Data, Analytics and Program Evaluation for Homeless Program Operations Part 1

1. Data, Analytics and Program Evaluation for Homeless Program Operations Part 1 VHA Homeless Programs 30 November 2016

2. Agenda • Introduction to data analytics in homeless program operations. • History of analytics and program evaluation in VA’s homeless programs. • Case study in use of data to drive homeless program performance. • Future of analytics in homeless program operations.

3. Introduction to Analytics in Homeless Program Operations Q: When you hear the word “data”, what image comes to mind? The Matrix? Confusing Scribbles? Insights?

4. Introduction to Analytics in Homeless Program Operations • Data: facts and statistics collected together for reference or analysis. • Program evaluation is a systematic method for collecting, analyzing, and using information to answer questions about projects, policies and programs, particularly about their effectiveness and efficiency. • Analytics is the discovery, interpretation, and communication of meaningful patterns in data. Especially valuable in areas rich with recorded information, analytics relies on the simultaneous application of statistics, computer programming, and operations research to quantify performance. Analytics often favors data visualization to communicate insight. Sources: Oxford Living Dictionaries, 2016 Wikipedia, 2016

5. Got Data?

6. Introduction to Analytics in Homeless Program Operations We can use data to obtain insights into our programs and help us make decisions to improve Veteran care and outcomes. If…we know what our questions are to begin with.

7. Introduction to Analytics in Homeless Program Operations Source: Gartner, 2016

8. History of Analytics and Program Evaluation in Homeless Programs – Beginnings • The Homeless Chronic Mentally Ill (HCMI) Program for Veterans was funded in 1987, at Homeless programs nationally. • These were the first nationally funded homeless programs, and were operational at 43 sites. • These programs were evaluated by the Northeast Program Evaluation Center (NEPEC). Strong results led to expansion of the HCMI program as well as the addition of multiple other programs, including HUD-VASH, SSVF, Grant and Per-Diem, HCHV Contracts, and Veterans Justice Programs. • 20 years later, we are funding over 1.4 billion dollars per year in homeless program services, serving over 300,000 Veterans per year – program evaluation and use of data and analytics have been primary drivers for expansion and funding!

9. History of Analytics and Program Evaluation in Homeless Programs – NEPEC “Blue Books” • Northeast Program Evaluation Center (NEPEC) “Blue Books” were a primary driver for program operations in homeless programs, dating back to the beginning of homeless programs. • These books were released once per year and were a valuable resource for programs to understand performance in the previous fiscal year. • All were based on submitted paper forms – mailed each month and tallied by NEPEC staff.

10. History of Analytics and Program Evaluation in Homeless Programs – NEPEC Electronic Forms • In FY2008, NEPEC and the Homeless Program Office developed an electronic data entry system for homeless programs, which made creation of reports much more efficient. • Quarterly reports were developed that provided more frequent insights into homeless program operations.

11. History of Analytics and Program Evaluation in Homeless Programs – HOMES • In FY 2011, NEPEC and the Homeless Program Office embarked on an ambitious plan to integrate data evaluation into one system – the Homeless Operations and Management Evaluation System (HOMES). • The impact of HOMES on our programs cannot be understated – HOMES has been a driving force in justifying funding for homeless program services since FY 2011. • It has also led to major improvements in program effectiveness since implementation.

12. History of Analytics and Program Evaluation in Homeless Programs – Homeless Services Cube • In FY 2012, the VHA Support Service Center (VSSC) created a powerful business intelligence tool for homeless program – the Homeless Services Cube. • For the first time, homeless programs were able to slice data in ways to provide tremendous insights into homeless program performance. • This tool integrated various data sources – from HOMES, the VHA’s Corporate Data Warehouse, and VBA.

13. History of Analytics and Program Evaluation in Homeless Programs – Homeless Services Scorecard • In FY 2013, in a partnership between VSSC and the Homeless Program Office, the Homeless Services Scorecard was developed. • This dashboard is a series of key performance indicators that provide insights into program performance and align VA-wide priority goals for homeless programs services at the VAMC, VISN and national levels.

14. History of Analytics and Program Evaluation in Homeless Programs – Veteran-Centric Operations and Planning (VIPO) Platform • Beginning in FY 2014, a number of new tools and capabilities were developed in partnership with the VA Center for Applied Systems Engineering (VA-CASE). • These tools fall under an operations management framework titled “Veteran-Centric Operations and Planning”, or VIPO. • VIPO is the operations management framework that drives homeless programs and collaborations at national, network, and VAMC levels, towards the goal of ending Veteran homelessness. • This platform uses data, program evaluation, analytics, and systems engineering to drive operations.

15. History of Analytics and Program Evaluation in Homeless Programs – Veteran-Centric Operations and Planning (VIPO) Platform • Key capabilities of the VIPO platform • Veteran Homelessness Gap Analysis • Web-based Homeless Program Operating Plans • Homeless Services Scorecard • Operational Planning Hub • Analytics Reporting

16. History of Analytics and Program Evaluation in Homeless Programs – Future Developments What does the Future Hold? • Expansion of real-time reporting capabilities to inform operations. • Community-level dashboards in partnership with the VA Center for Innovations. • Possible HOMES redesign. • Technologies to enhance community/VA data sharing. • Self-service and on-demand analytics services for VAMCs • Continued evaluation of program performance.

17. Case Study in the Use of Data Analytics to Drive Performance – the NF/SG Experience Using VERA and VSSC Hot Spot Data to Drive Operations Shawn Liu, LCSW, VHA-CM, HUD-VASH Program Manager North Florida / South Georgia Veterans Health System

18. What is VERA? • Veterans Equitable Resource Allocation • How VAMCs receive funding • Based on prior year’s care costs High Patient Care This Year = High $$ Next Year

19. Taking a Look at VERA in HUD-VASH • FY15 Performance Improvement Project • Aim 1: 99% of all HUD-VASH participants are vested. • Aim 2: 85% of all HUD-VASH patients receiving services consistent with basic homeless class or higher. • Aim 3: Total VERA reimbursement for HUD-VASH Veterans from the following year would increase by 5%

20. Stumbling Upon a New Challenge • As of July 2015 • NF/SG would receive $22.1M in VERA Reimbursement from HUD-VASH participants • NF/SG saw $27M in Medical Costs from HUD-VASH participants • $5M deficit in VERA reimbursement • 20 Veterans Represented $3M of that deficit • Most Veterans were at highest VERA price group

21. Stumbling Upon a New Challenge HUD-VASH Top 20 – July 2015

22. VERA Top 20 Analysis • Common Themes • Almost all due to ER Visits and Hospitalizations • Average Days in Hospital = 87.7 • Pain Management only = 15% • Substance Abuse = 20% • Both Pain and Substance Abuse = 25%

23. VSSC Eviction Risk Testing • Test in October 2015 • Hot Spot Veterans • ER Encounter or Inpatient Admission with a Mental Health or Substance Abuse diagnosis in the current month • Basic Assumption • ER / Inpatient = Greater Eviction Risk

24. VSSC Hot Spot Report

25. VSSC Hot Spot Data

26. VSSC Hot Spot Data

27. Our VERA and Hot Spot Overlap? 2% of July 2015 Top 20 showed up on October 2015Hot Spot 6% of November 2015 Top 20 Veterans showed up on the October 2015 Hot Spot

28. VERA vs Hot Spot

29. Going Down the Rabbit Hole

30. “Staying Housed” Care Protocol • Processes Checklist • Outpatient / Community Based SATT Participation within 7 Days of Discharge • PC or HPACT Enrollment • Vocational Rehabilitation Engagement • Follow Up with After Care Plans • Assessment and Activities for IDT Members • Key engagement with OT, ARNP, SUDs

31. Upcoming Plans • Incorporate projects into existing tracking tools • Monitor Hot Spot monthly • Monitor VERA vesting quarterly • Monitor VERA costs annually • Balance focus • Increase in focus to targeted Veterans

32. Development of Modified H-PACT in HUD-VASH • 2 Locations • Gainesville, FL and Jacksonville, FL • Disciplines • ARNP, Dietitian, Social Work, RN, and Schedulers already on HUD-VASH Team • Added on LPNs in FY17 • Projected Start FY16Q2

33. Wrapping It All Up • Program evaluation and analytics can help optimize outcomes for homeless Veterans, driving towards our goal of ending Veteran homelessness. • Data is a tool – it is not an end-all be-all. We need our homeless program staff to understand how to use data to improve outcomes. • However, this doesn’t mean that everyone has to be an expert coder – more like, how do you bridge data with operations to drive outcomes? • Part 2 will go into detail in each analytics category, with specific case studies.

34. Assignment for Next Week • What question do I have about my programs? • Why do I want to know the answer? • How updated do I need the information? • How do I want it displayed? • How often do I want it available? • What action do I want to take once I get the information I need?