case for a new initiative, you need to make sure that you identify the right resources in the right areas. We all live with resource constraints of one sort or another. The process of identifying resources, particularly for funding and staffing the project, will lead to fewer surprises down the path. As many government employees know all too well, it is better to be thorough in the budget planning process than to return to authorizing sources for additional funding while midstream in a project. 

Consider your possible outcomes

You cannot be too singularly focused in the wild; weather conditions change quickly, unexpected opportunities reveal themselves, and being able to adapt quickly is absolutely necessary in order for everyone to come home safely. Sometimes, you should take the trail less traveled, rest in the random lean-to that you and your group stumble upon, or go for a refreshing dip in a lake. By focusing on more than just one single objective, it often leads to more enjoyable, safe, and successful excursions.

This type of outlook is necessary to build a business case for a new initiative. You may need to step back during your initial planning and consider the full impact of the process, including on those outside your organization. For example, you may begin to identify ways in which the initiative could benefit both internal and external stakeholders, and plan to move forward in a slightly new direction. Let’s say you’re building a business case for a new land management and permitting software system. Take time to consider that this system may benefit citizens, contractors, and other organizations that interact with your department. This new perspective can help you strengthen your business case. 

Expect teamwork

A group that doesn’t practice teamwork won’t last long in the wild. In order to facilitate and promote teamwork, it’s important to recognize the skills and contributions of each and every person. Some have a better sense of direction, while some can more easily start campfires. And if you find yourself fortunate enough to be joined by a truly experienced hiker, make sure that you listen to what they have to say.

Doing the hard work to present a business case for a new initiative may feel like a solitary action at times, but it’s not. Most likely, there are other people in your organization who see the value in the initiative. Recognize and utilize their skills in your planning. We also suggest working with an experienced advisor who can leverage best practices and lessons learned from similar projects. Their experience will help you anticipate potential resistance and develop and articulate the mitigation strategies necessary to gain support for your initiative.

If you have thoughts, concerns, or questions, contact our team. We love to discuss the potential and pitfalls of new initiatives, and can help prepare you to head out into the wild. We’d love to hear any parallels with hiking and wilderness adventuring that you have as well. Let us know! 

BerryDunn’s local government consulting team has the experience to lead technology planning initiatives and develop actionable plans that help you think strategically and improve service delivery. We partner with you, maintaining flexibility and open lines of communication to help ensure that your team has the resources it needs.

Our team has broad and deep experience partnering with local government clients across the country to modernize technology-based business transformation projects and the decision-making and planning efforts. Our expertise includes software system assessments/planning/procurement and implementation project management; operational, management, and staffing assessments; information security; cost allocation studies; and data management.  

Read this if your organization is planning on upgrading or replacing an enterprise technology system.

It can be challenging and stressful to plan for technology initiatives, especially those that involve and impact every area of your organization. Common initiatives include software upgrades or replacements for:

• Financial management, such as Enterprise Resource Planning (ERP) systems
• Asset management systems
• Electronic health records (EHR) systems
• Permitting and inspections systems

Though the number of considerations when planning enterprise technology projects can be daunting, the greatest mistake you can make is not planning at all. By addressing just a few key areas, you can avoid some of the most common pitfalls, such as exceeding budget and schedule targets, experiencing scope creep, and losing buy-in among stakeholders. Here are some tips to help you navigate your next project:

Identify your IT project roles and resources

While most organizations understand the importance of identifying project stakeholder groups, it is often an afterthought. Defining these roles at the outset of your project helps you accurately estimate the work effort.

Your stakeholder groups may include:

• An executive sponsor
• A steering committee
• A project manager
• Functional leads
• A technical team

Once you’ve established the necessary roles, you can begin reviewing your organization’s resources to determine the people who will be available to fill them. Planning for resource availability will help you avoid delays, minimize impact to regular business processes, and reduce the likelihood of burnout. But this plan won’t remain static—you can expect to make updates throughout the project.

Establish clear goals and objectives to keep your technology project on track

It’s important that an enterprise technology project has established goals and objectives statements. These statements will help inform decision-making, provide benchmarks for progress, and measure your project’s success. They can then be referenced when key stakeholders have differing perspectives on the direction to take with a pending decision. For example, if the objective of your project is to reduce paper-based processes, you may plan for additional computer workstations and focus technical resources on provisioning them. You’ll also be able to measure your success in the reduction of paper-based tasks.

Estimate your IT project budget accurately

Project funding is hardly ever overlooked, but can be complex with project budgets that are either underestimated or estimated without sufficient rationale to withstand approval processes and subsequent budget analysis. You may find that breaking down estimates to a lower level of detail helps address these challenges. Most technology projects incur costs in three key areas:

• Vendor cost: This could include both one-time software implementation costs as well as recurring costs for maintenance and ongoing support.
• Infrastructure cost: Consider the cost of any investments needed to support your project, such as data center hardware, networking components, or computing devices.
• Supplemental resource cost: Don’t forget to include the cost of any additional resources needed for their specialized knowledge or to simply backfill project staff. This could include contracted resources or the additional cost of existing resources (i.e., overtime).

A good technology project budget also includes a contingency amount. This amount will depend on your organization’s standards, the relative level of confidence in your estimates, and the relative risk.

Anticipate the need for change management

Depending on the project, staff in many areas of your organization will be impacted by some level of change during a technology implementation. External stakeholders, such as vendors and the public, may also be affected. You can effectively manage this change by proactively identifying areas of likely change resistance and creating strategies to address them.

In any technology implementation, you will encounter change resistance you did not predict. Having strategies in place will help you react quickly and effectively. Some proven change management strategies include communicating throughout your project, involving stakeholders to get their buy-in, and helping ensure management has the right amount of information to share with their employees.

Maintain focus and stay flexible as you manage your IT project

Even with the most thought-out planning, unforeseen events and external factors may impact your technology project. Establish mechanisms to regularly and proactively monitor project status so that you can address material risks and issues before their impact to the project grows. Reacting to these items as they arise requires key project stakeholders to be flexible. Key stakeholders must recognize that new information does not necessarily mean previous decisions were made in error, and that it is better to adapt than to stick to the initial direction.

Whether you’re implementing an ERP, an EHR, or enterprise human resources or asset management systems, any enterprise technology project is a massive undertaking, involving significant investment and a coordinated effort with individuals across multiple areas of an organization. Common mistakes can be costly, but having a structured approach to your planning can help avoid pitfalls. Our experienced, objective advisors have worked with public and private organizations across the country to oversee large enterprise projects from inception to successful completion.

Contact our software consulting team with any questions.

Law enforcement, courts, prosecutors, and corrections personnel provide many complex, seemingly limitless services. Seemingly is the key word here, for in reality these personnel provide a set number of incredibly important services.

Therefore, it should surprise no one that justice and public safety (J&PS) IT departments should also provide a well-defined set of services. However, these departments are often viewed as parking lots for all technical problems. The disconnect between IT and other J&PS business units often stems from differences in organizational culture and structure, and differing department objectives and goals. As a result, J&PS organizations often experience misperception between business units and IT. The solution to this disconnect and misperception? Defining IT department services.

The benefits of defined IT services

1. Increased business customer satisfaction. Once IT services align with customer needs, and expectations are established (e.g., service costs and service level agreements), customers can expect to receive the services they agreed to, and the IT department can align staff and skill levels to successfully meet those needs.
2. Improved IT personnel morale. With clear definition of the services they provide to their customers, including clearly defined processes for customers to request those services, IT personnel will no longer be subject to “rogue” questions or requests, and customers won’t be inclined to circumvent the process. This decreases IT staff stress and enables them to focus on their roles in providing the defined services. 
3. Better alignment of IT services to organizational needs. Through collaboration between the business and IT organizations, the business is able to clearly articulate the IT services that are, and aren’t, required. IT can help define realistic service levels and associated services costs, and can align IT staff and skills to the agreed-upon services. This results in increased IT effectiveness and reduced confusion regarding what services the business can expect from IT.
4. More collaboration between IT and the organization. The collaboration between the IT and business units in defining services results in an enhanced relationship between these organizations, increasing trust and clarifying expectations. This collaborative model continues as the services required by the business evolve, and IT evolves to support them.
5. Reduced costs. J&PS organizations that fail to strategically align IT and business strategy face increasing financial costs, as the organization is unable to invest IT dollars wisely. When a business doesn’t see IT as an enabler of business strategy, IT is no longer the provider of choice—and ultimately risks IT services being outsourced to a third-party vendor.

Next steps
Once a J&PS IT department defines its services to support business needs, it then can align the IT staffing model (i.e., numbers of staff, skill sets, roles and responsibilities), and continue to collaborate with the business to identify evolving services, as well as remove services that are no longer relevant. Contact us for help with this next step and other IT strategies and tactics for justice and public safety organizations.