2017 Cambridge NonProfit Coalition Winter Summit Dr Antonio M Oftelie Leadership for a Networked World Technology and Entrepreneurship Center at Harvard Harvard School of Engineering and Applied Sciences ID: 556854
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The Future of Outcomes and Impact
2017 Cambridge Non-Profit Coalition Winter SummitDr. Antonio M. OftelieLeadership for a Networked WorldTechnology and Entrepreneurship Center at HarvardHarvard School of Engineering and Applied SciencesSlide2
You have one of the most
Important and Impactful roles in the world.Slide3
Jessica – The Worst Case
U.S. Marshals found four children slain by their mother in a Washington D.C. apartment.A review of this case revealed that multiple government and non-profit organizations had contact with the family in the preceding months. Each organization worked in a “silo” – no integrated business model, governance, processes, systems or structures were in place to share information and enable a coordinated response. Slide4
Juanita – What’s the Potential?
Single mother with four dependentsChildhood and adult traumaIn need of education
In need of housing and transportation
In need of food assistance
To be continued…Slide5
Why Are We Here? – The Meta View
Legitimacy
Outcomes
Value
Capacity
Business Model
ServicesSlide6
A Pathway to Outcomes and Impact
The Human Services Value CurveSlide7
Human Services Value Curve
In traversing the curve, the enabling business models and competencies of the human services organization mature and improve the organization’s ability to deliver broader and more valuable outcomes.Lnwprogram.org/
hsvc
7Slide8
Regulative Business Model
This level serves as a baseline – all human services organizations start here and must meet this level in order to comply with program requirements. 8Slide9
Regulative Measures & Impact
Measures of the inputs and outputs (such as program investment, number of families receiving services, percentage of cases closed in a given time period, etc.) that describe and quantify the activity and basic trends of a human services program or organization over time. 9Slide10
Reflection and Action
As you reflect on the Regulative Business Model:Where is being Regulative supporting our potential?Where is being Regulative limiting our potential?Slide11
Collaborative Business Model
As a human services organization progresses to a “Collaborative Business Model,” the focus expands beyond program “silos” and categorical management to support constituents in receiving all the services for which they are eligible and helping them address immediate needs.
11Slide12
Collaborative Checkpoints
Outcomes & Impact Design: The enterprise is shifting from silo-based output reporting to the measurement of outcomes by collecting information and metrics deeper within organizations and across programs. Organizational & Practice Design: The enterprise is working towards a customer-centric organizational model by sharing case information, coordinating services across programs and organizations, and shaping client-friendly solutions.
Systems & Technology Design:
The enterprise is actively adopting systems, technologies, and tools that
enable communication, information sharing, and decision- making across programs and organizations
. Slide13
Collaborative Measures & Impact
Measures of how a human services program has achieved broader outcomes (such as a client achieving self-sufficiency as opposed to leaving a program as a result of non-compliance) for individuals and families by capturing, correlating and communicating deeper data and detail. 13Slide14
Four Oaks - Total Child Program
Moving Up the Human Services Value CurveSlide15
Four Oaks: The Problem
The Board of Directors at Four Oaks—a non-profit child welfare, juvenile justice, and behavioral health agency in Iowa—was excited and concerned. Founded in 1973 to serve children, by 2007 the agency was enjoying a decade in which its budget nearly doubled, and it was serving almost 14,000 clients in more than a dozen cities across the state. Nevertheless, the Board was troubled by something more foundational:
it had no way of knowing whether the organization was
fulfilling
its mission of
assuring
that children become successful adults.” Slide16
Four Oaks: The Problem
Rooted in the agency’s approach. Four Oaks was a “single-service” organization focused on how its interventions affected specific conditions (e.g., whether a child had housing) in the short-term
.
In
order to
effect
more
far-reaching change
, Four Oaks needed to become a
multi-service agency
that understood the interaction among its programs and evaluated whether they collectively contributed to a child’s
long-term
self-sufficiency
. Slide17
Total Child: Moving Up the HSVC
Outcomes & Impact Design: TotalChild – a new program which would monitor children’s progress through their 18th birthday. Organizational & Practice Design: Integrated services in four core areas: youth, community, family, and school.
Success Manager tracks each client with “stability matrix.”
Systems
& Technology Design
:
Alignment of administration, technology, and financeSlide18
Total Child: Outcomes & Impact
Client base = 20,000. TotalChild enrollment reached and exceeded 1,000 children in 2016, with agoal to serve 1,400 children by 2018. TotalChild
approach resulted in
97% of those children maintaining stability
. Stability means their lives are not in chaos and they’ve achieved success in a checklist of areas which include basic needs, education, employment, housing and family supports.
University
of Iowa—which evaluated the pilot against a traditional service delivery model—to show that
TotalChild
has not just
benefitted
clients but also produced more
efficient
services because of reduced
recidivism.
Raised more than $6 million to support expanding efforts in Cedar Rapids, the state legislature began allocating funds for TotalChild, and
expansion of the program to two additional sites. Slide19
“What really drove the change for us was taking a look internally and saying,
‘What are we really achieving, and are we OK with that?’” Anne Gruenwald, President and CEO, Four Oakshttp://totalchildiowa.orgSlide20
Reflection
As you reflect on the Collaborative Business Model:Where do we have opportunities to grow our revenues and/or outcomes by working across traditional boundaries?Slide21
Integrative Business Model
With an “Integrative Business Model,” the focus broadens to complete integration of multiple programs and services in order to improve customer service, increase participation and support data- driven policy and decision making.
21Slide22
Integrative Checkpoints
Outcomes & Impact Design: The enterprise is activating an outcomes model that connects desired impact to overall community priorities and expands the focus to include cross-agency outcomes, metrics, and real-time situational awareness. Organizational & Practice Design: The enterprise is establishing new governance structures, management and operating processes, and data and analytics that focus on and help employees support and drive customer-focused outcome goals.
Systems & Technology Design:
The enterprise is implementing an
integrated, single-view system for case management across programs
and organizations and enabling service collaboration and outcome tracking by customer and by aggregate. Slide23
Integrative Measures & Impact
Measures that leverage trend and root cause analysis in order to forecast future performance and expected effects (such as families most likely to benefit from new forms of case management and services) of new interventions and program innovation. 23Slide24
Case in Point: State of Ohio
Converging on OutcomesSlide25
Ohio: The Problem
Ohio citizens were spending just over $7,000 per person on healthcare annually, more than 33 other states, and ranked 37th in health outcomes. $8 Billion budget shortfall.Archaic technology and 88 silos. Citizen demands for seamless service.Slide26
Ohio: Moving Up the HSVC
Outcomes & Impact Design: Modernizing Medicaid, streamlining health and human services, and paying for value. Organizational & Practice Design: Office of Health Transformation. Robust x-agency and x-county collaboration.
Medicaid expansion.
Systems
& Technology Design
:
New eligibility system (replaced 30 year old legacy system)
“Operating Protocol” for data and resources sharing. Slide27
Ohio: Outcomes & Impact
Reduced spending, fostered greater collaboration, and created an integrated system. The new eligibility system now identifies 500 veterans a month, 74% of whom are eligible for services they were not previously receiving. Ohio generated millions of dollars in savings and is piloting a “pay for outcomes” model. Slide28
Reflection and Action
As you reflect on the Integrative Business Model:Where do we have opportunities to expand efficiency, effectiveness, and cross-program growth – particularly via higher-level integration?Slide29
Generative Business Model
At this level the focus of the human services organization expands to address multi-dimensional family problems, socioeconomic issues and opportunities required to generate long-term individual and community success.
29Slide30
Generative Checkpoints
Outcomes & Impact Design: The enterprise is capturing community-wide and partner-wide outcome measures in order to predict service needs, forge new partnerships, generate new resources, and create new high-impact solutions. Organizational & Practice Design: The enterprise is “boundaryless”
and able to evolve policy, governance, programs, and processes dynamically to meet changing community outcome needs and
co-create solutions
with all stakeholders.
Systems & Technology Design:
The enterprise is leveraging predictive analytics and social technologies to
synthesize information community-wide,
track service loads and metrics, predict service demand, and communicate impact measures. Slide31
Generative Measures & Impact
Measures of the human services system-wide generative effect that enable new valuation and solutions (such as performance-based contracting, pay-for-success options, etc.) and improved service design, (creating, starting and ending programs) development and delivery. 31Slide32
Missouri Health Home Initiative
Generative Innovation in ActionSlide33
Missouri Health Home: The Problem
The average U.S. citizen lives into his/her late 70s; the life expectancy for a person with a mental disorder is 66; and if someone in Missouri has a mental disorder and is a Medicare or Medicaid beneficiary, that citizen is only expected to live to (roughly) the age of 55, on par with someone in sub-Saharan Africa. Slide34
Missouri Health Home Initiative
Disruptive FactorsGreat Recession – MO was cash strappedTraditional solutions – like incentivizing or increasing spending were not optionsUnderutilization of data and actionable insightsSilo-based treatment models and structures
Disruptive Model
Missouri’s
Health Home
Initiative:
A
program that created a place where high-need Medicaid recipients could receive
coordinated care from an integrated team
of medical, behavioral, and related social services specialists. Slide35
MO Health Homes: Moving Up the HSVC
Outcomes & Impact Design: Focus on life span and cost reduction. Public agencies and non-profit providers developed “health homes” in community health centers and primary clinics. Organizational & Practice Design: Office of Health Transformation. Cross-organization focus
on care management and coordination, health promotion, individual and family support, and community services.
Systems
& Technology Design
:
Cross-department data sharing for tracking outcomes – facilitated novel interventions and
solutions
.
Slide36
Missouri Health Homes: Outcomes
The program has shifted the burden of managing care away from Missouri’s previously overwhelmed Medicaid beneficiaries and, in just three years, created $59 million in savings, reduced blood pressure and cholesterol in beneficiaries, and decreased hospital admissions and emergency room visits. Missouri has also received national recognition, including the Gold Award from the American Psychiatric Association and an acknowledgment from the National Association of State Chief Administrators. Slide37
Reflection and Action
As you reflect on the Generative Business Model:How would you describe Generative in your organization? What about Cambridge-wide?What new paths to outcomes, impact, value, and revenue would open up?Slide38
Reflection and Action: Moving Up the HSVC
Outcomes & Impact Design: What would new outcomes look like? What new services would enable those outcomes?Organizational & Practice Design: What level of cross-organization or cross-program collaboration would you need?
What will governance/collaboration model look like?
Systems
& Technology Design
:
What alignment of systems and technology would enable your new service(s) and design?Slide39
The Leadership Reflection
Internal “System” FactorsThis dimension represents the internal organizational factors you have formal authority and influence on including your:Organizational
mission or strategy;
Trends
impacting your portfolio of activities;
The
design or structure of your organization;
Data
strategies;
Cultural
attributes of your organization
Cross-Boundary “Ecosystem” Factors
This dimension represents the external factors you have informal authority and influence on, but are necessary to mobilize including:
Partnerships; Policies; The broader portfolio or scope of our activities andPrioritization of opportunities and lines of business. Slide40
Remember:
You have one of the most Important and Impactful roles in the world.Slide41
Onward!
aoftelie@seas.harvard.edu@AntonioOftelie