Pennsylvania No Wrong Door DRAFT Plan

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Executive Summary

The Pennsylvania Departments of Aging, Human Services and Military and Veterans Affairs developed a plan to start the implementation of a No Wrong Door System (NWD) of access to Long Term Service and Supports (LTSS.) A NWD approach is a shared statewide approach for LTSS for all populations

regardless of age, income or ability and including all payers--federal, state, local and private.

In practice, NWD means that no matter where an individual goes, he/she receives a consistent consumer experience through a person-centered approach and gets what he/she needs—or at least the next step in planning. Individuals do not have to repeat their stories multiple times to multiple agencies—information follows with the individual among agencies. Once a plan to meet someone’s needs is developed, there is shared, coordinated management among providers and agencies.

In short, a NWD approach to long term services and supports means that people receive the support they need at the right time, in the right intensity and in the location of their choosing. Pennsylvania’s NWD plan builds on its investment in its Aging and Disability Resource Center (ADRC) program, called the Pennsylvania Link to Aging and Disability Resources or PA Link. Currently, the PA Link, a program of the Pennsylvania Department of Aging, operates through fifteen service areas that cover the entire Commonwealth.

The PA Link received a grant managed by the Administration on Community Living, Centers for Medicare and Medicaid Services and Veterans Health Administration (ACL/CMS/VHA) to develop a plan for Pennsylvania to implement a NWD approach. The PA Link led the NWD planning team through a nine-month process to identify gaps, develop strategies and define goals and a work plan. The NWD planning team comprised over 75 individuals involved in the LTSS network including county staff, service providers, consumers, advocates, state staff and agency leadership. All specialty service groups were represented including: aging, physical disabilities, intellectual disabilities, developmental

disabilities, behavioral health, substance abuse and veterans’ services.

To reach its vision and align with the federal vision, Pennsylvania will address gaps in its LTSS system: Federal NWD Vision:

Key Functions

PA Challenges and Gaps

1. Public Outreach and Coordination with Key Referral Sources

 Current outreach typically occurs in “silos” based on individuals’ diagnoses and LTSS needs.

 The general public is likely unaware of LTSS and may not be counseled if they transition from acute care.

 The “silo” approach fails residents when emergencies occur and multiple resources are immediately needed to avoid institutional placement.

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Page 3 of 47 2. Person-Centered Counseling

 The current certification process required for Person-centered Counseling/Options Counseling1_{is not as rigorous} as needed.

 There are limited opportunities for LTSS organizations to provide Person-centered Counseling/Options Counseling services.

 There is a limited reimbursement process for organizations to provide Person-centered Counseling/Options Counseling services.

 Outcome measurement is limited.

 The workforce with the most person-centered experience (Service Coordination agencies) have limited incentives to also perform Person-centered/Options Counseling.

3. Streamlined Access to Public Programs

 Procedures, processes, IT systems and forms vary in the LTSS network and at the state level.

 Dual-eligible2_{people may need to enroll multiple times if} their needs cross departments.

 The process is lengthy and can put people at risk for an institutional placement.

4. Intersection of the NWD System Person-Centered Counseling and Streamlined Access to Public Programs

 Person-centered Counseling/Options Counseling sessions may or may not include goals beyond health-related outcomes.

 Focus on vocational, social, recreational, and spiritual goals varies among providers.

5. State Governance and Administration

 LTSS spans across multiple departments and offices within agencies, each of which has separate funding, enrollment, delivery, oversight and outcome measurement policies, IT systems and procedures.

 There are no statewide LTSS measures or reporting of outcomes related to individuals, groups or stewardship of public funds.

1_{Pennsylvania is in the process of rebranding its ADRC planning service from “Options Counseling” to}

“Person-centered Counseling.” This change is to differentiate the service from both the Pennsylvania Department of Aging OPTIONS program and the Department of Human Services “Person-Centered Planning” service.

2_{In this case, dual-eligible refers to individuals with multiple diagnoses, e.g. both a behavioral and physical}

impairment. People who are dually eligible for Medicaid and Medicare will enroll in the new Managed Care system for LTSS.

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Page 4 of 47 Pennsylvania’s NWD Plan Goals:

1. Develop and implement a single IT solution for PA Link operations and program management including: person-centered counseling, referrals, data gathering, outcome reporting and web resource center.

2. Develop a person-centered counseling certification process for PA Link partners.

3. Ensure that NWD/PA Link partners are fully knowledgeable of all LTSS screening, education and referral tools.

4. Standardize Statewide Quality Assurance and Continuous Quality Improvement (CQI) functions for the PA Link.

5. Implement an outreach and onboarding program for PA Link/NWD partners. 6. Assess current capacity of PA Link/NWD system to meet potential unmet needs. 7. Develop more formal communication strategies with NWD/LTSS stakeholders. 8. Expand and develop state level executive oversight of the PA Link/NWD system. 9. Standardize and promote the PA Link brand to the public across the Commonwealth.

Meeting these goals will improve the entire system of LTSS planning and delivery. The implementation of Managed Long Term Services and Supports (MTLSS) can streamline and provide coordination for people already enrolled in Medicaid programs. A NWD approach streamlines access to these programs and also provides support for those not eligible for Medicaid programs.

NWD Mission and Vision

A No Wrong Door (NWD) System in Pennsylvania is a shared statewide approach for Long Term Services and Supports (LTSS) for all populations regardless of age, income or ability and including all payers--federal, state, local and private.

The practical outcome for recipients will be that:

 No matter where they go, they receive a consistent consumer experience through a person-centered approach to get what they need—or at least the next step in planning.

 They do not have to repeat their stories multiple times to multiple agencies—the information follows them among agencies.

 Once individuals plan their services, there is shared, coordinated management among providers and agencies.

 With more coordinated systems, Pennsylvania can be a more effective steward of public funds and resources.

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Page 5 of 47 The conceptual basis is:

 Shared responsibility for outcomes among all LTSS entities—public and private.  Transformed ways of thinking about LTSS and in doing business.

 Willingness to work with people without immediate, guaranteed reimbursement.

 Development of relationships among agencies, providers, non-profits, health systems and private payers to better serve Pennsylvanians.

This vision aligns with the federal vision of a NWD System.

To address the gaps and fulfill the federal and state NWD vision, the PA Link to Aging and Disability Resources in full partnership with the PA Departments of Aging, Human Services, Military and Veteran’s Affairs and key stakeholders, in the course of a one year project, developed an action plan that will be used to implement a coordinated and integrated NWD system for individuals to access long term services and support.

The NWD vision was developed through facilitated input from the public, consumers, providers and other stakeholders with additional research as necessary. Its foundation is intense collaborative partnerships and expanded use of new and shared technology that will enable individuals to access and maintain services more efficiently and effectively. The goal of this project was to develop a specific plan of action to implement the ACL/CMS/VHA NWD vision.

Overall NWD Plan Objectives

 Strengthen relationships and increase awareness among current and future partners, consumers, stakeholders and the public.

 Increase public awareness of the multiple sources of LTSS information.  Reduce unnecessary nursing facility placements.

 Reduce unnecessary hospital readmissions.  Improve LTSS responsiveness and efficiency.

 Ensure NWD system accountability and sustainability.  Streamline enrollment processes and reduce timeframes. Specific Project Outcomes

1. A three-year plan to implement the ACL/CMS/VHA vision of a NWD system in Pennsylvania. 2. Increased public awareness of cross agency sources of LTSS assistance.

3. Functional requirements for integrated management systems. 4. Certification program for Person-Centered/Options Counseling.

The vision and direction of Pennsylvania’s NWD System has been in development for years. Individual agencies, advocates and providers have expressed concerns and noted areas for improvement in service and in stewardship of public resources. Their input has been reflected in strategic plans, reports, listening

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tours, legislation and program enhancements at the state and local levels. Advocates, agencies and providers have identified the challenges through multiple means. The project leadership team synthesized years of experience and input into the vision, mission, goals and objectives. Project stakeholders refined these items as part of the planning process.

The planning for and implementation of Pennsylvania’s NWD System is a process, not an event. Sustained effort and processes with a critical eye for continuous measurement and refinement are essential to ensuring that NWD stays relevant, current and responsive to an ever-changing environment.

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NWD Assessment

Assessment Process

The assessment process comprised three phases: metadata analysis, confirmation and refinement by workgroup teams and presentation to stakeholder groups.

Metadata Analysis

The Departments of Aging, Human Services and Military and Veteran’s Affairs and their

individual bureaus regularly assess their effectiveness and conduct short and long-term planning. The project team did not need to repeat these efforts and convene stakeholder meetings to ask the same questions again. Reports reviewed and analyzed include, but are not limited to:

 2015 Balancing Incentives Program (BIP) Stakeholder Outreach Session Outcomes

 2014 Pennsylvania Long Term Care Commission Final Report

 2012-2016 Pennsylvania Department of Aging State Plan on Aging

 2014 Joint State Government Commission Report on Long Term Care Services and

Supports for Older Pennsylvanians

 2014 Office of Developmental Programs Futures Planning Report

 2014 Pennsylvania State Plan for Alzheimer’s Disease and Related Disorders All of these reports contain the strengths, weaknesses, opportunities and barriers in Pennsylvania’s LTSS Systems.

The project workgroup teams reviewed and analyzed each agency’s strategic plans. In addition, Pennsylvania’s BIP team conducted stakeholder outreach this year focused on identifying strengths, weaknesses, opportunities and barriers. The BIP team collaborated with and shared information with the NWD project team to avoid duplication of effort. NWD workgroup teams reviewed and analyzed the reports and then met to discuss and apply all results to designing a NWD System.

Finally, the results of the assessment process were presented as part of the draft plans presented to stakeholder groups in May and June 2015. The project team convened fifteen working sessions throughout the Commonwealth to present draft strategies to implement a NWD system in Pennsylvania. Participants in the sessions reviewed assessments, refined plans and made recommendations to the project team.

Stakeholder Involvement in Assessment

Stakeholder involvement occurred on multiple levels. The review of individual bureau and affinity group plans reflected stakeholder needs across all aspects of the LTSS spectrum. In addition, stakeholders were involved through workgroup teams comprising local, county and state subject matter experts from aging, physical disability, intellectual disability, mental health, consumer and veterans groups. Finally, a broader spectrum of stakeholders reviewed the

assessments and added input through the fifteen stakeholder planning sessions held in May and June 2015.

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Assessed Strengths, Weaknesses, Opportunities and Barriers

Based on data gathered from other planning efforts and the engagement of key stakeholders on NWD workgroup teams, the following are the strengths, weaknesses, opportunities and barriers in PA’s LTSS system.

Strengths

PA Link to Aging and Disability Resources. Since 2003, the PA Link has developed and facilitated collaboration among LTSS organizations. The mission of the PA Link is to provide person-centered support to people with LTSS needs regardless of age, income or ability. The structure of the Link is based on leveraging and expanding the expertise already working in silos. Area Agencies on Aging, Centers for Independent Living, United Cerebral Palsy agencies

(UCPs) and other service providers and organizations work together so that anyone looking for assistance receives the education, guidance, counseling and referrals necessary to design a person-centered approach that works to develop the life the individual wants.

PA Link Call Center. Pennsylvania has a statewide toll-free number for its Link to Aging and Disability Resources. The call center staff has been trained to work with callers in a person-centered approach. The staff assist callers with finding local resources to take the next steps in meeting their immediate and long-term needs.

PA Link Web Resource Center. For individuals who prefer to start the LTSS process in a more self-directed manner, Pennsylvania is developing the PA Link Web Resource Center. The PA Link Web Resource Center will go live in the Spring of 2016. The site features self-assessments, educational resources matched to conditions, diseases and programs, level one screening,

provider search functions and self-referrals that will match seekers with providers.

Existing System of Cross Training. A common challenge for the No Wrong Door approach is knowledge and experience. Professionals who serve specific populations are expected to specialize and deepen knowledge in specific areas—the silos of expertise and service

provisioning. Broadening knowledge and experience sets the stage for the NWD approach. All professionals can achieve a baseline of knowledge to identify, discuss and refer people beyond the professionals’ specialty area. The PA Link has invested in and provides multi-modal cross-training for all partners and potential partners including online cross-training, classroom cross-training and regular local cross-trainings and networking meetings. For example: thirteen online modules provide program knowledge on all aspects of LTSS from housing, employment, transportation and legal issues to finding local, state and federal resources. The trainings cover all potential LTSS users: older adults, veterans, people with physical and intellectual disabilities and those with mental health and substance abuse issues.

Existing Partnerships and Coalitions. Pennsylvania has many effective local and state

partnerships that can provide a foundation of cross-system collaboration. Housing and Homeless Partnerships, Nursing Home Transition Programs, Care Transitions Programs and several

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groups demonstrate the necessity and benefits of a collaborative approach and yield best practices on which a statewide NWD system can build.

State Regulations. PA Code regulations include requirements for a person-centered approach to planning and requirements for waiver providers to include non-waiver services and holistic elements to planning that increase overall quality of life. The regulations also removed silos so that any qualified provider can support populations under or over age sixty. This further motivated providers to expand their knowledge base and collaborate beyond their silos.

Current Administration Support. The current state administration, led by Governor Wolf, has expressed support for expanding and enhancing Pennsylvania’s Home and Community Based Services for people with long term care needs.

Weaknesses/Barriers

Money. Federal and state funds are sources dedicated to specific, discrete cohorts: under age 60, over age 60, diagnosis, ability and income. This dedicated funding does not allow flexibility to serve certain individuals, especially those with multiple needs.

Funding shrinks as need increases. Federal and state budgets do not guarantee funding for Home and Community Based Services. HCBS is not an entitlement. In times of scarcity, agencies and organizations can become more risk averse and less likely to embark on new ventures, such as NWD person-centered counseling. This project will develop potential options to reimburse providers for performing person-centered counseling.

Workforce. In many cases, the most highly trained and experienced current resources that could provide person-centered counseling cannot receive compensation to provide this service. Home and Community Based Service Waiver Service Coordinators are already trained in person-centered approaches, as mandated by the PA Code. They are also already knowledgeable of non-waiver services. However, NWD person-centered counseling would be perceived as a “cost of doing business” for these organizations, as opposed to a reimbursable service. Many agencies do not have the financial resources to accommodate this overhead.

Infrastructure. Information does not follow the person through the LTSS system even when processes are streamlined. Depending on the diagnosis and need there are multiple bureaus, multiple forms, multiple processes and multiple information technology systems that do not share information. This requires duplicative effort at multiple levels and precludes statewide outcome measure of the LTSS system as a whole.

Piecemeal approaches. Current and past approaches to improving LTSS and long-term care in Pennsylvania have omitted key groups such as intellectual disabilities, substance abuse,

behavioral health, veterans, and developmental disabilities. Health services are the sole focus. In addition, initiatives have been spread across the executive and legislative branches.

Regulations. PA Code regulations for waiver services have resulted in many separate entities being involved in enrollment and service delivery with no single coordinating agency.

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Regulations related to conflict-free service coordination, independent enrollment broker(s) and a single financial management services organization have created more entities with which

individuals must work. Individuals are “on their own” to work with each entity, including: independent enrollment broker, service coordinators, service providers, financial management services, and county assistance offices. There is no single agency responsible for enrollment with authority to expedite or influence the process. These are all critical pieces that do not answer to a central authority or a clear path of escalation.

State Level Support. Collaboration among bureaus, offices and departments at the state level is inconsistent. A NWD system will require close collaboration at all levels, including executive leadership in state agencies. State level support and coordination is crucial to ensure that policies and procedures do not present barriers to a NWD approach. State level support is needed to facilitate communication and information sharing among agencies and among regions. Finally, state level support is required to develop and monitor statewide LTSS outcomes across agencies and constituencies.

Outreach and Education. Current outreach typically occurs in “silos” based on individuals’ diagnoses and LTSS needs. The general public is likely unaware of LTSS and may not be counseled if they transition from acute care. The “silo” approach fails residents when emergencies occur and multiple resources are immediately needed to avoid institutional placement.

Opportunities

Existing Systems. Since 2003 the Pennsylvania ADRC, known as the PA Link to Aging and Disability Resources, has led the initiative to strengthen partnerships and broaden collaborations among multiple agencies to transform our LTSS system from functional silos of local, state and federal players into an integrated system of information and access where consumers can learn about and be linked to (not just given a phone number) various LTSS resources. The service is for all populations and payers no matter which PA Link partner the consumer first contacts. As such, Pennsylvania does not have to build a new system to reach its NWD vision. Pennsylvania can further develop and expand the existing PA Link structures to reach its vision.

Recent Legislation. PA House Bill 753 of 2015, signed into law this year, creates a Long Term Care Council comprising members from the following communities: PA Departments of Aging, Human Services and Veterans Affairs, Elder Law, Consumers, Providers, Area Agencies on Aging, Insurers, Medical Community, Academic Research, County Commissioners and other stakeholder groups. As envisioned in the Bill, the Council would consult and make

recommendations, conduct studies and generate reports. This is an essential first step in ensuring state level support of the NWD system.

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Page 11 of 47 Initial NWD Plan Objectives

These initial objectives were identified in the grant response and metadata analysis processes. These objectives were initially identified as the priority elements that would propel Pennsylvania toward its vision. As stakeholders reviewed these items and developed strategies to address these objectives, they discovered new and alternative priorities and strategies to replace these initial objectives.

1. Increase public awareness (especially in hard-to-reach populations) of sources of LTSS information by organizing a clear, multi-tiered, multi-channel, statewide outreach system so that all individuals, regardless of age or income, know where they can turn for unbiased and conflict-free help in accessing LTSS.

2. Reduce unnecessary hospital readmissions by developing a plan and ongoing measures to strengthen current programming and coordination among acute care, LTSS providers, Care Transition programs, Nursing Home Transition programs and PA Link.

3. Improve LTSS responsiveness and quality by expanding existing PA Link community

resource teams in local areas that serve as a point of intensification for emergency and complex cases and provide quality improvement recommendations.

4. As part of its BIP program, Pennsylvania will be implementing a level one screening tool for long term supports and services by Spring 2016. As part of this planning grant, the NWD planning team will develop a plan to assure the continued effectiveness and usefulness of this screening tool after its implementation.

5. Develop functional requirements for information management systems that interface with multiple state systems while maintaining the privacy of health information. This will allow consumer information, once entered, to follow the individual across systems in the LTSS network. The requirements will be incorporated into a system design in the three-year implementation phase.

6. Ensure the quality, competence and capacity to maintain a NWD system by determining the best ways to train entities in person-centered counseling for individuals. The training would include proficiencies in person-centered counseling, knowledge of state and local

resources/programs, use of information technology systems, as well as reporting and outcome measurement standards.

7. Explore opportunities for a sustainable reimbursement process for Person-Centered Counseling/Options Counseling services.

8. Refine and further develop the PA Link’s current data gathering and outcome measurement processes.

9. Reinforce the role of Person-centered Counseling/Options Counseling in facilitating plans that include goals and resources beyond typical LTSS objectives.

10.Define and include demonstrations of skill and knowledge in the Person-centered Counseling/Options Counseling certification process.

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11.Develop and formalize relationships with vocational, recreational, spiritual, social, transportation and training resources at the state, regional and local levels.

12.Develop statewide NWD Continuous Quality Improvement processes and outcome measures

to capture and analyze data to measure progress on goals in all key functional areas. The processes will include survey and feedback tools to assess public perceptions, consumer outcomes, LTSS provider performance, and stakeholder buy-in and engagement.

Stakeholder Session Feedback: Identifying Priorities

Twenty-eight stakeholder sessions over fourteen days were convened and facilitated across the Commonwealth. Stakeholders agreed with the findings of the workgroup teams and further refined and added input related to prioritizing how to address challenges and opportunities in PA’s implementation of a NWD system. The summary of priority challenges is below:

Inconsistent understanding of the PA Link/ADRC. Many stakeholders in the NWD Planning Grant stakeholder sessions did not know about the PA Link or were not accurate in their

understanding. Even contiguous counties had widely varying levels of partner participation and program knowledge. This speaks to both a branding and outreach challenge within the PA Link. Pennsylvania opted to implement a distributed ADRC approach. Instead of creating a parallel set of person-centered counselors in dedicated settings, Pennsylvania opted to leverage its existing resources in its LTSS system. This approach avoided “reinventing wheels” and duplicating staff and services. This approach requires an entire network of providers to opt into the program. Collaborative ventures require constant, persistent communication of value, mission and message. Communication effectiveness varies widely among counties.

Inconsistent levels of partner engagement. There were many reasons noted for this and most revolved around deficiencies in communicating the message, intent, roles and brand of the PA Link to current and potential partners. In addition, the paperwork required to be reimbursed for person-centered planning services was considered to be onerous. Key to this is the lack of a simple IT system to track reimbursement information.

Divergent views on person-centered counseling. Participants in the stakeholder sessions differed in their interpretation of what a person-centered approach entails and in terms of how it differs from Information and Referral, Information and Assistance and 211 services. The

divergence of perceived program inconsistencies in current and potential partners limits effective outcome measurement as the service is provided in different ways in different areas.

Concerns about limited capacity in the PA Link network. The lack of public outreach for the PA Link in most areas of the Commonwealth occurred by design. With no information on the potential unmet need, counties that do offer PA Link/NWD services did not want to risk opening “floodgates” of person-centered planning demand without sufficient capacity to meet it. This sentiment was reinforced vigorously in stakeholder meetings. The consensus is that it would not be prudent to advertise services without assessing likely demand against capacity.

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Challenges in serving rural populations. Many counties in Pennsylvania have populations that are dispersed over great rural distances. This presents challenges in providing human services, including long-term services and supports. Limited transportation options and the limited number of qualified providers in rural areas present additional barriers in access to planning and

enrollment for vulnerable, underserved, low income populations in rural areas.

Absence of an information technology (IT) solution that supports person-centered planning, referrals and outcome measurement activities. All of these activities are tracked in separate systems or on paper. Further complicating all of these issues is the fact that each LTSS silo in Pennsylvania uses its own IT systems, language and standards. Not all partners belong to every silo. Moreover, the lack of an effective, interactive internet presence that would support

consumer driven education and self-direction creates further complications for consumers. Stakeholder consensus holds that addressing PA Link structures, branding and information technology issues are the critical first steps in implementing a NWD system.

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NWD Governing Body

Pennsylvania’s NWD Governing Body is an extension of the leadership and management body that managed the No Wrong Door Planning Project. It includes representation from the following agencies and bureaus as they have administrative oversight of all regional and local agencies that provide LTSS:

 PA Department of Aging

 PA Department of Military and Veterans Affairs

 PA Department of Human Services including the Offices of Long Term Living,

Developmental Programs and Mental Health and Substance Abuse Services. In Pennsylvania, the NWD Governing Body includes the project leadership teams from the Balancing Incentives Program, Money Follows the Person Program, various housing initiatives and the NWD Planning Project. Together, this group is the Rebalancing Initiatives Leadership Team. They meet bi-weekly to report on progress on the different projects. The team has subcommittees focused on specific areas such as education, outreach, web resources and online information and referrals. All of the member groups have a shared interest in ensuring that Pennsylvanians can receive the services that they need in the setting of their choice. The groups are dedicated to affordable, quality home and community based services. Members are expected to participate in meetings and brief others in their specialty areas.

In addition, the NWD portfolio of projects has its day-to-day leadership in the PA Link

leadership and management teams. Assisting the PA Link leadership and management teams are the NWD leadership team and NWD workgroup teams. Workgroups focus on specific project areas such as branding, person-centered counseling, outreach and others. Workgroups comprise management from all levels and specialties in the LTSS network across the state. This diverse group provides the breadth and depth of experience and perspective to ensure that NWD planning includes all potential stakeholders.

The NWD project team workgroups produced and approved the detailed strategy, work plan and budget. Moving forward into implementation, workgroup teams will re-form to accomplish the tasks in the plan. Workgroup teams monitor progress on specific tasks. Workgroups report to NWD leadership. NWD leadership reports to the Rebalancing Team Leadership. The

Rebalancing Team routinely briefs and updates Department Secretaries.

Multiple layers of accountability and communication ensure that efforts are not duplicated, that communication is timely and accurate and that diverse perspectives, talents and experience inform the development and implementation of PA Link/NWD projects.

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NWD Stakeholder Engagement

In developing the State-wide System Change NWD Strategic Plan a comprehensive initiative was needed to capture information and analysis from a broad and diverse cross-section of

interested parties throughout the commonwealth, including consumers, public and private service providers, state staff, local agencies, public officials, advocates, affinity groups, subject matter experts and the public. This approach had worked well in similar interventions including the 2009 Statewide Human Service Transportation Study and the 2012-2016 State Plan on Aging. The NWD Strategic plan elements were developed by stakeholders. This promotes their ongoing commitment to the vision, implementation and ongoing success of PA’s NWD system. Because Pennsylvania’s vision is to include all people regardless of income, age or ability everyone is a stakeholder.

Practically, involving “everyone” required a layered approach to engagement and meaningful participation in engagement. The bulk of the planning work was completed by stakeholders in workgroup teams. The teams provided a focused effort on the key function areas and allowed for concurrent processes in the one-year timeframe. The initial team members were identified by project leadership and represented a cross-section of state and local agencies and service

providers. The first task of the teams was to identify additional members of diverse perspectives to bring added knowledge and experience to the group.

In Pennsylvania, there is already current data, information and documentation about all of the NWD plan objectives. Other planning projects have gathered stakeholder information about barriers and gaps in the LTSS system. This project focused its attention on removing barriers and bridging gaps.

To ensure that the team did not “reinvent the wheel,” they reviewed and analyzed current reports and findings. This provided the basis for the team to identify what it did not know and to develop “straw man” draft approaches for stakeholders to consider in focus groups.

When the team subject matter experts, in consultation with other stakeholders, developed

potential strategies, they engaged a broader audience to refine them. This provides another layer of engagement and commitment. People who may not have had time to participate in a

workgroup had the opportunity to provide meaningful input into the NWD system. Again, participation in development builds commitment to the plan’s success.

Depending on the specific plan strategy, input came from groups of providers, caregivers, participants, state agencies, local agencies, non-profit organizations, elected officials, advocates, hospitals, insurance companies and others. The engagement started with focus group sessions featuring carefully crafted agendas designed to get the project team the action plan elements they needed to develop a NWD plan. The meetings were supplemented by follow-up e-surveys to assist in quantifying perceived priorities and in setting baselines for later outcome measurement. This project focused on developing an action plan to address the gaps of which PA is already aware. The sessions were tailored and facilitated to get action-oriented planning results. Taking all of the information, workgroup teams refined action plans to fulfill their assigned objectives. The draft plans were made available for broader public and stakeholder reaction.

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Every participant in outreach sessions received an invitation to comment and had the opportunity to share the report with others.

The last phase was final plan development and presentation to Department leadership for review and acceptance. Project and workgroup team leaders modified the project plan as needed to meet their goals. The tasks are listed below.

Stakeholder engagement activities included:

 Internal planning sessions within the Pennsylvania Departments of Aging, Health, Public Welfare, Military and Veteran’s Affairs, and Labor & Industry. The planning sessions identified key leadership resources and ensure executive support for the approach and outcomes.

 Stakeholder workgroup meetings dedicated to developing plans to address specific aspects of the NWD vision: person-centered counseling, public outreach and governance.

 A series of focus groups across Pennsylvania with subject matter experts in a variety of fields on issues related to physical, intellectual and developmental disability, aging, and long-term services and supports.

 Targeted electronic/written surveys of stakeholder groups: public, consumers, providers, affinity groups, advocates, state staff, and caregivers.

The essential element of stakeholder engagement is to facilitate their “owning” the solution. Consumers, providers, insurers, caregivers, elected officials and the public will live with this system. PA wants it to be a system that is developed collaboratively by all stakeholders so that all Pennsylvanians have commitment to its long-term success and sustainability.

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Goals and Action Items

Governance and Administration

Currently, the PA Link to Aging and Disability Resources (PA Link) provides Pennsylvania with its No Wrong Door (NWD) functions: facilitating relationships among Long Term Services and Supports (LTSS) stakeholders, providing cross-training among LTSS specialty areas, performing person-centered counseling and assisting consumers with access to public programs.

These services are provided locally by PA Link partners who enter into agreements with the state to carry out these functions. Pennsylvania identified public resources in each service area and brought them together to serve as a PA Link Oversight Committee for each area. Oversight Committees determine the best strategies in the local areas to provide person-centered counseling, streamlined access to services and ongoing networking and training about local LTSS resources.

The PA Link resides in the Pennsylvania Department of Aging (PDA).

Pennsylvania has five main Governance and Administration goals based on the Administration for Community Living (ACL)/Centers for Medicare and Medicaid Services (CMS)/Veterans Health Administration (VHA) requirements for a NWD system of access:

1. Expand and develop state level executive oversight of the PA Link/NWD system.

2. Assess current capacity of PA Link/NWD system.

3. Standardize Quality Assurance and Continuous Quality Improvement (CQI) functions for the Pennsylvania Aging and Disability Resource Center (ADRC) program known as the PA Link.

4. Develop and implement a single IT solution for PA Link operations and program management including: person-centered planning, referrals, data gathering, outcome reporting and web resource center.

5. Develop more formal communication strategies with NWD/LTSS stakeholders.

1. Expand Executive Level Oversight

The PA Link serves consumers in specialty areas whose executive oversight and leadership is in different agencies including the Department of Human Services and Department of Military and Veterans Affairs. To coordinate leadership support, the PA Link reports to and receives input from multiple agencies. This level of inter-Deputate executive leadership is crucial to PA Link operations. Their collaborative relationships have been strengthened and expanded throughout the PA NWD Planning Grant process.

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Page 18 of 47 1.1Goal

Expand executive level oversight to include all agencies involved in the LTSS system. Executive oversight activities and responsibilities include: reporting on LTSS outcomes, studying the LTSS system, providing a venue for stakeholder and consumer input, developing policies and best practices and making recommendations to Departments, the Legislature and the Governor. In 2015, the Pennsylvania Long Term Care Council Act was signed into law. The Long Term Care Council Act creates a standing council, with an executive director, that includes

representation from all areas of the LTSS system. The council comprises the following:

Secretary of Aging, Secretary of Community and Economic Development, Secretary of Health, Secretary of Human Services, Insurance Commissioner, Executive Director of the Pennsylvania Housing Finance Agency, two members of the PA Senate and two members of the House of Representatives. In addition, the Governor will appoint the following members to the council: one member from the PA Council on Aging, one member who represents Area Agencies on Aging, five members who represent consumer advocacy groups across the LTSS spectrum including at least one LTSS consumer, one member who represents the elder law section of the PA Bar Association, one member who is a tenured long term care insurance producer, six members who represent providers across the LTSS spectrum, one member with caregiver experience, one member who represents the medical community, and one member who represents the County Commissioner’s Association of Pennsylvania.

The NWD project workgroup team recommends the addition of the Adjutant General of the Pennsylvania Department of Military and Veterans Affairs, the Secretary of the Pennsylvania Department of Transportation, the Secretary of the Department of Labor and Industry and the Secretary of the Department of Education. In addition, the workgroup team recommends the addition of representation from Pennsylvania’s Centers for Independent Living, UCPs, county mental health and intellectual disability administrators and at least two LTSS consumers who are under age 60 and two who are over age 60. The proposed Long Term Care Council will establish committees to research and study access to quality care, regulatory review, community access and public education, LTSS service models and delivery, workforce and housing. The council has the authority to commission reports. The NWD project workgroup team will recommend the addition of specific responsibilities related to statewide outcome reporting.

The Long Term Care Council, including the project team recommendations, meets the

ACL/CMS/VHA vision of the breadth of oversight required to implement a NWD approach. The Long Term Care Council will have the authority to commission statewide quality and capacity studies, the influence to pull together executive leadership to support change and the

responsibility to report on outcomes of the NWD approach and the overall health of Pennsylvania’s LTSS system.

The PA Link is Pennsylvania’s NWD management and operations entity. The PA Link will be responsible for ongoing management, operations, communication, data-gathering and quality monitoring. It will remain in the Department of Aging and will make regular reports to the PA Council on Long Term Care.

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Page 19 of 47 1.2 Action Items

The NWD project team will work with representatives from the Governor’s office and the

Department of Aging to support the expansion of the Long Term Care Council membership. This includes:

 Producing a position brief approved by the Governor and the Departments of Aging, Human Services and Military and Veterans Affairs.

 Gathering written support from the LTSS network of agencies and providers including all stakeholders listed as potential council members.

 Meeting with sponsoring staff.

 Testifying, as needed, before committees.

 Assisting with education of the LTSS network.

1.3 Group Responsible

The NWD project team will work with the policy offices of the Governor and key Departments to produce briefs and testimony as needed. The PA Link, through its network of partners, will assist with education about the role of the PA Long Term Care Council.

1.4 Target Dates

The PA Long Term Care Council would be in place, including workgroup recommendations, and functioning before the end of the current gubernatorial term in 2018.

1.5 Potential Barriers

As with all new legislation, it is important that significant effort is placed on explaining the need and importance of the legislation. Failure to mount a concerted effort to explain this need could delay implementation of this Act.

1.6 Outcome Measurement

Currently, executive leadership of PA Link/NWD is in the PA Department of Aging. However, because the PA Link serves consumers in specialty areas whose executive oversight is in different agencies (Department of Humans Services and Department of Military and Veterans Affairs) the PA Link reports to and receives input from multiple agencies. This will continue with overall oversight being a function of all three agencies.

Specific success on the goal above will be measured by the expansion of the council to provide greater structure and broader representation. Intermediate success will be measured by how well the NWD project team and its partners prepare materials and deliver support related to passage of the bill.

1.7 Budget

There are no budgetary implications for this goal. Working with and educating legislators is part of the mission and regular activities of the PA Link leadership and management teams.

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Page 20 of 47 1.8 Priority Level

This is a low priority goal. The Council has the power to expand and the project team does not anticipate challenges or barriers to its expansion. In addition, there are already oversight and leadership groups in place to guide and develop the PA Link/NWD system in Pennsylvania and these leaders work even more closely together as a result of the Balancing Incentives and NWD Planning Grants.

2. Assess Current PA Link/NWD System Capacity

2.1 Goal

This goal lays the groundwork for a NWD implementation. A capacity assessment includes two main areas: a measurement of likely unmet person-centered counseling needs and a measure of the current PA Link partners’ capacity to meet those needs. This unmet need and capacity assessment is especially important in Pennsylvania because of the known inconsistency in the current PA Link’s workforce and resources across its service areas. This current inconsistency could cause deficiencies in meeting unmet consumer needs. The capacity assessment results will also be used as a baseline to measure LTSS access in Pennsylvania. This assessment is different from the Medicaid assessments performed in developing Pennsylvania’s Managed Long Term Services and Supports (MLTSS) system. The MTLSS assessments focused on Medicaid enrollment.

Based on lessons learned from the United Way of Lehigh and Northampton Counties and

Pennsylvania’s implementation of an independent enrollment broker, it is essential to the success of the NWD system to accurately assess the likely unmet consumer need and the current

operational capacity of the PA Link. The United Way project demonstrated best practices in measuring a baseline of LTSS access for older adults and laid the groundwork to measure ongoing successes in increasing access to and satisfaction with LTSS.

Pennsylvania’s implementation of an independent enrollment broker provided lessons learned. Capacity was not accurately assessed. Initially, the IEB did not have staff adequate for demand. The result was an overly lengthy enrollment process.

Failure to accurately assess unmet need and operational capacity could result in an overload of an already stressed LTSS System once consumers become more aware of the existence of person-centered counseling services. The assessment is critical to both building capacity and to how early broad-based public advertising is implemented.

2.2 Action Items

The action items for this goal follow standards and best practices for capacity and quality surveys. The major action items and steps include:

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 Publishing Requests for Proposals for the statewide capacity and quality assessment to determine unmet consumer LTSS needs regardless of age or ability.

 Selecting an outside organization as a partner to perform the assessment.

 Designing a methodology and tools to measure unmet need and PA Link capacity.

 Interpreting data and reporting.

 Educating executive staff, management teams and NWD/PA Link partners on results and

implications for processes and procedures.  Post implementation support and reporting. Project phases and timeframes include:

2.2.1 Project Initiation (Months One through Three)

The initiation phase will include key project kickoff activities including developing the communication plan, hiring an outside support organization and recruiting workgroup team leadership. The initiation phase should be completed within three months of the project start date.

2.2.2 Designing Methodology and Measurement Tools (Months Three through Twelve)

The next phase involves designing and developing the methodology for surveying the unmet LTSS need and PA Link capacity. The outside organization/vendor engaged to survey quality and capacity in the current LTSS network will develop and present for approval its survey and reporting methodology.

2.2.3 Conducting Quality and Capacity Surveys (Months Thirteen through Twenty)

The outside organization engaged to conduct the unmet need and capacity survey will conduct the survey and provide initial findings in this phase. Further analysis and reporting will occur in the next phase.

2.2.4 Final Assessment Presentation (Months Twenty-one through Thirty)

The outside vendor engaged to survey current unmet need and capacity will finish its analysis, develop recommendations and provide a draft report of findings to the project team for review and acceptance.

The PA Link will review the report to confirm assessed gaps, develop remediation plans and present findings to executive management.

Pennsylvania looks forward to working closely with the Administration for Community Living (ACL), the Centers for Medicare and Medicaid (CMS) and the Veterans Health Administration (VHA) in this process by soliciting information and providing feedback on progress and lessons learned.

NWD project team will engage a research university and/or other subject matter experts to perform the unmet need and capacity assessments.

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Page 22 of 47 2.4 Target Dates

Target dates are noted in the action items. 2.5 Potential Barriers

Concern with findings. A capacity survey could uncover areas in the Commonwealth that lack LTSS resources sufficient to support a NWD system. This could be perceived as a requirement to add more resources—though the more likely outcome is to have foreknowledge of challenges and a plan to work within current resources. LTSS networks could potentially fear that findings may reflect poorly on the currently system and have unintended effects related to funding. Another barrier to the capacity assessment is a lack of funding. To perform an effective, accurate assessment, time and expertise is required to survey statistically significant populations in terms of their needs and compare that with existing levels of resources.

Success for the current LTSS system unmet need and capacity assessment will be based on its thoroughness as measured by acceptance of the methodology, scope of data collected and effectiveness of the analysis and its presentation. If executed well, the assessment and its findings will be accepted by executive leadership.

2.7 Budget

The budget is for a research university or expert organization to design, develop, administer and report on a statewide capacity assessment.

2.8 Priority Level

This is a high priority goal. Before marketing a new service to all Pennsylvanians, the

Commonwealth would need to understand both likely unmet consumer demand and its capacity, in the PA Link network, to meet that need.

3. Standardize Quality Assurance and Continuous Quality Improvement

Currently, the PA Link collects and reviews data related to delivering a quality program. The PA Link actively refines and further develops its quality assurance measures and processes each year. PA Link partners are required to gather quality data as well. Each PA Link Service Area is required to develop a quality assurance process that is managed by the Service Area’s Oversight Committee. There are fifteen Service Areas that could potentially develop fifteen different approaches. The PA Link seeks to standardize its quality assurances into a continuous quality improvement program.

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Page 23 of 47 3.1 Goal

The PA Link will develop a statewide continuous quality improvement (CQI) program. To ensure quality NWD outcomes, Pennsylvania must develop measures that reflect NWD goals, identify a baseline of performance for each, document how measures will be gathered and train PA Link leadership, partners and other stakeholders on how to gather data, interpret results and communicate information. These objectives will be met by partnering with an expert outside organization to study quality measures, design continuous quality improvement process for the PA Link/NWD System and to implement the processes and education needed for initial and ongoing quality management.

The outputs and products of this goal include a baseline of service measures, a plan for continuous quality improvement, training programs for local and state staff and a state level entity to monitor and manage quality. Pennsylvania looks forward to working closely with the ACL, CMS and VHA throughout this process.

The action items for this goal follow standards and best practices for CQI implementations. The major action items and steps include:

 Publishing Requests for Proposals for the statewide quality assessment and for support of developing a Continuous Quality Improvement process.

 Selecting an outside expert organization as a partner.  Designing a methodology and tools to measure quality.

 Conducting surveys and analyses and developing Continuous Quality Improvement

(CQI) program.

 Interpreting data and reporting.

 Educating executive staff, management teams and NWD/PA Link partners on quality

program, processes and procedures.

 Post implementation support and reporting. Project phases and timeframes include:

The initiation phase will include key project kickoff activities including developing the communication plan, hiring an outside support organization and recruiting workgroup team leadership. The initiation phase should be completed within three months of the project start date.

3.2.2 Designing Methodology and Measurement Tools (Months Three through Twelve)

The next phase involves designing and developing the methodology for building the CQI

program. The PA Link must identify, document and refine its partners’ and stakeholders’ input in terms of quality and outcome measurement. Stakeholder engagement is essential at this point. Success or failure will depend on how effectively stakeholders were engaged in identifying what is and is not needed for outcome measurement and quality processes and policies to work and in

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identifying opportunities and barriers in data gathering, management and reporting. The NWD project team and its vendor will be guided by the input and outputs of the NWD Planning Grant stakeholder sessions.

The outside organization engaged to develop the CQI program will conduct its stakeholder sessions in this phase. Stakeholder sessions, including consumers and caregivers, will build on the information gathered in the NWD Planning Grant outreach. Sessions provide a venue for input and discussion about priorities, methods, barriers and procedures involved in implementing a NWD CQI system.

3.2.3 Developing CQI Program (Months Thirteen through Twenty)

The outside organization engaged to develop the CQI program will present its draft proposal in this phase. The NWD project team will review, discuss and present both sets of findings to stakeholders and executive management for approval. Once approved, the outside organization will document policies and procedures including data-gathering and storage requirements. Data reporting elements will be tested in pilot form. Final educational documentation will be

developed for multiple audiences: partners who need to gather and report data, PA Link

Management who review data and report information and executive management and legislative representatives who receive outcome reports.

Pennsylvania looks forward to working closely with ACL, CMS and VHA in this process by soliciting information and providing feedback on progress and lessons learned.

NWD project team will engage an outside expert organization to facilitate the process of developing a CQI program.

Target dates are noted in the action items. 3.5 Potential Barriers

Potential barriers related to implementing a CQI that pertain to a NWD approach include:

 Concern with gathering, interpreting and communicating measurements in an LTSS

system where no one agency has full authority or administrative oversight.

 Concern with how outcomes are used. (There could be a perception of “penalties” when multiple organizations at multiple levels are involved.)

 Challenges related to any change, especially one that requires data gathering and reporting.

 Lack of administrative and funding support for the time and cost to educate the LTSS network, management and executives about the CQI program.

Funding could be a barrier related to the speed with which Pennsylvania can develop its CQI program. An expert outside organization has the focus and resources to complete the process in

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less than two years—engaging a wide array of perspectives necessary to ensure network acceptance and quality outcomes.

Success for the CQI program will be based on its comprehensiveness, consumer-focus and accuracy of metrics. The consumer-focus will be reflected in the final program’s inclusion of consumer recommendations for quality discovered in the stakeholder engagement process. The accuracy of metrics will be determined by management acceptance of the data elements. Comprehensiveness will be determined by the initial criteria identified in the project kickoff phase, but will include quality measures related to: consumer outcomes, consumer perceptions, provider competence, provider capacity, IT systems effectiveness and LTSS provider relations. 3.7 Budget

To launch the program as efficiently as possible, the PA Link would secure funding to hire an outside expert organization to develop a methodology and program. In the absence of funding, the PA Link will work with internal resources to improve the current system.

The NWD project team will engage an outside organization to facilitate the process of developing its CQI program.

This is a high priority goal. Identifying the goals and measurable outcomes for the PA

Link/NWD system will drive other aspects of planning and development. The PA Link is already working toward standardizing its quality program using internal resources and partnering with other bureaus. The speed with which this goal is accomplished will be determined by the availability of an outside organization to perform the tasks. Regardless, the PA Link is committed to quality outcomes.

4. Single Information Technology Platform for PA Link Program Management

4.1 Goal

To meet the Management Information Systems requirements, Pennsylvania will develop and implement a single IT solution for PA Link operations that can integrate with existing and future IT systems. The PA Link needs an IT solution to support person-centered counseling, consumer follow-up, partner collaboration, data collection and to provide easy access to program, quality and management data.

The deployment of a technology solution for the PA Link will be significant because of the necessity to track consumer information, quality, quantity and outcomes. There is no system to do this at present. The absence of technology is a key reason that partners opt not to provide person-centered counseling or receive reimbursement: the paperwork and documentation are

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considered to be onerous. The PA Link also requires an effective internet presence that allows for consumer self-direction and education.

Based on stakeholder feedback and on researching technology used in other states’ NWD approaches, the following are functional specifications for a NWD information technology solution.3

 Existing systems do not provide a cost-effective solution. Currently, waiver participants under age 60 are supported by the HCSIS system and all people over age 60 are supported by the SAMS system. These systems are old and at capacity. (Current HCSIS users expressed challenges accessing the system.) Neither systems’ user interface facilitates data entry in real time while consumers are on the phone. The systems do not feature an open architecture. They do not interface with each other. Update costs are substantial. In addition, an NWD system must accommodate veterans—whose services are managed in a third, closed system.  The NWD system must facilitate referrals among all LTSS agencies and providers without

compromise of protected information. Typical person-centered planning sessions may include personal health information. Transmission of and access to this information must follow the confidentiality rules of the Health Insurance Portability and Accountability Act (HIPAA).

 The NWD system must be highly accessible and available with limited costs for NWD users. This typically points to a web-enabled application that does not require expensive upgrades to computers at NWD partner sites. (Neither current system is web-enabled; both require individual licenses for all users.)

 The NWD system must have a flexible interface that allows partial entries. People seeking person-centered counseling may not want to share all of their health and environmental information when seeking services. Third parties (such as caregivers, children) may not have all of the information. The system must be able to “handle” blank entries and allow partial inputs. Typical person-centered planning sessions may gather information related to specific issues and concerns. Though counselors are trained to invite a broader conversation, people may not wish to share everything. At a minimum, the system would require basic

demographic and contact information.

 The system must be capable of storing and sharing person-centered counseling session plans and follow-up procedures. Person-centered counseling includes facilitating the development of action items, referrals and follow-up plans based on individuals’ preferences. The system must be able to store planning information, provide a “tickler” for follow-up, track plan outcomes, support consumer satisfaction follow-up and report on all aspects of program utilization.

 The system must be capable of handling information, follow-up and reporting for all

Pennsylvanians, not just those likely to use a public program. This speaks to capacity issues and to the comfort afforded individuals who would like person-centered counseling without being forced into “the system” as a result.

3_{A more complete list of stakeholder feedback on specifics of a technology platform is available as an Appendix to}

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Based on these criteria, the NWD system would be separate from existing waiver and program support systems. The goals, intent and data sets are different. System segregation makes sense from a utility standpoint and from an economic standpoint. The output for this objective is a functional system delivered on time, within budget and a rating of “expectation met or exceeded” by those who use it. Sustainability is ensured through Pennsylvania’s current commitment to the operational support of the PA Link.

The action items for this goal follow standards and best practices for technology implementations. The major action items and steps include:

 Publishing a Request for Proposal

 Selecting an IT support vendor

 Conducting thorough needs and business assessments

 Designing the IT platform application  Piloting the application

 Training end-users and “super-users”

 Implementation

 Post implementation support and reporting

Project phases and timeframes include:

The initiation phase will include key project kickoff activities including developing the communication plan, hiring outside support organizations and recruiting workgroup team leadership. The initiation phase should be completed within three months of the project start date.

4.2.2 Needs Assessments and Business Impact Analysis (Months Three through Twelve)

The PA Link must identify, document and refine its partners and stakeholders’ needs in terms of information systems requirements, training and IT system support. Stakeholder engagement is essential at this point. It sets the stage for later buy-in and provides critical insights into what is happening and what the best possible solutions can be. The teams will be guided by the input and outputs of the NWD Planning Grant stakeholder sessions. This step takes those higher level conversations and molds them into practical application.

Although workgroup teams are focused on different objectives, the teams will participate in cross-over meetings and assessments. The IT team will benefit from hearing the conversations surrounding outcome measures and data gathering. The person-centered planning team will need to provide inputs to the IT team and the oversight/quality assurance team. Team leaders and members (recruited from all silos at state, county, local, private and consumer levels) will participate as much as possible on other implementation areas. This will encourage a more outcomes-focused, tightly integrated set of solutions across policy, procedure, technology,

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outreach and training objectives. Effective needs assessments also form the basis of acceptance testing for information systems.

4.2.3 Designing and Developing Solutions (Months Thirteen through Twenty)

The next phase involves designing and developing solutions for testing and review. At this point, outside organizations will present their proposed solutions to workgroup teams and project leadership for review and changes. Once the review process is complete, the IT support

organization will prepare a pilot application for the next phase. The pilot IT system will be rigorously tested for acceptance before training begins.

4.2.4 Outreach and Training (Months Twenty-one through Thirty)

Technology systems will not work for users without proper training. This phase of the project focuses on promotion and training, including developing materials and convening training sessions. In addition to direct end-user training, the IT support organization will train and

develop “super-users” and trainers to provide ongoing refresher training and 1st_{echelon technical} support to PA Link partners.

4.2.5 Deployment, Follow-up Support and Reporting (Months Thirty-one through Thirty-three)

The last step in deployment is to “turn-on” the new PA Link/NWD IT platform and to provide immediate support in the first days and weeks of its use. This support will be part of the IT support organization project plans and scopes of work. Internally, the state’s “super-users” will participate in the support process to gain experience and insight into common areas of concern. The last step in the IT platform implementation project is analysis and documentation of the project’s success in meeting its objectives, maintaining collaborative relationships, building networks and leveraging existing resources. This after-action report will rate how well the IT support organization and the internal NWD project team met stakeholder expectations of the system and its implementation. The analysis and documentation will also include briefs and publications that describe the value of the project outcomes in demonstrating significant, measurable advances toward achieving the NWD vision.

The NWD project team will select an IT support organization to provide a “turn-key” solution. That is, the IT support organization will be responsible for the design, project management, project communication, implementation, training and initial support of the full solution. The NWD project team will facilitate meetings and training, gather necessary information and coordinate with the IT support organization.

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Page 29 of 47 4.5 Potential Barriers

Potential barriers to the successful implementation of a NWD system IT platform include the following:

 Change management. A core element of any successful technology project is effective communication and change management. Budget and time must be included in the project to allow for adequate communication, education and stakeholder feedback.  Insufficient funding to perform all necessary steps in a successful IT implementation.

Too often, projects fail because funding is not provided for design analysis and training. Projects fail most often in the design and analysis phase through a failure to take the time to understand how users’ needs and expectations will be met by system configurations. There is also an assumption that systems are “intuitive” and do not require specialized training. This is a false assumption.

The project’s success will be measured by how well it met its objectives including design

accuracy, zero defect programming, training effectiveness and user acceptance. (Deliver on time and within budget are measured as base requirements as well.) The after-action report will rate how well the IT support organization and the internal NWD project team met stakeholder expectations of the system and its implementation.

The application will be tested against the design specification developed in the business analysis phase. Users will rate ease-of-use, availability and the quality of the change management

process. NWD project teams will measure how well the IT support organization met its requirements in terms of project management and communication.

4.7 Budget

The implementation of an IT platform to support all operations, referrals, planning, data gathering, and outcome measurement is a significant undertaking. It requires careful design, piloting, testing and training.

This is a high-priority goal. As noted in other sections of this report, the lack of a technology platform to support person-centered planning, partner management, outcome measurement, quality reporting and compliance is a hindrance to moving toward a coordinated NWD approach.