Policy & Practice | Fall 2024

The Magazine of the American Public Human Services Association Fall 2024

Modernizing for the Future of Human Services

Changing economic conditions. Changing community needs. Confidently navigating change.

Health and Human Services agencies can strengthen communities and empower residents by delivering core safety services efficiently, in ways that are responsive to the changing needs of the population. At Deloitte, we bring innovative yet practical solutions to navigate this vastly complex market — to protect and provide better outcomes for communities, through programs to assist with social welfare, unemployment, or family care, in addition to physical and mental health.

Visit booth (#303) at the ISM + PHSA 2024 Conference or scan the QR code to learn more.

Copyright ©2024 Deloitte Development LLC. All rights reserved.

TODAY’S EXPERTISE FOR TOMORROW’S SOLUTIONS

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contents

Vol. 82, No. 3 Fall 2024

features

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10

Framing the Future Executing New Mexico’s Blueprints for a Reimagined Medicaid Program

Emerging Technology and Process Innovation Modernizing for the Future of Human Services

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The Next Generation of Eligibility Operations Improving Performance and the Customer Journey Beyond Integrated Eligibility Systems

Paving the Road to ACCESS Early Insights from the Aligned Customer-Centered Ecosystem of Supports & Services (ACCESS) Initiative

departments

4 Partnering for Impact

8 Workforce of the Future

32 Technology Speaks

Synchronizing Program Vision with Technical Innovation to Shape Future Frameworks for Government Agencies

How AI integration Is Transforming Service Delivery: Agencies Integrating

Modernizing Integrated Eligibility: Pathways to Success

GenAI with Other Automation Tools—and Human Judgment

34 Technology Speaks

6 Partnering for Impact

Artificial Intelligence in Action: Key Lessons Learned Over Eight Years in Production

28 From Our Partners

One Year with Artificial Intelligence: What the Illinois Department of Children and Family Services Learned About Natural Language Processing

Empowering Government to Deliver Experience-Driven Outcomes for Human Services Agencies

37 Staff Spotlight

Raneem Karboji, Policy Coordinator

30 From Our Partners

Staff Spotlight Blake Turpin, Process Innovation Associate

GenAI in Child Welfare Redux: Making the Knowable Known

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Fall 2024 Policy & Practice

Strategic Industry Partners DIAMOND

APHSA Executive Governing Board

Chair Grace Hou, Secretary, Illinois Department of Human Services Vice Chair Rodney Adams, Principal/CEO, R Adams & Associates Treasurer Kathy Park, CEO, Evident Change

Elected Director Christine Norbut Beyer, Commissioner, New Jersey Department of Children and Families Elected Director Kristi Putnam, Secretary, Arkansas Department of Human Services Elected Director Sherron Rogers , Vice President & CFO, Johns Hopkins All Children’s Hospital Elected Director Terry Stigdon , CEO, American Red Cross Elected Director Jennifer Sullivan , Enterprise Senior Vice President, Strategic Operations, Atrium Health Immediate Past Chair Dannette Smith, Commissioner, Behavioral Health Administration President & CEO Reggie Bicha, President & CEO, APHSA

Leadership Council Chair Kelly Kennedy Garcia, Director, Iowa Department of Health and Human Services Local Council Chair

Dan Makelky, Director, Douglas County (CO) Department of Human Services Elected Director Derrik Anderson, Executive Director, Race Matters for Juvenile Justice Elected Director Vannessa Dorantes, Managing Director, Casey Family Programs

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Policy & Practice Fall 2024

Policy & Practice™ (ISSN 1942-6828) is published four times a year by the American Public Human Services Association, 1300 N. 17th Street, Suite 340, Arlington, VA 22209. For subscription information, contact APHSA at (202) 682-0100 or visit the website at www.aphsa.org. Copyright © 2024. All rights reserved. This magazine may not be reproduced in whole or in part without written permission from the publisher. The viewpoints expressed in contributors’ materials are the authors’ own and do not necessarily reflect the policies or views of APHSA. Postmaster: Send address changes to Policy & Practice 1300 N. 17th Street, Suite 340, Arlington, VA 22209

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Editor Amy Plotnick

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APHSA’s blog, The Catalyst , encourages the exchange of creative ideas and promising initiatives to strengthen the human services sector and accelerate our collective impact. Featuring content from members, partners, and staff, our blog posts focus on what it takes to build well-being from the ground up. Organized around areas of impact as well as a variety of special series, our goal is to spark new ideas and accelerate the spread of promising approaches that help realize our shared vision for thriving communities built on human potential.

Read the Latest Post, Visit https://aphsa.org/the-catalyst/

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Fall 2024 Policy & Practice

partnering for impact

By Pat Aguilar

Synchronizing Program Vision with Technical Innovation to Shape Future Frameworks for Government Agencies

W e live in the age of experi ence. Due to the influence of consumer messaging, the public has come to expect a high level of customer experience when engaging with any organization, including gov ernment agencies. State and local government leaders are increasingly turning to the wide range of emerging technologies avail able to them to improve the public services their agencies deliver daily. As agency leaders aim to modernize their programs for the future, they recognize the importance of deploying digital tools and applications, using advanced analytics to measure impact, and implementing technologies such as artificial intelligence or machine learning to achieve success. However, these leaders also under stand that the success of new program initiatives is not solely dependent on the technology itself. It requires thoughtful alignment with the objec tives of a specific agency’s program as well as a focus on improving the lives of staff and consumers alike. For government agencies under taking a modernization project, effective collaboration is a common theme in all successful initiatives. Consider these three tips for any mod ernization effort: 1. Start by Listening The best industry partners will commence any project by listening to agency leaders describe the challenges and desired outcomes that, in turn,

inform the business and technical support needed to ensure solution quality. Every level of the organiza tion, from end-users to senior leaders, should be engaged to develop an understanding of their pain points and priorities. By promoting open dialogue and collaboration, leaders can leverage their team’s collective wisdom to create a modernization plan that effectively addresses challenges and implements change.

2. Partner Program and Technology Modernization is fundamentally about improving the lives of indi viduals and communities. Effective collaboration between the technology and program teams is essential to understand the benefits from each perspective. Throughout the process, everyone involved should keep the needs of the agency and the people it serves front and center. By human izing the modernization process,

Illustration by Chris Campbell

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Policy & Practice Fall 2024

leaders can ensure the technology serves as a tool for empowering and enhancing programs. 3. Connect Vision to Objectives Effective communication of project vision and objectives connects technology decisions to program improvement strategies. Modernization should be driven by the program's needs and priorities. It is important to cultivate a program centric mindset that ensures decision making aligns with the overarching objectives. One of the major chal lenges is getting people to realize that the program is not there to support information technology (IT), but that IT exists to support the program. How It Can Work: ATrusted Advisor to the Illinois’ Child Welfare Program The Illinois Department of

pioneering approach to both system implementation and oversight. Departing from conventional meth odologies, Illinois embraced a unique approach unlike any other state. A key innovation that DCFS adopted is an Enhanced Independent Verification and Validation (IV&V) model that enables advisory support in addition to traditional IV&V services. Integration of this advisory capability within the IV&V framework expands on the common practice of engaging with a vendor to oversee a technology implementation. The enhanced model establishes a trusted advisor role to support DCFS business and tech nical teams in reviewing and guiding architectural designs and plans. This expanded footprint of the IV&V team also allows for greater monitoring capabilities. For DCFS, the increased architecture and technical monitoring means it can provide a more complete view to its federal partners. DFCS views its enhanced IV&V vendor as a true partner rather than an oversight entity. By leveraging the

expertise of business and technical advisors, DCFS is expanding the capa bilities and capacity of its technical and functional teams. The enhanced model enables improved decision making for the department and aligns DCFS, its IV&V vendor, and its federal partners with the state’s modernization goals. The Future for Government Agencies Navigating modernization projects across government agencies requires more than technical expertise. It requires clear communication, a unique strategic vision, and a shared understanding of objectives. By embracing these principles and partnering with trusted industry experts like Maximus, government leaders can confidently complete their modernization journeys with the tools and guidance needed for success.

Children and Family Services’ (DCFS) Comprehensive Child

Pat Aguilar is the Managing Director, Program Modernization Consulting, at Maximus.

Welfare Information System (CCWIS) project, IllinoisConnect, represents a

Your trusted advisor in government program modernization.

CSG’s services help our government clients realize their IT and program modernization goals and objectives and maximize their return on investment.

Project Management Quality Assurance Strategy and Planning

Independent Verification and Validation Organizational Change Management

Visit us at Booth #317 at ISM or visit www.csgdelivers.com to learn more.

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Fall 2024 Policy & Practice

partnering for impact

By Jim Daugherty and Julie Barbosa

One Year with Artificial Intelligence: What the Illinois Department of Children and Family Services Learned About Natural Language Processing

R oughly one year ago, the Illinois Department of Children and Family Services (IL DCFS) became one of the first child welfare organizations in the United States to recognize the benefits of artificial intelligence (AI) in sup porting child welfare staff. We selected Augintel as our vendor and completed a state-wide rollout of the AI capability of natural language processing (NLP) to more than 6,000 child welfare staff and child welfare–contributing agencies across the state. Similar to the majority of state child welfare orga nizations across the country, IL DCFS was looking to modernize and stream line operations and take advantage of

advances in technology to truly support child welfare practice. We realized, early in our mod ernization journey, accessing the unstructured data in case notes was one key to achieving this goal. We knew that caseworkers were spending too much time combing through nar rative data to understand the story of the family and think through potential courses of action. We knew that the ability to read, summarize, and present information in the notes would save child welfare teams valuable time and give them a complete view of the family’s story on which to base their decisions. The time traditionally spent

clicking through and reviewing case notes could be better spent in any number of ways, such as spending more time with families. In a survey earlier this year, staff confirmed that our objectives for adopting NLP are being met. A resounding 97 percent indicated that accessing the information in case notes is very important or critical to doing their jobs. And regular users reconfirmed earlier time savings estimates—they are saving up to 5 hours each week on tasks such as preparing for court, locating specific information such as medications, and identifying family members and fictive

Illustration by Chris Campbell

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Policy & Practice Fall 2024

Face-to-face visits between caseworkers and family members are essential for effective intervention and support. Every hour spent with a family and not on paperwork is another step toward positive outcomes for that family.

kin mentioned in the case. That same survey also confirmed that front-line staff uses the time savings to spend more time with families. Face-to-face visits between caseworkers and family members are essential for effective intervention and support. Every hour spent with a family and not on paper work is another step toward positive outcomes for that family. Another one of our goals is to use NLP to facilitate knowledge transfer when a case is reassigned, or when a new provider or specialist joins the case. Our specialized NLP platform from Augintel recognizes when somebody new is added to a case and automatically sends that team member an email with a summary of key points from the case. This has been greatly appreciated across the organization, with one caseworker saying, “I see how helpful this is, par ticularly when we transfer cases or get new ones. What an easy way to search and organize important aspects of the case. I appreciate having such a helpful tool.” Since implementing the tool, 124,000 of these emails have been sent to caseworkers, providers, and specialists to quickly get them up to speed on a case. Addressing Worker Safety At the time of rollout, we were also excited about the ability to use the data in case notes to help address the safety and well-being of our staff. Whenever new team members are assigned to a case, the platform auto matically mines the case notes for any references to weapons, pets inside the Facilitating Knowledge Transfer

home, violence in the neighborhood, or other information contained in case notes. If the data suggest there might be a safety risk to the case worker, an alert is sent via email. Nearly 9,500 alerts have been sent over the past 12 months, with the majority of recipients agreeing that the alert nudged them to look further into the history of that case to better understand where and when safety concerns occurred. Perhaps the most significant finding surrounding the workers’ safety feature is the widespread and genuine sentiment of appreciation, felt by all staff, that the State of Illinois was adding a layer of protection for them. In recent feedback, a Child Protection Specialist put it like this, “Just the fact that the state arranged someone looking over the investigator’s shoulder means a lot.” Mining Narrative Data Has Far-Reaching Benefits Supporting our staff was what drove us to adopt NLP as part of our trans formative modernization efforts at DCFS, but the benefits and the ability to mine narrative data across a group of cases—or the entire agency—are far-reaching. It has given agency lead ership the unprecedented ability to identify, measure, and count things they never could before. As of today, the IL DCFS is tracking 18 different indicators across the agency that can help determine service arrays, inform agency practices, and contribute to overall agency success. Quality assurance specialists are now easily able to identify cases that fall outside practice guidelines for note quality, gaps in documentation, adher ence to practice guidelines for required

conversations, visits, or documentation and take necessary action. Leadership can monitor across cases for early warning signs such as a lack of family engagement, pre-incident behaviors, domestic violence, or mentions that a child is unsafe. And they can monitor cases for disruptions in placements allowing them to take necessary action to ensure the safety and well-being of the children in those cases. Mining the narrative data across the agency is also helping our specialists better understand service needs and be more proactive in reaching out to families in need of specialized services such as language assistance or support for disabilities. For example, IL DCFS specialists were able to discover that 30 percent more families needed assis tance with hearing loss. Armed with this data, specialists were then able to make referrals for these services. The ability to identify needs and act on them has proved to be a major benefit for our specialists. We’re very pleased with our progress over the last 12 months! Our deci sions are now more data informed, we’re becoming more proactive and productive, and we continue to find new ways to leverage the meaningful data in case notes. This information benefits everyone involved within the organization and most important, the families we serve. Jim Daugherty is Chief Information Officer at the Illinois Department of Children and Family Services. Julie Barbosa is the Chief Deputy Director, Strategy and Performance Execution, at the Illinois Department of Children and Family Services.

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workforce of the future

By Jamia McDonald, Hari Murthy, Naman Chaurasia, Shawn Bowers, Will Arnold, Michael J. Walsh, and Tiffany Dovey Fishman

How AI integration Is Transforming Service Delivery: Agencies Integrating GenAI with Other Automation Tools—and Human Judgment

H uman services agencies across the country are exploring how to use generative artificial intelligence (GenAI) and traditional AI tools to ease the workload for overburdened staff and provide constituents a more responsive, higher-quality customer experience. Their goals are two-fold: n To accelerate efficiency improvement by automating tasks that have histor ically required significant manual, human intervention n To personalize service delivery for constituents by analyzing behavior patterns and preferences to make service recommendations Many states are beginning to ideate GenAI use cases, experiment with proofs of concept, and evaluate the early-stage capabilities needed to realize value (Figure 1). Other states have moved to incorporate AI and GenAI pilots into their ongoing digital trans formation efforts. While each state’s AI journey looks different, the theme remains consistent: many agencies are seeking new ways of working that can support their workforce in delivering better mission outcomes. Early GenAI Pilots While it’s still early days for human services agencies’ use of GenAI, pilots are beginning to show promising results in improving service delivery. Illinois and Oregon have operationalized AI use cases and are already realizing value while collecting insights that will inform future implementations.

The Illinois Department of Children and Family Services added GenAI to its suite of automation capabilities when modernizing the department’s modular web-based system for child welfare workers. IllinoisConnect’s AI-powered policy bot allows nearly 1,000 employees to search and retrieve key insights across more than 6,700 pages of written policy, procedures, and laws, boosting the agency’s capacity to support front line caseworkers with navigating

complex situations involving children and families. Workers submit plain English questions in a simple user interface and, within seconds, receive a summarized answer, exact cita tions from written policy, and links to source materials. The policy bot’s rapid responses reference up-to-date statutory authority, department rules, procedures, and policy documents. Farther west, the Oregon Department of Human Services and Oregon Health Authority have made

Illustration by Chris Campbell

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62 percent of surveyed workers said they do not have the skills to use GenAI effectively and safely. It is critical for leaders to take steps to build workforce skills to adopt GenAI, articulate guardrails, and communicate goals early and often to mitigate risk.

progress on multiple customer expe rience initiatives for the 1.5 million Oregonians they serve. To provide customers with 24x7 navigation support and answers, the agencies implemented service assistant chatbots on the Oregon Eligibility (ONE) Applicant Portal, the online platform for applying and managing Medicaid, the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), and child care benefits. The service assistance chatbots use various AI technologies to interact with more than 30,000 customers online every quarter, responding to questions on more than 200 topics. In fulfilling nearly three-quarters of requests, the chatbots have helped boost customer satisfaction 27 percent since initial implementation. Additionally, Oregon recently piloted a new GenAI solution called ORBIT with the statewide opera tions support and help desk teams. ORBIT enables staff to quickly receive answers to complex questions across the universe of various program policy and procedures documentation, along With use cases illustrating how human services agencies can use GenAI to optimize service delivery, now is the time for leaders to start scaling and planning for longer-term solutions. As agencies realize value from their AI investments and establish clear governance and ownership over the capability, leaders should define with citations and references. Preparing for GenAI

and enforce leading standards while ensuring that tools are current. GenAI can open up transforma tive possibilities for agencies when thoughtfully paired with complemen tary AI tools and human judgment. Yet the path to adopting this new technology can be daunting. Many employees may find GenAI possibilities exciting even as others voice appre hension. While a prepared workforce is essential to successful AI imple mentation and adoption, 62 percent of surveyed workers said they do not have the skills to use GenAI effectively and safely. 1 It is critical for leaders to take steps to build workforce skills to adopt GenAI, articulate guardrails, and communicate goals early and often to mitigate risk. To prepare the work force for what’s to come, leaders should consider the following: n Share the vision: Convene the agency around the GenAI vision, importance of workforce readiness,

and value potential for the organiza tion's mission. n Open lines of communication: Keep the workforce informed about the agency’s vision for GenAI use, the safeguards in place to mitigate risk, and the expected benefits from adoption. Regularly communicate updates and milestones, including the introduction of approved GenAI technology, and the rationale behind decision making. Establishing a GenAI center of excellence can facili tate sharing of best practices across the organization. n Become familiar with underlying

technology: Because GenAI is a rapidly evolving technology, it’s important to establish a baseline

See AI Service Delivery on page 36

Figure 1. Agencies are at different stages of their generative AI journey

Phase 2: SCALING Agencies have realized significant GenAI value and defined clear governance and ownership over the capability, but need to define and enforce best-in class standards and tools while continuing to update their product and model inventory for organizational usage and adoption

Phase 1: IMPLEMENTING Agencies are starting to

Phase 0: EXPLORING Agencies are ideating use cases,

operationalize and implement their early wins, educate their organization on a cohesive gen AI vision, and develop the capabilities needed to deliver the breadth of use cases to capitalize on value realization

experimenting with proofs of concept, and starting to evaluate the early-stage capabilities needed to realize immediate business value from generative AI

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In

Executing New Mexico’s Blueprints for a Reimagined Medicaid Program

a transformational journey from replacement to reinvention, the New Mexico Medicaid Management Information System Replacement (MMISR) program is reimagining its Medicaid Management Information System (MMIS) with a modular solution, aligned with guidance from the Centers for Medicare and Medicaid Services (CMS). It is part of New Mexico’s Health and Human Services 2020 (HHS 2020) initiative, which aims to establish a highly responsive and effective system atic approach to service delivery to improve the health and well-being of all New Mexicans. With approximately 43 percent of New Mexico's popula tion covered by Medicaid and the Children's Health Insurance Program (CHIP) as of July 2024, the largest percentage for a state population in the United States, the implications of this transformation are significant.

By Paula Morgan, Anil Sharma, and Amiran Gelashvili

Amidst a complex, multivendor envi ronment, the blueprints guiding the program remain clear in their purpose and vision: helping New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and support services. Guided by those blueprints, New Mexico has successfully laid a solid foundation for the MMISR program, selecting, procuring, and onboarding module vendors, technologies, and a System Integration Platform (SIP), the KPMG Resource Integration Suite (KRIS) Connected Platform. Four of the eight functional MMISR modules—the Consolidated Customer Service Center, Unified Portal, Quality Assurance, and Data Services modules—are live, along with the SIP. Four are in develop ment, including the Internal Portal, Financial Services, and Care and Case

Figure 1: New Mexico “Casa Medicaid”

Management System modules, as well as the Benefits Management Services module, which is going live this fall. The Data Services module went live this summer, enabling a new era of robust data analytics and reporting. It is building on the groundwork of the Data Governance Council and enabling stakeholders to make more informed decisions via a single, authoritative source of data. With the blueprint laid out before us and the materials at our disposal, our task now shifts to meticulously building the rooms of this house, the proverbial “Casa Medicaid.” It is now about execution, ensuring each space serves its purpose, enriches the lives within, and contributes to the creation of a thriving home for all New Mexicans (see Figure 1). As the MMISR program has pro gressed, common challenges have emerged—from resource constraints and integration challenges to data management issues. Changes abound, both planned and unplanned. As we navigate the development of “Casa Medicaid,” our lessons learned continue to be the building blocks that guide the transformation: n Pivot, pivot, pivot, continuously examining and refining the roadmap The Building Blocks of Transformation

n Prioritize collaboration, fostering effective relationships n Embrace people-centric, business-led transformation, keeping the con stituent at the center of all decisions Architecting Agility: Revisiting the Roadmap This year introduced new leadership in key positions across the Medicaid program, as well as the broader New Mexico health and human services ecosystem and state. The New Mexico Health Care Authority (NM HCA), formed in July 2024, merged the Human Services Department and several other health care–related teams, creating a single agency respon sible for health care purchasing, policy, and regulation. Embracing the integration of new stakeholders as an opportunity rather than just a challenge, our NM HCA Information Technology (IT) division and larger agency have actively engaged new leaders and stake holders, inviting them to examine and probe the MMISR roadmap. This has enabled us not only to uncover invaluable fresh insights, but to drive innovation and foster a culture of col laboration that has been instrumental in navigating the complexities of such a large-scale project. Throughout the MMISR trans formation, our IT division has itself

Paula Morgan is the Chief Information Officer of the New Mexico Health Care Authority.

Anil Sharma is a Managing Director in the

KPMG LLP Health and Government Solutions practice.

Amiran Gelashvili is a Managing Director and the US Health and Human Services Lead at KPMG LLP.

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transformed, moving through the forming, storming, norming, and per forming stages of group development. 1 We are now shifting our organizational model, looking at recruiting and devel oping new skill sets that align with evolving business needs. From primarily technical roles focused on development and maintenance, NM HCA is working to move more toward a product owner model for solutions, helping drive greater alignment with technology, business, and end-user needs alike. We have actively championed a philosophy of flexibility, encouraging our teams to remain open to new approaches and to adapt our strategies in the face of emerging challenges and opportunities. By regularly revisiting our roadmap, we have been able to make informed decisions, course-cor rect when necessary, and avoid costly and timely misalignments as priorities evolve (see Figure 2). The Mortar of More: Transformation Advisory Services As the saying goes, “the whole is greater than the sum of its parts.” Simply having the people, pieces, and a plan isn’t enough. With this aware ness, NM HCA engaged KPMG, the current System Integration vendor, to provide Transformation Advisory Services (TAS). In this role, KPMG is overseeing the tangible and intangible activities that are helping all teams work better and faster together. TAS drives the application of six key disciplines critical to a successful transformation: 1. Strategic services and financial management 2. Enterprise architecture 3. Quality control and assurance 4. Policy and program outcomes 5. Governance and program management 6. Organizational change management and training NM HCA identified opportunities to improve tactical areas necessary to drive the successful transformation of not only technology but also people and processes. Those areas included: Organizational Change Management: With a team of two

Figure 2: Building “Casa Medicaid”

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Fall 2024 Policy & Practice

people focused on organizational change management, we did not have the bandwidth to scale training and change programs to the full MMISR program. KPMG has helped our team support the human side of the MMISR transformation—implementing change, communications, and training programs that are helping our teams adapt to new processes and technologies. helped enrich our future state design process, helping ensure that the enter prise architecture reflects the needs of all stakeholders and aligns with long-term goals. CMS Certifications Planning: We have worked with KPMG to update our certification planning and preparation process based on CMS Streamlined Modular Certification/ Outcomes-Based Certification (SMC/ OBC) requirements. TAS has enabled us to drive a holistic, people-centric, and technology-enabled approach that considers the transfor mation’s impacts to all aspects of the organization. This is especially indis pensable when building shared services that other departments can leverage. The MMISR program strategically incorporates shared services that other New Mexico Health and Human Services departments will be able to utilize, enhancing our collective efficiency and impact. By building integrations and enterprise functions, we are not only streamlining our own processes but also fostering cross departmental collaboration so that all New Mexicans receive more cohesive and comprehensive care. Constructing Connections at Partner Palooza In April 2024, NM HCA hosted an event, the "Partner Palooza," uniting MMISR vendors and project stake holders for a three-day, in-person forum that included great New Mexican cuisine and mariachi music. The event was thoughtfully designed to foster holistic collaboration, encour aging vendors to work together in a series of workshops. A highlight was the workshop dedi cated to project schedule integration, Augmenting the Enterprise Architecture Team: KPMG has

Figure 3: HHS 2020 Neighborhood

where each MMISR partner arrived equipped with their individual project timelines. Together, they embarked on a collaborative journey to weave these separate schedules into a single, cohesive plan. The result was a more realistic and achievable collective project schedule. New Mexico Health and Human Services executive leadership attendance at the Partner Palooza underscored the commitment to our objective. Leaders from five of the six agencies that make up the broader New Mexico HHS 2020 ecosystem attended. Their presence and collabo ration with partners reinforced that we all function not in parallel but as a unified team. Both our successes and our failures are shared.

Across the event, the synergy was palpable as we discovered common ground and forged stronger bonds. Particularly in the age of hybrid and remote work, the immersive dialogue, shared understanding, and collec tive effort at Partner Palooza led to a stronger sense of shared owner ship, as well as more effective and realistic progress toward our goals post-Palooza. Design with Purpose At the Partner Palooza, we also reexamined stakeholders’ needs, concerns, and goals through three distinct personas: a health care provider, a Medicaid member, and a Medicaid employee. The exercise allowed us to delve deeply into the

Every decision, every innovation, and every strategic pivot needs to be made with the welfare of the constituents in mind. It has inspired us to lead not just with ambition, but with a greater sense of empathy, foresight, and a commitment to thoughtful strategy.

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unique priorities for each group— from streamlining delivery, improving accessibility, and enhancing the con stituent experience, to minimizing employee stress and frustration—and plan and pivot accordingly. Keeping the constituent at the center of all decisions has been a beacon throughout the MMISR journey. Every decision, every innovation, and every strategic pivot needs to be made with the welfare of the constituents in mind. The collective work continues to deepen our state leadership’s apprecia tion for the nuanced and diverse needs of our constituents, and of the detailed orchestration required to manage transformation of this magnitude. It has inspired us to lead not just with ambition, but with a greater sense of empathy, foresight, and a commitment to thoughtful strategy. A Home that Forges a Neighborhood As we stand on the threshold of a new year, we are reminded of the importance of building not just

for today but for tomorrow. Our immediate focus sharpens on the deployment of the four remaining core modules of the MMISR program. The completion and certification of these core modules will signify the construc tion of a functional, resilient, and constituent-centered “Casa Medicaid.” However, our vision extends beyond building a singular house. The full realization of "Casa Medicaid" and the future integration of enterprise-shared services will mark the beginning of an entire modern health and human services neighbor hood. This neighborhood, envisioned in the HHS 2020, is about creating a cohesive ecosystem where health and human services programs work in harmony to address the diverse needs of our communities. The lessons learned, the relation ships formed, and the milestones achieved continue to bolster our resolve to continue building not just for today, but for a brighter, healthier tomorrow for every New Mexican. Because there’s no place like home.

Reference Note 1. Tuckman, B. W. (1965). Developmental sequence in small groups. Psychological Bulletin. 63 (6), 384–399. https://doi.org/10.1037/h0022100 The information contained herein is of a general nature and is not intended to address the circumstances of any particular individual or entity. Although we endeavor to provide accurate and timely information, there can be no guarantee that such information is accurate as of the date it is received or that it will continue to be accurate in the future. No one should act upon such information without appropriate professional advice after a thorough examination of the particular situation. © 2024 KPMG LLP, a Delaware limited liability partnership and a member firm of the KPMG global organization of independent member firms affiliated with KPMG International Limited, a private English company limited by guarantee. All rights reserved. The KPMG name and logo are trademarks used under license by the independent member firms of the KPMG global organization.

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are living in a historic moment in which emerging technology, especially Artificial Intelligence (AI) and the proliferation of Generative AI (Gen AI), are pro viding new opportunities for governments to create innovative solutions and rethink the way we work. From automating operations, to lever aging data-driven insights and generating new and innovative solutions to complex problems, AI is now helping government agencies address staffing shortages, respond to disruptions, and modernize outdated processes to work smarter. AI adoption is poised to expand dramatically in the public sector as the technology proves its value in a variety of use cases. Government agencies can revolutionize the way they engage with providers and clients, deliver person-cen tered services, and operate departments such as information technology (IT), finance, human resources, and procurement. Data insights from AI solutions can inform equitable, ethical deci sions that drive meaningful impact resulting in reduced risk and improved outcomes. Modernizing for the Future of Human Services Emerging Technology and Process Innovation We By Thomas Nisbet and Samantha Nie

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Fall 2024 Policy & Practice

Impact of AI for Human Services In the human services industry today, agencies are focused on improving customer experience and services delivery to create measurable and sustainable outcomes, while simultane ously facing the challenges of a reduced workforce and an increasing pace of client needs. The capabilities of AI can transform how agencies drive improved outcomes for program beneficiaries, while also addressing the challenges of hiring, retention, and staff workload. Now, as in the past, a logical strategy to deal with these challenges is to turn to technology. Technology has long been an enabler of automation and scalability, but with the recent advances in AI, its capabilities have moved well beyond that. AI is evolving as a technology change agent for driving improved business processes and outcomes. When paired with humans, what we call the human-AI tandem, AI facilitates accessible exper tise that supports agency staff so they can work more effectively and deliver outcomes more efficiently, Agencies leading the way in AI deploy ment are applying AI for improvements in areas such as back-office efficiencies, workforce productivity, cybersecurity, and user experience. Just as important, they are creating structures such as

governance committees and centers of excellence that spread successful use cases and best practices across agency departments and divisions. This article discusses key factors related to planning for AI impact from the start of a project, and for creating a successful, long-term AI journey that delivers on the full promise of using AI to change the way agencies operate and achieving AI at scale. Achieving Impact with AI Initiatives Impact means thinking big, starting small, and never stopping. Success with AI begins with a big idea or goal. With an epic vision guiding a long-term AI journey, AI’s long-term impact can be equally as epic. What do we mean by an epic guiding vision and AI journey? Let’s start by what it is not. An AI journey is not a use case, pilot, proof-of-concept, or software point solution. These are examples of a “technology first” initiative, an initia tive with a narrow vision and a defined, short-term finishing point from the start. These finite endeavors limit the scope and scale of an AI journey because they generally lack a broad business goal from the start. AI initiatives should have impactful business goals with broad visions–– such as creating the best customer service experience in government, promoting administrative staff to roles that deliver higher levels of contribu tion, or automating human-intensive processes across the enterprise. While the ideas are big, agencies do not need to take on the full-scale, epic enterprise vision from the begin ning. It is essential to remember that AI is complex and rapidly evolving and requires a gradual and incremental approach to adoption. Starting with a meaningful and impactful business case that is technically feasible allows you to gain hands-on experience, learn from your mistakes, and build a strong foundation for future growth. By starting small, you can also identify potential roadblocks and refine your approach before scaling up. When starting small, it is also impor tant to avoid stops and pauses in AI development as these become barriers to continued progress. The AI landscape

is constantly evolving and changing, so it is crucial to never stop learning and exploring. Staying ahead of the curve requires continuous innovation and iteration. AI development should be a continual and ongoing process. Thinking big and thinking long term, from the beginning, while progressing incrementally and continually, is the way to achieve impactful results and successful business outcomes. Impact is a business metric. Business impact is a measurable objective that is meaningful to the business. When starting an AI initia tive, it is most important to clearly define the business impact and objec tives you intend to achieve. Human services agencies should ask, “What is important to our business, our agency, and our clients? What are our strategic priorities and associated pain points?” And then, “How do we use AI to help achieve those objectives?” rather than, “How do we replicate what another agency did using generative AI, whether or not it makes sense for our goals?” An AI journey is business led and technology enabled. This means that the value of the AI initiative is determined by its business impact, and that impact needs to be measured from day one. In addition, to understand the full impact of the initiative, metrics should not only reflect the AI solution performance, but also its broader impact on program key performance indicators (KPIs). Measuring business impact incremen tally is also important. An AI initiative may start small with a phase 1, but to achieve long-term goals, agencies should know their objectives for phases 2, 3, 4, and beyond, from the outset, and measure impact at each phase. Impact requires executive commit ment and enterprise collaboration. Finally, for any project to be suc cessful, executive buy-in is a must. AI projects are no different. Success starts at the top with a strategic vision and with long-term executive commitment. Executive sponsorship is the glue that supports and invigorates collabora tion across the enterprise and the strategic alignment of the business and IT, another essential element of a suc cessful AI journey.

Thomas Nisbet is an AI and Analytics Associate Partner in IBM Consulting’s State, Local, and Education practice.

Samantha Nie is an AI and Analytics Senior Managing Consultant in IBM Consulting’s State, Local, and Education practice.

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Policy & Practice Fall 2024

Child Welfare Agency: Using AI for effective policy management. A state child welfare agency is dedicated to protecting children and families. To achieve this mission, they rely on effective policy management, ensuring that policies are up-to-date, accessible, and easily understood by all stakeholders. The agency used AI to transform policy management, making it a produc tive and efficient process. Working with IBM, they introduced an AI assistant that provided instantaneous access to relevant policy information, reducing the need for tedious and error-prone searches, and the risk of misinterpreta tion. Employees can also access policies at the moment they need them without extensive research or technical exper tise, making policy management a productive and user-friendly experience. The AI assistant is just the beginning of the potential impact of AI in paving the way for a more efficient, trans parent, and effective Child Welfare service. The agency looks to leverage AI for more innovative applications in policy management and for other use cases in the future. In Summary AI is here. And human services agencies are ready to begin their AI journeys. They should start with big goals, epic visions, and ambitious aspi rations from the beginning, but also remember that this is a journey: To create an AI-driven enterprise, early initiatives will reap value incremen tally. The AI landscape is constantly changing, and maintaining continual momentum and progress is key. Business impact is a measurable objec tive that should be tracked from the start. Executive commitment, continuity of support, and collaboration across the enterprise and over the lifespan of the project, especially between the business and IT, is essential. With the human–AI tandem approach, government agencies are on the precipice of creating a mind shift in the way their organizations work. With big ideas, measurable objectives, strategic executive leadership, and alignment of business and IT teams, this AI journey will be a success.

To drive a successful solution with meaningful organization and commu nity impact, the business and IT must each take responsibility for appropriate aspects of the initiative and the related decisions—the business to lead and define objectives, and IT to design and implement a technology solution. IT departments are the enablers, not the drivers. And just as it is not IT’s responsibility to establish business objectives, it is not the business’s respon sibility to drive technology decisions or specific tool selections. Each party’s role is critical and essential to building and steering the AI ship in the right direction. A partnership in which both parties are fully aligned on their respec tive roles and responsibilities is key. An Outline for AI Initiative Success Following are outlines of recent, suc cessful AI initiatives IBM has completed. State Health Agency: A long-term vision and commitment from the start paid off. A state health agency had a vision of providing the best customer service in government. Through executive perspective and planning, the agency established a long-term strategy with

a roadmap, a sustained budget, and a plan to implement their vision. They developed a multiphase, multiyear roadmap to implement an AI-driven customer experience. Working with IBM, the agency conducted Design Thinking sessions that established inclusive stakeholder engagement across the organiza tion to refine the vision and define specific goals. The project provided multichannel and multilingual inter active, self-service capabilities for clients. These user-focused experi ences automated millions of client interactions, significantly reducing the cost of unnecessary human interac tions. Together with IBM, the agency delivered a modernized customer expe rience to improve customer service, staff efficiency, and agency KPIs. Their approach committed to long term success by continuously tracking measurable outcomes against their defined business goals to prove the ongoing value of the AI initiative from Day One. This approach was expanded across programs and is now positioned for long-term deployment across future programs. The agency, its programs, and most important, its clients, are positioned to continue reaping the benefits of this initiative into the future.

Images by Chris Campbell via DALL-E

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Fall 2024 Policy & Practice

The Next The

Next Generation of

Eligibility

Operations

Improving Performance and the Customer Journey Beyond Integrated Eligibility Systems By sean toole

T

he typical applicant for the Supplemental Nutrition Assistance Program (SNAP) waits up to 30

and vacancy rates for jobs that are hard to fill, and we have a bad situation leaving families in need without adequate support. Fortunately, new approaches and tools are emerging that have the potential to truly transform eligibility operations. There is a future in which eligibility staff can focus on family needs and not robotic tasks, where self-service is comprehensive, and needs are met in minutes, not weeks. This opportunity is both real and achievable. By designing a customer journey grounded in a deep understanding of policy and practice, agencies can move beyond the pain of a constrained Integrated Eligibility System to a visionary, family-focused Eligibility Operations reality.

days for benefits and for up to 45 days for Medicaid. Despite years of massive invest ments in eligibility systems, call centers, and online portals, most states cannot keep up with the high volume of work. Error rates have soared to 40 percent, and customers may face wait times of several hours in call centers. Add in high turnover