Five Ways Health and Human Services Agencies Can Ace IT Modernization

“Modernization” is on the minds of every state HHS agency across the country. Even in the early days of the pandemic, COVID-19 revealed critical shortcomings in delivering vital benefits and services to states’ most vulnerable residents. Not only did agencies need to immediately shift to remote work, but the residents’ agencies serve demanded contactless services. States experienced a dramatic increase in the need to support case managers, caseworkers, and residents. Suddenly, system modernization leapfrogged many states’ existing priorities.

The idea of replacing the legacy systems that have supported HHS agencies for over 40 years can be overwhelming. While the journey has its unique twists and turns, each state’s destination is the same: thoroughly modernized, resident-centered, flexible, extensible, and easily maintained systems that will last.

As you discuss your path to modernization, consider the following five principles.

1. Develop a Modernization Roadmap.

Modernization needn’t be a massive undertaking, but it does call for planning. You need a roadmap for how projects will proceed.

Start with best practices. Talk to states that have already made progress. Many states are willing to share insights, so take advantage of their lessons learned. Understand the Federal guidance and regulations. Consider input from an experienced consultant.

Then, get buy-in from all levels of government. The Legislators that approve your budget will hold you accountable. A solid plan will help you manage expectations and demonstrate how you’re achieving the expected return on investment.

Finally, aim for 18-month horizon planning, not five-year grand schemes. You need the flexibility to accommodate for new regulations or changing administrations that reshuffle priorities.

2. Clean Up Your Data with a “Data First” Approach.

Many HHS agencies hang on to legacy systems because they’re the foundation of eligibility and case management processes. But their age and inflexibility have resulted in datastores that are inconsistent, redundant, and in many instances inaccurate.

For instance, legacy systems typically allow for two gender classifications, male, female, and perhaps other. Because of the interconnectedness of legacy technology, updating this field to accommodate classifications such as nonbinary, intersex, and transgender would likely require months of coding and testing. To work around and enter the necessary information, case managers may enter gender data in other fields, and before long the dataset is unreliable.

Without accurate data, reporting becomes increasingly unreliable. Too agencies resort to ad-hoc reporting, which is cumbersome, time consuming, and prone to human error.

Data cleansing involves identifying and resolving incomplete and inaccurate records. Building a modern data store can provide a solid foundation for the rest of your modernization efforts. Once available, the fresh data will provide better reports, allowing your agency to make more informed decisions. Understanding your data lends to developing procurements for eligibility and enrollment systems that better meet your needs. Modernized data stores offer the flexibility to adapt to changing data needs, supporting ongoing data reliability.

3. Modernize in Parallel and One System at a Time.

”Incremental modernization” was once a buzzword for a waterfall approach to dissecting and decoupling interwoven systems. For instance, legacy SACWIS, Child Support, and Social Services Case Management systems share the same database. Using a data first approach to create a new data store provides the foundation for choosing the order in which legacy systems are modernized.

Today, the term “incremental modernization” has become more about breaking the large system efforts into more manageable and meaningful projects. Best practices are to consider and undertake smaller, more foundational efforts such as Business Rules and Legacy System Analysis as well as the Data First approach previously described.

By analyzing your legacy programs, your Subject Matter Experts identify the existing rules you still need, the rules you can discard, and consider the new rules required for the modernized system to meet today’s needs. This can be done for each system in parallel, allowing you to develop and issue procurements for the new systems. In addition to data and legacy system analysis, modernizing rules engines and developing/designing the new enterprise platform may be completed in parallel.

The more legacy information you can include in your Requests for Proposals, the more specific your vendors’ responses will be. Between the quicker wins of the smaller efforts of creating a cleansed and normalized data store and analyzing legacy business rules and dependencies, modernization covers the tasks that can be performed in parallel as well as those with dependencies. These quicker wins will enable you to report progress, maintain and gain buy-in from decision makers, and demonstrate ROI – all without significant disruption.

4. Don’t Fall for Vendor Lock-In.

For decades, state agencies have struggled with long-term contracts awarded to one vendor. Because legacy systems are largely interwoven and share important dependencies, it made sense for one vendor to manage and maintain all of the agency’s social services systems. Over time, agencies grew hesitant to break these contracts into smaller projects and award them to multiple vendors. Agencies avoided this for fear of unmet Service Level Agreements and disagreement among multiple vendors.

However, best practices and the approaches summarized here provide a new approach to successfully managing multiple vendors within the same modernization effort. By modernizing systems incrementally, you can free yourself from vendor lock-in. You can normalize your data with one vendor, implement an application for a specific use case with another, create a self-service web portal with another, and so on. You can get the best solution for each purpose, sign shorter contracts for smaller-scope projects, and change vendors in the future. This requires strong leadership and contract management from the agency, which is an important consideration and contributor to meeting milestones.

5. Remember, the Resident Comes First.

Legacy system design historically focused on eligibility and case management rather than resident-focused features and functions. Today, the agency’s priorities determine how technology must support the business. Using the many avenues available, residents express their issues with outdated systems and processes, which provide another level of insight for the business to consider. Focus groups, surveys, and case manager feedback contribute to a more wholistic view of the resident experience.

Many states have opted for a resident-friendly, “no wrong door” portal experience. Maryland’s MDTHINK program has achieved success with their design, as well as the District of Columbia. Other states such as Pennsylvania implemented a resident portal and continue to evolve the technology.

Your modernization effort will follow a similar path. Consider starting with simple use cases to achieve results in three to six months. Adapting your internal business processes to a new way of delivering services will guide your decisions on replacing systems. Build your vision and mission to include and champion resident-centered designs and decisions. Priorities and challenges will arise; priorities will shift. Starting with a roadmap will demystify the journey and lead you to success.