ValueCurve
- 2. February 2015 Policy&Practice 9 “Talk is cheap. Let’s go play.” —JOHNNY UNITAS, QUARTERBACK, PRO FOOTBALL HALL OF FAME Johnny Unitas was a highly suc- cessful professional quarterback who’d have a hard time even making a profes- sional football roster today. His height, strength, speed, and throwing power did not, shall we say, statistically check the right boxes. Cut in rookie camp by the team drafting him out of college, Unitas recovered with great resilience and resolve against long odds, understanding that actions and results speak louder than perceptions or expectations. His general leadership philosophy is captured in his standard six-word pep talk to his Colts team- mates, made leaning against the locker room doorway before many games they would play together, including many hard-won championships. Championship-level change efforts are advancing throughout the health and human service system today. At the Kresge Foundation’s 2014 Human Services Grantee Policy Convening, a meeting of national health and human service associations, the group was commenting on the upbeat feeling in the room despite the environmental challenges we all continue to face. Our conclusion was that the well-conceived actions and innovations being driven today by real-world communities are defying the odds. We see improved performance and successful change being driven by well-planned, action- able product and service strategies, known in football as a “playbook.” But plays need to be diagrammed before they’re practiced and used on game day. So what’s supporting these winning efforts to develop better playbooks and drive actions and inno- vations around the country?
- 3. Policy&Practice February 201510 Part of the answer lies in an ini- tiative that was launched in 2010, co-sponsored by Harvard, Accenture, and APHSA, where agency, federal government, and private provider leaders have come together annually to understand and advance the Health and Human Services Value Curve (see graphic at right). Now when I think of Harvard or summit meetings, I don’t immediately think of Johnny Unitas and his adage about talk being cheap. And when I first saw this Value Curve four years ago, I worried that it would result in a bit more concept than action. Even the best designed playbook looks like a bunch of symbols that mean nothing to anyone who hasn’t taken the field to learn through action what it all means. But four years later, we see many examples around the country of agencies and their partners decoding this Value Curve—communicating about it more confidently, applying the framework through a range of actionable strate- gies, and winning stakeholder support for advancing through its four stages. At its core, the Value Curve describes how health and human services are provided to those we serve at four pro- gressive levels of value, each building from and expanding the consumer value delivered at the more formative levels: 1 At the regulative level, con- sumers receive a specific product or service that is timely, accurate, cost-effective, and easy to understand. Many agencies and systems around the country are focused on achieving efficient and effective service within a specific program area, and to a large extent this is good for consumers. But we know the value limitations of sending product and service flexibility, and enhanced service delivery. This is all geared toward supporting people to prevent problems upstream versus fixing or recovering from them down- stream. This all requires redefining casework practice and skills, pro- viding real-time technology tools for caseworkers, establishing new forms of data and analysis geared toward problem prevention, and instituting highly adaptive program design and funding mechanisms. 4 At the generative level, dif- ferent organizations providing various products and services are joining forces to make the consumer’s overall environment better for them, resulting in value that is broader and more systemic than an individual or family might receive directly. At this stage of value, agencies, with their partners, focus on general consumer advocacy and co-creating capacity at a community-wide level as a means to meet consumer needs. This requires collective efforts targeted at community-level infrastructure building, and enhancing societal beliefs and norms about government, in general, and those we serve, in partic- ular. This ultimately results in greater commitment to leveling the playing field, plugging everyone into the Phil Basso is the deputy executive director for Strategic Communications and Organizational Effectiveness at APHSA. those we serve through many program doors, engaging them within a limited program scope, or focusing primarily on program compliance and related output goals as measures of our own performance and value, whether or not these outputs are having the desired consumer impact. 2 At the collaborative level, con- sumers “walk through a single door” and have access to a more complete array of products and services that are available “on the shelf.” At this level, agencies with their partners focus on cross-programmatic efficiency and effectiveness, which often require operational innova- tions like unified intake and eligibility systems, cross-program service plans that address multiple consumer needs, and shared data platforms or protocols to support these integrated services. Certainly a big step up in value for con- sumers, but not the best we can do. 3 At the integrative level, products and services are designed and customized with input from consumers themselves, with the objective of best meeting their true needs and enabling positive outcomes in their lives. The focus in this stage is on more consulta- tive consumer engagement methods, Efficiency in Achieving Outcomes Effectiveness in Achieving Outcomes Generative Business Model Integrative Business Model O utcom e Frontiers Collaborative Business Model Regulative Business Model
- 4. February 2015 Policy&Practice 11 community as a whole, and employing practical solutions that work. Thinking of Johnny U’s little pep talk, here are three straightforward, real-world examples of how agencies are decoding and applying the Value Curve today: l An agency improving SNAP benefits accuracy and timeliness builds upon its successes by partnering with community-wide program providers to meet together with consumers on Saturdays. After a series of these “open houses,” the various partners develop protocols to engage with common consumers and determine service eligibility more holistically. This is a strengthening of regulative value and a shift from the regulative to the collaborative stage. l A local agency with multiple program responsibilities decides to affect out- of-home service and placement rates for children, youth, and its aging population, by working with the state, city manager, and the courts to blend and braid funds and customize service plans at the individual and single-family levels. It is guided by the view that “families are the best experts of what they need to thrive.” This is a shift from the regulative to the integrative stage. l A county-wide citizen service board is established to develop shared outcomes goals and determine the predictive “risk factors” it will track to ensure the community as a whole evolves in a way that benefits all citizens, including those experi- encing acute risk factors. Improved infrastructure projects and economic development efforts with greater taxpayer support result in their col- lective efforts. This is a shift to the generative stage of value. APHSA’s Journey through the Value Curve Stages Since 2010, APHSA has created a new playbook and taken the field under the leadership of our governing Board and executive director, Tracy Wareing. Prior to that time, the policy and program emphasis here was to help our agency members understand and navigate the current ones better, and to advocate for “more money and less rules” within current programs. The federal level of the system was thought of as an arbiter of our state members’ funds and of the rules they did or didn’t like. Our focus has since shifted to policy and program inte- gration and innovation targeted to improving consumer outcomes. Since local agencies often drive innovation within existing policy and program structures, we now view them as the primary incubator of what would form the basis for later broad-scale reforms. Our focus at the federal level has evolved to cross-programmatic and cross-jurisdictional influence, toward enabling increased service integration and more preventive service designs at the consumer levels. This is a shift from the regulative to the collaborative and integrative stage for us. Prior to 2010, APHSA did not have a formal strategy. We’ve since developed formal strategic plans and rebranded ourselves, with Pathways emphasizing a vision for the future of our field—how we can all work together to create a desired future state of our organiza- tions and practices that better impact outcomes for those we serve. Our Innovation Center has focused on pro- moting promising ideas and strategies throughout the field, such as alterna- tive financing and adaptive leadership practices. Our National Workgroup on Integration is designed to explicitly support Value Curve movement within communities across the United States. We are now communicating with our members about how to transform themselves, often through real-world accounts of how some of our members are achieving transformative progress today. This is a shift from the regulative to the integrative stage for us. The APHSA Organizational Effectiveness (OE) technical assis- tance practice was launched in 2004, replacing a classroom-based, fixed leadership development curriculum. OE was, for years, thought of as a side- table experiment that survived by paying for itself and contributing net revenues to our bottom line. Today, our change management and continuous improvement products and services are being integrated into most of our strategic initiatives. OE has evolved from experience, directly consulting with our members, through custom- ized projects that they help design and adjust as we work together, similar to consultative casework approaches. The OE practice has now been exter- nally evaluated, with very promising findings about its impact on sustained change, performance, service quality, and outcomes. This is a movement from the regulative to the integrative stage for the association. Prior to 2010 we were often reluc- tant to partner with industry, private providers, other associations, and on the international scene, though experi- ments with each were occurring. These partnerships were often viewed as “nice-to-have’s, but not essential” or only important for additional funding purposes. Today, such partnerships are integrated into our board roster, primary conferences and committees, and broader influence strategies. A broad range of partners is now working with us to better understand how we can all drive transformative change at the community level and in our society as a whole. This is a movement from the regulative to the integrative and generative stage for APHSA. Our hope is that more examples emerge of agencies and their commu- nities decoding the Value Curve and putting their related playbooks into practice—delivering greater levels of value and creating better communities for all. If you decide to take the field, know that we’re lacing up our cleats with you. We see many examples around the country of agencies and their partners decoding this Value Curve— communicating about it more confidently, applying the framework through a range of actionable strategies, and winning stakeholder support for advancing through its four stages.