Policy & Practice February 2015

Part of the answer lies in an ini- tiative that was launched in 2010, co-sponsored by Harvard, Accenture, and APHSA, where agency, federal government, and private provider leaders have come together annually to understand and advance the Health and Human Services Value Curve (see graphic at right). Now when I think of Harvard or summit meetings, I don’t immediately think of Johnny Unitas and his adage about talk being cheap. And when I first saw this Value Curve four years ago, I worried that it would result in a bit more concept than action. Even the best designed playbook looks like a bunch of symbols that mean nothing to anyone who hasn’t taken the field to learn through action what it all means. But four years later, we see many examples around the country of agencies and their partners decoding this Value Curve—communicating about it more confidently, applying the framework through a range of actionable strate- gies, and winning stakeholder support for advancing through its four stages. At its core, the Value Curve describes how health and human services are provided to those we serve at four pro- gressive levels of value, each building from and expanding the consumer value delivered at the more formative levels: 1 At the regulative level , con- sumers receive a specific product or service that is timely, accurate, cost-effective, and easy to understand. Many agencies and systems around the country are focused on achieving efficient and effective service within a specific program area, and to a large extent this is good for consumers. But we know the value limitations of sending

Efficiency in Achieving Outcomes

Generative Business Model

Integrative Business Model

Collaborative Business Model

Outcome Frontiers

Regulative Business Model

Effectiveness in Achieving Outcomes

product and service flexibility, and enhanced service delivery. This is all geared toward supporting people to prevent problems upstream versus fixing or recovering from them down- stream. This all requires redefining casework practice and skills, pro- viding real-time technology tools for caseworkers, establishing new forms of data and analysis geared toward problem prevention, and instituting highly adaptive program design and funding mechanisms. 4 At the generative level , dif- ferent organizations providing various products and services are joining forces to make the consumer’s overall environment better for them, resulting in value that is broader and more systemic than an individual or family might receive directly. At this stage of value, agencies, with their partners, focus on general consumer advocacy and co-creating capacity at a community-wide level as a means to meet consumer needs. This requires collective efforts targeted at community-level infrastructure building, and enhancing societal beliefs and norms about government, in general, and those we serve, in partic- ular. This ultimately results in greater commitment to leveling the playing field, plugging everyone into the

those we serve through many program doors, engaging them within a limited program scope, or focusing primarily on program compliance and related output goals as measures of our own performance and value, whether or not these outputs are having the desired consumer impact. 2 At the collaborative level , con- sumers “walk through a single door” and have access to a more complete array of products and services that are available “on the shelf.” At this level, agencies with their partners focus on cross-programmatic efficiency and effectiveness, which often require operational innova- tions like unified intake and eligibility systems, cross-program service plans that address multiple consumer needs, and shared data platforms or protocols to support these integrated services. Certainly a big step up in value for con- sumers, but not the best we can do. 3 At the integrative level , products and services are designed and customized with input from consumers themselves, with the objective of best meeting their true needs and enabling positive outcomes in their lives. The focus in this stage is on more consulta- tive consumer engagement methods,

Phil Basso is the deputy executive director for Strategic Communications and Organizational Effectiveness at APHSA.

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Policy&Practice February 2015