The Department of Social Services (DSS) is the largest of Connecticut’s state agencies, overseeing more than a quarter of the state’s $19 billion budget. The agency, whose biggest responsibility is providing health coverage to more than half a million state residents, faces some of state government’s greatest challenges over the next four years.
National and state health reforms include a dizzying array of new opportunities and challenges to add to the department’s plate. The department, which has struggled to operate routine, basic health care programs that are commonplace in other states, will need to implement new, very complex payment and delivery innovations.
The department’s HUSKY program, for instance, has been repeatedly criticized for overpaying HMOs, underpaying doctors, and delivering too little care. This program, that now struggles to serve the needs of 400,000 people, will soon have over 100,000 more to care for.
Finding someone to lead this moribund agency through the new health care landscape is one of Governor-elect Malloy’s greatest challenges. The new commissioner will need to restore faith in DSS’ ability to handle complex challenges, build trust in data and policymaking integrity, and restructure incentives and communications across the agency to foster innovation and productivity while improving morale.
The new commissioner will have to attract providers to participate in Medicaid, a deeply unpopular program, and engage new partners. It will also be critical to establish strong independence from the managed care industry. Above all, the new commissioner must commit to transparency and making its taxpayer-funded work open to the public.
The new commissioner will need to rebuild credibility across a set of skeptical stakeholders here in Connecticut, especially providers, consumers, and their advocates. The job requires someone who knows Connecticut’s health care landscape and is skilled in collaboration and communication. We need someone who listens more than talks.
And if that is not enough, these challenges will have to be addressed in the context of a historic budget deficit and scarce resources.
Among my top questions for any candidate for DSS Commissioner,
· Are you comfortable collaborating and working with people, internally and externally, who do not agree with you, people with different perspectives and experience?
· How will you address DSS’ poor reputation among external stakeholders and overcome deep suspicion about the organization’s capacity for change? How will you reach out to DSS’ customers, legislators, advocates, and the media?
· What is your experience working with Connecticut advocates, hospitals, physicians and other providers, payers, Members of Congress and health staff, health policymakers in other states, and federal agencies including the Centers for Medicare and Medicaid Services, the Office of Consumer Information and Insurance Oversight, and the Office of the National Coordinator for Health Information Technology among others?
· Are you willing to devote precious internal resources to collecting and analyzing information on program performance and efficiency, even if the results are not flattering to the agency? Are you willing to publicly release the data, take responsibility, and make corrections?
· Are you willing to consider all options for troubled programs, even those such as Primary Care Case Management that disturb powerful interests? Are you willing to give all good ideas a fair chance to succeed?
· In a tight budget climate, how will you manage the high expectations of groups that have been neglected and underserved for over a decade?
Leading DSS will be an exceptionally difficult job – almost as difficult as finding the right person to fill it. Connecticut’s health care advocates are looking forward to new leadership and a constructive relationship with the department as Connecticut faces exciting new opportunities and daunting new challenges in health care.
Ellen Andrews is the executive director of the Connecticut Health Policy Project.