Restructuring and Integrating Health and Human Services

The Client

Home to more than three million residents, San Diego County is the fourth most populous county in the United States. Its population is also among the most ethnically and geographically diverse, with almost 20 percent of residents being immigrants from other countries and speaking 68 different languages. The county includes a mixture of urban and rural communities and encompasses an area of 4,300 square miles. The San Diego County Health and Human Services Agency is responsible for delivering health and social services to residents countywide.

The Challenge

The Federal welfare reform bill of 1997 resulted in a substantial human services policy shift—not only were welfare program decisions being transferred to state and local government, welfare was being changed from an entitlement program to a temporary program. In San Diego County, the service delivery system was not organized in a way to assist families in moving quickly from being dependent on government to being self-sufficient. Indeed, health and human services in the county were extremely fragmented in design. The various services—mental health, drug and alcohol treatment, public health, child care—operated in their own vacuums, with little communication among them and minimal knowledge of common clients. Each division had separate technology, record keeping, facilities, and staff. What was needed was a full-scale restructuring of the various health and human services agencies in the county to form an integrated Health and Human Services Agency.

The Solution

After meeting with various health services departments within the county, BearingPoint’s project team developed a plan for a restructuring of the agency, following a "client service" model that divided the county into six regions focused on community services. Our recommendations included:

• Improve communications and reduce managerial and clerical staff by upgrading the agency’s systems to intranet technology.
• Integrate service delivery by moving to a regional, community-based operation.
• Instill competition by challenging public sector managers to compete with the private sector for delivery of services.
• Invest the savings achieved from these initiatives into the agency’s mission of prevention.

The Benefits

Upgrading the agency’s technology was a key component of the restructuring plan. Dr. Robert K. Ross, agency director, said “My strategic director and I worked very hard educating the Board of Supervisors that if they wanted us to achieve a business model, we needed their support for a $5 million infusion of resources for technology. We received that funding in a unanimous vote because we presented a business plan that made sense and was consistent with their vision.”

The Health and Human Services Agency’s new business model is creating a services delivery system that results in family-focused, community-based, high quality, cost-effective services. Public health nurses, social workers, and welfare workers no longer work for separate programs; instead, they work for a single, integrated regional team, whose customers are the families of San Diego County.
View/Download the San Diego Health and Human Services Agency case study (25 KB)