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Human services: Rethinking delivery for greater impact

by Sundhar Sekhar, John O'Leary, Tiffany Fishman
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    07 February 2018

    Human services: Rethinking delivery for greater impact The State Policy Road Map: Solutions for the Journey Ahead

    07 February 2018
    • Sundhar Sekhar United States
    • John O'Leary United States
    • Tiffany Fishman United States
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    Advances in technology and analytics can help state human-service agencies focus more on client families. Further, transformational models can make data accessible to clients and caseworkers alike, helping achieve potentially life-changing outcomes in efficient and cost-effective manners.

    What is the issue?

    Although its core mission is to improve the trajectory of people’s lives, human services has long been more transactional than transformational.

    For most human services programs, the business day consists of programmed actions and reactions, inputs and outputs, moving back and forth among government workers, their data systems, and their clients. In executing complex human services policies, success is defined primarily by the timeliness and accuracy of these transactions rather than their results. This has led to a model in which outcomes are in fact merely outputs: Did we issue food stamps in a timely fashion? Did we respond to 95 percent of our hotline calls within 24 hours?

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    Rather than identifying and addressing the problems that bring individuals and families into contact with the social safety net, human services programs instead tend to see people through the lens of eligibility: Clients are enrolled in eligible programs, which means there is a particular set of services they can receive, even if those might not be the ones they really need to improve their situation. This program-centric view is a lingering byproduct of the way human services programs were originally created—as stand-alone programs rather than as an integrated safety net.

    Thanks to advances in technology and analytical techniques, human services agencies are now poised to move beyond transactional service delivery. If agencies can put their data in front of both clients and caseworkers in a way that they can readily understand, and in time use the data in a way that affects results, then what was once a transactional business model can become a transformational one, capable of achieving potentially life-changing outcomes in an efficient and cost-effective manner. Instead of executing mundane tasks, social workers can focus on families and the help they need.

    Issue by the numbers: Human services delivery

    • Child support has become an increasingly important lifeline for impoverished families. Child support represents 41 percent of the income of poor families that receive child support payments, up from just 29 percent a decade prior.1
    • By introducing no-touch (self-service) and low-touch options for determining eligibility for health and human services programs, one state automated 78 percent of its daily applications, reducing processing times by 35–50 percent and saving a projected 1 million hours in labor.2
    • In Camden, New Jersey, residents in just two buildings accounted for $200 million in medical services from January 2002 to June 2008. That’s more than $30 million every year from just two buildings.3 By better coordinating these clients’ health care and addressing their social circumstances, the Camden Coalition of Healthcare Providers was able to cut these costs by more than half.4

    How can state leadership tackle the issue?

    Accelerate the value of self-service through automation

    Advances in technology are significantly reducing manual processes and the need to manipulate reams of paperwork. These advances can free up caseworkers to focus their time and attention on providing specialized case management for clients, rather than becoming enmeshed in what they need to do to take care of transactional tasks and processes. Automation enables labor-saving innovations such as self-service eligibility portals, and back-end systems that can refer clients to services with little or no caseworker involvement. In some instances, outdated policies haven’t kept pace with new technologies, such as allowing for electronic correspondence with photo attachments or tele-interviews, which are more easily automated than paper-based processes.

    Identify opportunities for RPA technologies to automate administrative tasks

    Robotic process automation (RPA) technologies automate repeatable, rules-based tasks. Unlike a typical automated system function, RPA software, also known as a “bot,” operates at the user interface level and mimics the activities of a caseworker as it interacts with multiple applications in the execution of a task.

    Take the foster family application process, in which repetitive tasks can eat up hours. Imagine having a bot take a scanned foster family application, enter it into the appropriate system, and even validate in a separate system to determine if a mandatory lead inspection was completed in the home. This not only frees up the caseworker to spend more time determining if the home meets quality expectations, but also retrieves the lead inspection information without needing to build a data link to a separate system.

    This is just one example. The challenge is to look for low-risk, high-volume, repetitive tasks that traditionally take valuable time away from the caseworker and support staff, and give those tasks to the bot.

    Redesign programs to serve unique customer segments

    Just as businesses break their larger customer populations into subgroups with similar characteristics, human services programs too can segment their client bases. The goal is to deliver the right services to the right people. By rethinking the design and delivery of programs, human services agencies can better understand the diverse spectrum of needs among individual citizens and families. This can move human services systems from a “one-size-fits-all” approach to a “right-size-for-all” way of thinking about customers and what they need.

    Transform practice through analytics

    Enhanced data collection, coupled with the proliferation of agile and inexpensive technologies, is allowing for the increased use of analytics. This shifts the focus of human services from “hindsight” to “foresight and insight,” which can offer unprecedented opportunities for efficiencies and cost savings. It can also make sure that the right solutions get to the right people at the right time.

    Extend caseworker capabilities using AI-based technologies

    The introduction of artificial intelligence (AI) can bring big changes to human services agencies, freeing caseworkers to focus on life-changing work. AI can also help them to do a better job, providing the insights necessary to do the right work, for the right people, at the right time, thus achieving meaningful results for the individuals and families they serve.

    To make the most of AI investments, agencies should consider redesigning their talent strategies so that a job is viewed not as an individual production function, but rather as a collaborative problem-solving effort, where a human defines the problems, machines help find the solutions, and the human verifies the acceptability of those solutions.5 Chatbots are another way to provide clients with smart guidance on questions about eligibility and policy, improving accuracy without tying up human resources. In addition, digital workflows can also augment worker impact through data analytics and behavioral “nudging.”

    You don’t need to look too far for inspiration

    Data-driven child support enforcement in Florida

    The Florida Child Support Program uses a predictive model to select compliance actions that will produce the best return on investment (ROI), bringing in the most collection money when compared with the costs. The model is based on two specific parameter groups—the financial compliance levels of cases and the indicators of the parents’ ability to pay (criminal history, employment, institutionalization status, and disabilities). For each case, the system then identifies the best course of action, selecting and prioritizing actions from a catalog of 11 possibilities. This minimizes the chance of using an expensive remedy, such as contempt, which requires activity by attorneys, in cases where that option is not likely to result in payment.

    Simplifying eligibility verifications in San Diego County

    Caseworkers today often must manually verify beneficiaries’ eligibility by fetching data from multiple systems. In San Diego County, for example, caseworkers use two different systems for eligibility verifications. The first stores all the required documents to verify eligibility. The second has 500 different application forms; each form, or combination of forms, requires different documents.

    Because these two systems don’t share information, caseworkers had to open forms from one system and then look for supporting documents in the other. Since there are 500 forms, these requirements create hundreds of business rules, which a caseworker had to verify manually. The process was complex and consumed a great deal of time.6

    To automate the process and connect both systems, the county deployed RPA software. It looks at the open forms on a caseworker’s screen, sifts through the verification fields, identifies relevant documents, and then pulls up those documents from the other system. The entire manual task was replaced with the stroke of a hot key. Thanks to RPA, the county slashed the time it takes to approve a SNAP application from 60 days to less than a week.7

    Authors

    Sundhar Sekhar a principal with Deloitte Consulting LLP, is the Public Sector Human Services leader and serves state Health and Human Services (HHS) clients. He is based in Harrisburg, US.

    John O'Leary is a manager with Deloitte Services LP, and is the state and local government research leader for the Deloitte Center for Government Insights. He is based in Boston.

    Tiffany Fishman Tiffany is a senior manager with the Deloitte Center for Government Insights. She is based in Arlington, US.

    Acknowledgments

    This article benefited greatly from the contributions of Purva Singh of Deloitte Services India Pvt. Ltd.

    Endnotes
      1. Vicki Turetsky, “Child support performance has never been stronger,” Child Support Report 38, no. 6 (2016). View in article

      2. B. J. Walker and Tiffany Fishman, Rethinking human services delivery, Deloitte University Press, September 18, 2015. View in article

      3. Atul Gawande, “The hot spotters,” The New Yorker, January 24, 2011. View in article

      4. Robert Wood Johnson Foundation, “A revolutionary approach to improving health care delivery,” February 1, 2014. View in article

      5. Peter Evans-Greenwood, Harvey Lewis, and Jim Guszcza, “Reconstructing work: Automation, artificial intelligence, and the essential role of humans,” Deloitte Review 21, July 31, 2017. View in article

      6. Automation Anywhere, “San Diego County – Health and human services agency case study,” October 17, 2015. View in article

      7. Automation Anywhere and Media IQ, “Webinar: How to deploy robotic process automation at scale.” View in article

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    Public Sector , Health Care , State Government

    Deloitte Center for Government Insights

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    Sundhar Sekhar

    Sundhar Sekhar

    Customer and Marketing Offering Portfolio Leader

    Sundhar, a principal with Deloitte Consulting LLP, leads Deloitte’s work in the areas of Customer Strategy and Applied Design, Digital Experience, Salesforce, Digital Transformation, and Human Services IT transformations for Federal, State, County, and Higher Education clients. He is passionate about helping Deloitte’s clients design solutions to deliver their services in a way that elevates the human experience for stakeholders. Sundhar has more than 30 years of industry and consulting experience working with state and federal government clients focusing on large scale IT, business and service delivery transformations that integrate innovative technology solutions with human centered design principles. He has published several articles and has testified before the US Congress on the impacts of program integrity in HHS.

    • ssekhar@deloitte.com
    • +1 717 651 6240
    John O'Leary

    John O'Leary

    Senior Manager | Deloitte Services LP

    John is a senior manager with Deloitte Services LP, and is the state and local government research leader for the Deloitte Center for Government Insights. Prior to joining Deloitte, he served as the vice president of communications and executive reporting with State Street Bank. John previously served in multiple senior leadership roles for the Commonwealth of Massachusetts and was a distinguished research fellow at the Kennedy School of Government at Harvard University. He is the co-author of the 2009 Washington Post best-seller, “If We Can Put a Man on the Moon.”

    • jpoleary@deloitte.com
    • +1 617 437 3576
    Tiffany Fishman

    Tiffany Fishman

    Senior Manager | Deloitte Services LP

    Tiffany is a senior manager with the Deloitte Center for Government Insights. Her research and client work focuses on how emerging issues in technology, business, and society will impact organizations. She has written extensively on a wide range of public policy and management issues, from health and human services reform to the future of transportation and the transformation of higher education. Her work has appeared in a number of publications, including Public CIO, Governing, and EducationWeek.

    • tfishman@deloitte.com
    • +1 571 882 6247

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