the work

 

We pursue design solutions that cascade throughout complex institutions

 
Public benefit applications in the State of Michigan, filed away at a local field office. Photo by Janice Cho

Public benefit applications in the State of Michigan, filed away at a local field office. Photo by Janice Cho

 

Re:Form - A Civilla Case Study in unlocking access to government serviceS

Millions of Americans struggle to access critical government services. For residents, navigating complex bureaucracies feels overwhelming and de-humanizing. For government agencies, these services are highly inefficient to operate and often fail to deliver desired outcomes. Civilla has been on a mission to unlock access to government services - starting with the public benefit system which impacts 25% of Americans each year. Over the past 25 months, the Civilla team has been working with the State of Michigan to redesign the experience of applying for public benefits. By prioritizing the needs of residents & caseworkers the team has developed an alternative that drastically reduces the State's operational burden while improving experiences and outcomes for millions of residents.

Dr. Latina Denson - a Michigan resident who engaged the public benefit system for the first time after having a stroke that left her in a coma. After 10 years of recovery, she has joined Re:form to help transform the experience of accessing benefits in Michigan. Photo by Marisol Dorantes.

Dr. Latina Denson - a Michigan resident who engaged the public benefit system for the first time after having a stroke that left her in a coma. After 10 years of recovery, she has joined Re:form to help transform the experience of accessing benefits in Michigan. Photo by Marisol Dorantes.

Aqueelah Abdullah - a MDHHS caseworker whose background in social work inspired her to pursue a career in civil service. Aqueelah is one of many caseworkers who have guided Re:form since its inception, shaping a solution that is rooted in the needs of field staff. Photo by Marisol Dorantes.

Aqueelah Abdullah - a MDHHS caseworker whose background in social work inspired her to pursue a career in civil service. Aqueelah is one of many caseworkers who have guided Re:form since its inception, shaping a solution that is rooted in the needs of field staff. Photo by Marisol Dorantes.

 
 

Context

The Michigan Department of Health and Human Services (MDHHS) touches nearly every Michigan resident through programs and services which range from health, income and nutrition supports to advanced laboratory capabilities and state vital records. The largest of these programs, and to a great extent those most commonly associated with MDHHS, support over 2.6 million Michigan residents through healthcare, nutrition, income, child care, and emergency relief services. With almost $1 Billion of allocated benefit left unclaimed each year, one of the primary barriers to services is the long and complex application. 

The entry point to Michigan's public benefit system is an application that is up to 64 pages long. With over 1000 questions and more than 18,000 words it is the longest application of its kind in the United States. 

The entry point to Michigan's public benefit system is an application that is up to 64 pages long. With over 1000 questions and more than 18,000 words it is the longest application of its kind in the United States. 

Not only does this application create a significant barrier to services for residents, but it is also extremely cumbersome for the State to administer and process. There must be a better way. The Michigan Department of Health and Human Services (MDHHS) has linked arms with Civilla to launch Project Re:form - an effort that is focused on developing a faster, simpler and more customer-centered application for Michigan's largest assistance programs. The goals of the project are to create a clear path for residents to access these programs, humanize that experience, and streamline the complex, bureaucratic processes that sit behind them.

Process

Civilla began working with MDHHS in Fall of 2015. Through months of field work, the Civilla team developed a nuanced understanding of the experiences of both residents and caseworkers. The team lifted up these stories in an immersive exhibit that walked State leadership through the full journey of applying for benefits. In parallel, Civilla established relationships with the USDS, Code for America, the Urban Institute, CBPP, and state government agencies to lift up best practices from the US and abroad. 

New concepts for the application that reflected user insights were developed in partnership with residents and caseworkers. These designs were improved through rigorous field testing and many iterations. The design process - facilitated in partnership with DevMynd - resulted in an integrated application that has been embraced by residents, caseworkers, and State leaders alike. In parallel, it delivered an 80% reduction in complexity (words, questions, pages) without any structural shifts in administrative rules, State laws, or Federal regulations.

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Photo by Janice Cho
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Going Live

After months of navigating the required policy, legal, and departmental review process - Civilla launched a pilot program to test the new application in field offices across the State of Michigan. The purpose of the pilot was to conduct mixed-methods research that would allow the team to gather robust feedback on the design for the new application and fully measure benefits for both clients and field staff. Throughout the pilot, the application went through several iterations while complex data sets were captured and analyzed to achieve a full understanding of how a restructured business process would effect the system.

This results of the pilot were very positive. Overall, residents embraced the new application, reporting that they could complete the application more quickly, more confidently, and more independently. For caseworkers, the new design resulted in more complete and accurate applications - which decreased processing times overall. With that additional time, caseworkers reported being able to engage in higher value conversations and activities with their clients. By its conclusion, the pilot had produced a field-driven application that had the potential to greatly reduce the burden on the Michigan public benefit system and improve outcomes for millions of residents.

Pilot feedback was so strong, in fact, that State leaders felt confident to make the decision to sunset the application they had been using for more than thirty years and instead roll out the newly designed alternative across 100+ offices statewide starting in January 2018. Civilla was subsequently engaged to lead the State through another chapter of changework: at-scale implementation. This included conceiving and executing a communications strategy to engage individuals inside and outside of the organization, and designing and running an immersive, in-person training for 5000+ State workers. The work continued to achieve enthusiastic support from an ever-widening group of stakeholders. The application was recently awarded Federal-level approval by the two relevant government agencies: The U.S. Department of Health and Human Service's The Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Agriculture's Food and Nutritional Service (FNS) - the two relevant government agencies.

Early evidence suggests that the new application will drastically reduce MDHHS’ operational burden while improving experiences and outcomes for millions of residents. Further, this work will lay the groundwork for structural improvements across MDHHS in policy, technology, and business processes. 

Photo by Janice Cho

Photo by Janice Cho

Future

Civilla's work with the State of Michigan is establishing a strong proof point for what it looks like to design institutional services that are human-centered from the inside-out.

The team is pursuing new pathways to accelerate innovation in the public benefit system across the US and, eventually, in government services for all Americans - including veteran services, student loans, and the IRS tax code.

Leaders across several industries and sectors (including a host of Fortune 500 companies) have begun leaning in to ask how working in a similar Way could help them achieve meaningful and enduring change within the complex institutions that they lead. 

In the Media

Read about it: featured in Harvard Business Review

Listen to the story: featured on the podcast One Billion

 

 

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