Business Model

APHSA's Business Model for Horizontal Integration of Health & Human Services

The full Business Model is available here. 

 

Questions This Guidance Will Answer

 

What is a business model? 

Why is it important to have a defined business model for a public benefits and service delivery system? 

What does a modern marketplace experience mean for health and human services? 

How will the 21st century business model for government health and human services differ from the current system? 

What does the new business model look like? 



**Also Check Out -Top 10 Reasons Why States Should be Integrating Their Health and Human Service Business Processes and Information Technology Systems Now 

  1. Opportunity . The time-limited offer of 90 percent federal funding for Medicaid eligibility systems and components requires interoperability among state systems that individuals and families use to apply for services, including Medicaid, cash assistance, child care, supplemental nutrition assistance (food stamps), etc. As a human service leader, taking advantage of the A-87 cost allocation waiver to plan for interoperability efforts related to the shared services of these systems puts you in the driver's seat to innovate.
  2. Client Needs/Services. Heads of households who responded to welfare reform by going to work just can't go to state offices and sit and wait to renew their child-care assistance, medical benefits for their kids, etc. Just as states have modernized driver's license offices for the convenience of working citizens, social service agencies must do the same so people can do what we are asking them to do—get to their jobs, support their families, and be productive citizens.
  3. Performance Improvement. If there's a tragedy with a social service client, it's likely that you had data on the victim or the perpetrator in your state systems because the individual or family was already involved in your cash or nutrition or mental health or other programs that could have provided clues to the danger and led to preventive action.
  4. Cost Savings. The technology has caught up. Shared services, data bases, and software programs are a whole lot easier and cheaper to build than they were even five years ago. Integration projects used to be high-cost and high-risk. It doesn't make sense to keep paying for the duplication, which just adds complexity and cost.
  5. Confidentiality Preserved. The public expects and demands "one-stop shopping" with appropriate confidentiality protections. They get cynical about the use of their tax dollars if they have to provide the same information to different government agencies multiple times for different needs.
  6. Workforce. There are huge labor savings to be gained by modernizing and integrating human service systems. In some states, integrated systems enable significant workforce reductions in other places; they enable skilled workers to turn their attention to difficult casework backlogs and complex cases, instead of paperwork.
  7. Bending the Cost Curve. It's clear that the major increases in health-care costs are related to problems like substance abuse, mental illness, homelessness, joblessness, domestic violence, and other problems that the human service system addresses. There's simply no way to bend the health-care cost curve down without integrating human service programs in the effort.
  8. Accountability. Modernizing and integrating these systems is the best way to prevent waste, fraud, and abuse. Most states have gotten pretty good at auditing way after the fact and finding excess benefits or ineligible people, but it's hard to recover expended funds. Today, however, business intelligence from integrated systems can find the problems early and prevent the money from going out the door in the first place.
  9. Increased Caseloads. Today's integrated health and human service systems can absorb the increased workload without comparable budget increases and can streamline multi-system processing for additional administrative savings long-term.
  10. Modernization. Simply layering new technology over old, outdated, systems will not do. Nor can we afford to build new modern systems on the health side while ignoring the human service side of the house—if we don't modernize both now, it may be virtually impossible to link them in the future.



 

 

 


National Workgroup on Integration




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