Integration Data Systems and Evidence Based Policy Analysis in Los Angeles County

1. Integration Data Systems and Evidence Based Policy Analysis in Los Angeles County Manuel Moreno, Ph.D. Director of Research, Research and Evaluation, Chief Executive Office, Los Angeles County June 15, 2010 Prepared for: INTELLIGENCE FOR SOCIAL POLICY NETWORK MEETING University of Pennsylvania

2. Confidentiality Laws and Data Sharing The Problem Over the past decade, Los Angeles County has become increasingly receptive to the use of evidence based research as a means to making informed policy decisions. However, while departments are especially interested in looking at how their client populations receive services from other departments, confidentiality laws create barriers to inter-departmental data sharing

3. The Adult Linkages Project and Integrated Data Systems • Under the rubric of the Adult Linkages Project (ALP), we developed a data integration system that de-identifies client records with the use of encrypted Statistical Linkage Keys. • This system has made it possible to match and link administrative records across departments by means that remain in conformity with confidentiality laws. • The ALP was initially developed to analyze the service utilization patterns and histories of the County’s General Relief (GR) population. Since its initial deployment, the ALP has opened new opportunities for inter-departmental analysis and is now being expanded as a case management tool.

4. Analyzing the Impact of Los Angeles County’s General Relief Housing Subsidy and Case Management Pilot Project The ALP’s data integration system has played a major role in the County’s efforts to make the GR program more efficient and effective. A key component in these efforts is the GR Housing Subsidy and Case Management pilot project. In 2009, we used the ALP integrated data system to evaluate outcomes and cost avoidance associated with participation in the housing subsidy program.

5. Analyzing the Impact of Los Angeles County’s General Relief Housing Subsidy and Case Management Pilot Project • Policy Question: To what extent does the provision of housing subsidies to General Relief recipients offset the utilization of expensive services and increase the likelihood that disabled recipients will become eligible for SSI benefits? • Providing an answer: The ALP’s data integration system enabled us to observe the service utilization histories of GR recipients in the areas of health, mental health and law enforcement. The following County Departments were included in the study: -The Department of Public Social Services; -The Department of Health Services; -The Department of Mental Health; -The Department of Public Health; -The Sheriff’s Department.

6. Demonstrating Cost Avoidance • Comparison: 900 GR recipients who received the housing subsidy versus a propensity score matched control group of GR recipients who did not receive the subsidy. • Serviceutilization costs were close to three times lower for the recipients receiving the subsidy. • The total annualized service utilization cost after one year: • 900 GR recipients receiving the subsidies: $5.2 million. • The control group of GR recipients not receiving the subsidies: $14.5 million.

7. SSI Eligibility Outcomes • SSI approval rate for SSI-eligible GR recipients: • Subsidy recipients: 50 Percent; • Control Group: 25 percent. • Regression analysis reveals subsidy recipients to be 2.5 times more likely to gain eligibility for SSI than non recipients. These outcomes, important in their own right, additionally spill over into cost avoidance considerations. When GR recipients are approved for SSI benefits, the $221 monthly GR grant, which is paid for with County funds, is replaced with an SSI grant of as much as $821 per month, which is paid for with State and Federal funds. SSI eligibility further represents an important means of cost avoidance insofar as SSI recipients are additionally entitled to Medi-Cal benefits, which provide comprehensive medical care,

8. Housing Subsidies as a Strategic Investment The deployment of the ALP’s record linkage procedures to help guide efforts to re-structure the GR program constitutes a major step for Los Angeles County in using evidence based research to inform policy formation. The evaluation results of the GR Housing Subsidy Program enabled us to demonstrate for the County Board of Supervisors that the provision of housing subsidies represents a strategic investment that will save the County millions in service costs. As a result of this, the GR Housing Subsidy program has become a major plank in the GR re-structuring efforts.

9. From Evaluation to Case Management • The success of the ALP as a research and analysis tool has Los Angeles County to also explore its potential for case management. In providing the capacity to view the service utilization patterns and histories of the GR client population, the ALP can be deployed to offer targeted and increasingly cost effective services to clients, provided the clients sign a confidentiality waiver giving DPSS the ability to link records with their personal identifiers across departments, thereby providing a picture of their specific needs and the most effective and efficient ways to meet them. • The County Board of Supervisors has approved this initiative as part of the GR re-structuring efforts. • The use of the ALP as a case management tool, in addition to its analytical utilization, is expected to boost the effectiveness of client services and save the County millions in service costs.

10. Conclusion:The Importance of Integrated Data Systems in the Current Fiscal Environment Like many other localities, Los Angeles County is currently faced with a difficult combination of rising caseloads and declining revenues. Within this context, the effective service delivery and cost savings made possible by the ALP’s capacity to legally integrate data across departments, for purposes of both analysis and service provision, has become critical. The County is currently using the ALP as a central part of its GR restructuring efforts. If this application yields its expected cost savings, it will be in the County’s long-term interests to expand the use of the ALP ‘s data integration system more broadly.

11. THANK YOU Manuel Moreno, Ph.D. Director of Research Chief Executive Office Research and Evaluation 222 S. Hill Street, Fifth Floor Los Angeles, CA 90012 (213) 974-5849 mmoreno@ceo.lacounty.gov