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Unifying Health and Human Services in California

This blog is an excerpt from GovLoop’s recent guide, Cybersecurity, Analytics, & More: The 8 Government Health IT Trends You Need To Know. Download the full guide here

The California Health and Human Services Agency (CHHS) is a massive organization, spanning 12 departments of varying sizes, 33,000 workers, and running over 200 public health programs. Coordinating health efforts across an organization of that size brings several challenges, but California has worked to overcome departmental mission and data silos to move toward a unified agency.

Scott Christman is the Chief Information Officer at the Office of Statewide Health Planning and Development, one of CHHS’ departments, and the Acting Agency Information Officer for CHHS overall. He talked to GovLoop about the strategies CHHS used to create a unified agency, challenges faced, and trends he sees for the future.

Traditionally, Christman said, the 12 departments “focused on their individual programmatic missions,” creating data silos. In addition, “[CHHS has] a very large Medicaid program, we have a full range of social and human services delivery; all things that you would expect from a health and human services organiza- tion are included in the portfolio.” CHHS also partners with counties as well as the federal government. This means CHHS had to deal with several individual strategies and governance plans throughout the departments, programs, and civil partners.

However, CHHS is shifting from a programmatic focus on healthcare to a whole-person view and person-centered care. This new focus requires more collaboration among the separate departments, so CHHS now views their agency as a single unit with a portfolio of 12 different departments. The departments coordinate their efforts in order to serve the broader agency. Christman offered an example of this new focus: “If we need identity and access management functionality, ideally we can leverage a shared service that would deal with identity and access management for any CHHS program, as opposed to individual programs developing their own functionality.”

This movement to shared investments across the agency is most clearly manifest in the governance structure. Christman noted, “We’ve created a horizontal agencywide cross-cutting governance structure that has representation from the 12 departments. This is a structure that’s sponsored by the Secretary and Undersecretary [of CHHS], and it’s allowed us to begin thinking about leveraging investments across departments and focusing on shared services that can provide a functionality that many programs benefit from.”

The departmental input and high-level support are key aspects of the structure’s success so far. When asked what tips he had for other agencies attempting a similar project, he recommended creating a short, simple, focused strategy. Decide what is important for your agency, develop your strategy around that, and don’t let the plan just sit on the shelf. He also emphasized the importance of strong leadership and a high-level champion for the plan, as well as reinforcing a core message to help shift organizational cultures.

In terms of cultural shifts, CHHS’ open data project, the first agency-wide initiative, has been a major success. Christman said, “It’s greatly improved accessibility to data. We can have better informed conversations, and it can drive more informed work in communities. But it also helps us internally and advances our interest in data sharing. We aren’t doing Medicaid open data and public health open data; we’re doing Health and Human Services open data.” This shift matches the agency’s new focus on person-centered care and design, allowing users to identify relevant information without having to delve into departmental divisions.

Christman acknowledges that there are still challenges. One of the biggest challenges is the variation in departmental size. The Department of State Hospitals has 11,000 employees in hospitals across the state, while the smallest department has around 80 people. The differences in departmental capacity and resources make it difficult to standardize initiatives across the agency. Another challenge is the lack of a developed data science employ- ment pool for state government, making it difficult to recruit new staff to aid in the initiative.

Cloud provides a solution for some of those challenges, providing scalable capacity and a collaboration platform throughout the agency. Christman said, “We want to focus our resources on our core competency, and we want to focus more on the development of data assets, for both public and internal use. Managing physical infrastructure is just not one of our core competencies. The resources spent on that management could be used instead for critical agency initiatives.” This includes using data to solve problems and improve agency programs and services.

Looking ahead, the future for CHHS will continue the focus on development of data assets and building a culture of using data to improve operations and services. In order to match the idea that CHHS is one agency, Christman said, “We should be able to move data between departments in order to put the data together, provide better analytics, and drive better programs, better service delivery, and better outcomes.” These steps and constant progress will help unify an extremely diverse system, which means better care for California residents in the end.

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