A New Era of Health & Human Services

CareDirector recently exhibited at the APHSA HHS Summit in Baltimore, a great event with lots of interesting insights. The Tuesday afternoon General session, “The State and Local Landscape: A New Dynamic was a practical look at health and human services in an era of funding uncertainty. Zach Patton, Executive Editor of Governing was the moderator. The panel was composed of HHS executives at the state, county and local provider level and  took place a couple of days prior to the House passage of the revised AHCA.

The discussion began with an acknowledgement that while HHS funding instability pre-dates the 2016 election, the situation has escalated enormously; “With this Administration, everything is on the table.”

Nick Lyon described how the consolidation of agencies including behavioral health, public health, aging, vocational rehabilitation, SNAP, CPS and cash assistance into the merged Department of HHS is helping Michigan do better serving people. They are currently designing a statewide integrated services portal. He said that they work within the parameters they are given, but would like to become outcome focused rather than “topical” focused.  He later added that the consolidation of HHS in Michigan has allowed them to “marry” the views of behavioral health with physical health. They hope to add dental, and are moving this approach into CPS, with the ultimate goal of mitigating trauma. Nick talked about making rules consistent, and using common sense. He gave the example of an overly complex, incredibly long application form which they were able to reduce significantly. He also again advocated putting prevention first.

Anita Friedman told us that Arlington, Virginia has a dense population in a small space, and that despite a median income of $109k, 25% of the population comes to HHS for services including public health, behavioral health, housing and employment assistance. HHS constantly re-evaluates funds and allocations. Gone are the days of “sacred cow” programs; if money isn’t being spent timely with supporting outcomes, back it goes into the pot for re-allocation. Non-profits are “being slaughtered; “ their funds being re-purposed and re-allocated. It’s not a “cultural shift,” but a reflection of reality. “We are not just service providers. We are community builders. Be a voice for the people who come to you who don’t have a voice. Make politicians understand that services are a crucial investment in the future of the community“.

Denise Cross introduced us to Cornerstones of Care, a behavioral health agency providing services to children from birth to age 25, and their families. Their services include therapeutic foster care, adoption, residential care and pediatric psychiatric hospitals. Cornerstones operates in Kansas and Missouri, with additional services in Nebraska and Illinois.  She supports reform at the federal level, especially increased focus on early intervention and prevention. They are diversifying their funding streams to reduce dependence on single at-risk sources, and building partnerships and strategic alliances with entities such as the University Hospital system. Cornerstones participated in a local tax initiative to support children’s services, as have ten other counties in Kansas. The issue passed. There is some risk of the state “punishing” the locals, but the community feels that they own the issues, and the solutions. Cornerstones invested in a robust EHR. They believe that data sharing is needed, and outcomes which prove they are making a difference, and that funding services isn’t a drain, but an investment in the future of the community. She said “Keep in mind, we all have the same goals, and we are all experts. Can we agree on a core set of values?” and noted that while “flexibility” looks good, who decides?


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