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CalCareNet Business Case Study and Analysis March 2008


6.  Technology Assessment
Phase II CalCareNet concluded with a model website prototype for an integrated CalCareNet; a summary overview of best practices in integrated information systems, around the country and in California; and, critical stakeholder feedback on long-term support information system needs and preferences.  It also provided the following technology assessment recommendations upon which to build Phase III CalCareNet.

Establish CalCareNet Portal Hosting Capabilities – addresses hardware, software, and network components acquisition, licensing, and implementation.  Portal Hosting also involves Legacy Transformation capabilities to access third party legacy systems across state departments and public and private agencies. 

Develop CalCareNet Portal Technical Components Standards – CalCareNet Portal Technical Components Standards will enable the “uniform” integration of external systems, databases, and content owned by second or third party vendors at the state and local levels.

Develop Maintenance Model for the Technical Components and Standards – the Maintenance Model will help to define and support site methodology, procedures, and functions to maintain its efficacy, reliability, and integrity.

Establish Documentation and Content-Update System – to ensure that site content and functional capabilities are well defined and understood by stakeholder groups, Phase III CalCareNet will focus on developing comprehensive documentation of all site protocols, content inclusion and exclusion criteria, and a viable system for facilitating regular and comprehensive content updates. 

In addition to these recommendations, the CalCareNet Steering Committee added the following recommendations:

Ensure CalCareNet requirements are in full compliance with federal universal accessibility standards

Employ Security Measures – Vendor to use an integrated system of industry best practices and technologically advanced safeguards, approved by the State, to secure the CalCareNet system

7.  Risk Management Approach
Risk Management Process

The technology vendor will develop a comprehensive Risk Management Plan and process as a contract deliverable, prior to commencing work on the pilot prototypes.   At that time, procedures for risk mitigation (preventive measures), risk tracking (processes for recording tasks accomplished, outstanding issues/risks to be resolved, and next steps), and risk control (appropriate contingency plans to ensure success of the project) will be developed. 

Once the plan and procedures are in place, the Project Director and vendor will participate in regularly scheduled project management meetings to identify, track, analyze, and discuss project risks.  This process facilitates prioritization of risks in the areas of organizational environment, policy, data, operations, and technology. The Project Director will monitor project risks and implement contingency plans when necessary. The following are examples of potential risks in these areas:

Organizational Environment Risk – Ongoing participation and commitment by members of the CalCareNet Steering Committee are critical to the success of Phase III. 

Policy Risk – Compliance with state and federal privacy legislation, including HIPAA, may present challenges to the development of various consumer tools.

Data Risk – The content required to populate a fully developed CalCareNet will be substantial.  Definition of content requirements, refinement of inclusion/exclusion criteria, and identification and collection of information sources (e.g., resource databases, health information, and long-term support definitions) will be essential to creating a successful information system.

Operational Risk – Schedule and budget risk represent two significant operational risks that will require ongoing monitoring

Technology Risk – Integrating information systems, developing complex technical platform elements – hardware, software, and network components, and constructing a feasible site maintenance model represent some of the serious potential technology risks for this project.

Security Risk – Monitoring security risks to the website constitutes a significant ongoing project goal.  The technology vendor will work closely with State IT representatives to ensure that managing Security Risks remains at the forefront of the project’s Risk Management Approach during both systems development and implementation.  

Outstanding Project Risk Issue

California has been busy preparing for an aging California.  A significant risk for the state however, is missing the opportunity to lead development of an Internet-based statewide long-term support information system – the CalCareNet system.  The proliferation of home and community-based services, fueled by the independent living movement and the Supreme Court’s Olmstead Decision, combined with growing support for an “aging in place” paradigm, indicate that times are changing.   Consumers need different information and different ways of obtaining goods and services than years past.  Long-term support consumers need ready access to a variety of long-term support resources, especially home and community-based resources.  They also need comprehensive information.  Similarly, health and social service providers require accurate up-to-date information to provide long-term support information to consumers.  Meeting all of these needs with Web-based as well as complementary information technologies would help California increase access to health and social services, promote choice and independence, and improve quality of life Californians with long-term support needs.

8.  Project Organization
The project organizational structure is comprised of the project sponsor – CHHS, State staff (Community Choices Project Director and other State staff), CalCareNet Steering Committee, and the selected technology vendor.  The Community Choices Project Director anticipates including additional staff and organizational components as new project dimensions unfold.   Current components are detailed below and are represented in Figure 2. Phase III CalCareNet Project Organizational Chart.

Project Sponsor is the California Health and Human Services Agency (CHHS). CHHS will provide project oversight and will oversee development of all Departmental Memorandum of Understanding.

Community Choices Director is responsible for overall project management, including resource, schedule, and scope management. 

State Staff will assist the Community Choices Director in delivering project support.

CalCareNet Steering Committee is responsible for providing guidance on the development and vision for the CalCareNet web portal; validating the direction for CalCareNet development; and providing technical input on web portal content and design during the development phase of the CalCareNet.

Technology Vendor is responsible for the design, development, and implementation of the CalCareNet prototype.  The vendor is also responsible for the development of baseline architecture to expand the CalCareNet pilots statewide.

Figure 2:  Phase III CalCareNet Project Organizational Chart
Figure 2 is a graphic illustration of the relationship between the entities involved in development and implementation of the CalCareNet Phase III.  The illustration demonstrates that the Choices Project Director serves as the connecting/facilitating link between the CalCareNet Steering Committee, the Technology Vendor and State Staff and reports to the project sponsor (CHHS); and the Technology Vendor reports directly to the Choices Project Director.
9.  Project Management
The Community Choices Project Director will work in conjunction with CHHS to develop a structured approach to project management.  CHHS recognizes that the success of Phase III CalCareNet is dependent on project compliance, integrity, and open and ongoing communication with the technology vendor.  The Community Choices Project Director and CHHS will finalize the project management methodology and the roles of the principals described below:

California Community Choices Project Director

The Community Choices Project Director will have full responsibility for overall project management, including resource, schedule, and scope management.    The Community Choices Project Director currently possesses the following qualifications:

  • Project management experience
  • Experience as business lead in design, development and implementation of websites and databases
  • Ability to coordinate and deploy projects that cross organizational boundaries
  • Knowledge of team leadership principles

In the course of project development, the Project Director will engage a part-time consultant (or identify State staff) to act as an Assistant CalCareNet Project Manager to facilitate and support development of website content and to assist with project management functions.

The Community Choices Director will report project risks, progress, and delays or overruns to CHHS and the CalCareNet Steering Committee.  Phase III will also regularly engage external stakeholders (consumers, state staff) in project evaluation.

Technology Vendor

The selected technology vendor will provide a project manager for that portion of the project involving design, development, and deployment of the pilots.  This project manager will be familiar with the solution components and experienced managing projects involving similar scope and services.

10.  Project Schedule and Implementation Strategy
The following table outlines the Phase III CalCareNet project schedule, implementation strategies, and next steps.  The dates following the description indicate project activity.
Table VI: Phase III CalCareNet Project Schedule and Implementation Strategy

Strategies and Major Action Steps

Strategy 1. Design Information Technology (IT) applications that will support program practices and processes that are consistent with participant-centered principles and enable consumers to direct their own services

  • Build on the CalCareNet Portal Enhancement Project to implement a piloted version of the site at the two CAL ADRCs; the piloted prototype, to be completed in a replicable template necessary for statewide expansion, will provide a comprehensive, easy-to-use, fully accessible, consistently updated Web-based aging and long-term support information and assistance system which provides consumers with an opportunity to direct their own services:  July thru September 2008, Field Test October thru December, Implement January 1, 2009
  • Establish new Steering Committee for the California Community Choices CalCareNet pilot project:  July thru September 2007.
  • Conduct competitive solicitation process:  October thru December 2007.  Release RFO January thru March 2008.  April thru June 2008
  • Select IT vendor:  April thru June 2008
  • Community Choices Project Director with Steering Committee to monitor contractor progress on all related project plans: April 2008 thru October 2009
  • Contractor to work with Steering Committee to develop Website Content:  April 2008 thru October 2009
  • Contractor to conduct user testing at the pilot sites to ascertain compliance with WC3 and 508:  October 2008 thru October 2009
  • CAL ADRCs and contractor to establish and train specialists to provide in-person assistance to persons with disability seeking access to information on the CalCareNet site:  October 2008 thru October 2009
  • Post Implementation Support: January thru October 2009

Strategy 2. Improve client access to long-term services through the use of integrated IT

  • Incorporate the various Web-based resources and data depositories already in existence in California:  April 2008 thru October 2009

  • Connect State-level program databases:  April 2008 thru October 2009

  • Connect local-level program databases in selected pilot areas:  April 2008 thru October 2009

  • Vendor to subcontract an experienced consultant in web accessibility to review final prototype for various forms of accessible technology:  April 2008 thru October 2009


11.  Conclusion  
The business case for Phase III CalCareNet and expansion statewide of this innovative and much-needed technology are compelling.  Without this tremendous tool, consumers in need of long-term supports will continue to flounder under California’s current county-by-county “hit or miss” system of access to and information about long-term supports.  With a mushrooming population of Californians requiring information and support in this area – consumers, caregivers, local, regional, and state planners, and providers – the State cannot afford to miss this opportunity to assume a primary leadership role in disseminating long-term support information.   

As interdependencies between public and private information systems grow, so too will the need to provide relevant, quality-driven home and community-based long-term service information to consumers.  Informed choices have the potential to reduce confusion, duplication of services, and ultimately unnecessary long-term support costs incurred by individuals as well as the State.  In addition to providing a comprehensive, easy-to-use, consistently updated Web-based system, CalCareNet will offer consumers a variety of complementary technologies, for those unable to use the Internet or without access.  These may include 1) creating a telephone system; and 2) coordinating with information centers, such as the CAL ADRCs, to arrange for in-person information and support, as well as public Internet access.

Large scale technology projects require completion of an extensive set of planning activities and approval, including: development of an IT procurement plan and related assessments of business needs, baseline analysis, proposed solutions, project management plan, risk management plan, and an economic analysis and funding plan. This rigorous process, which includes multiple levels of governmental review and approvals, helps insure project success and a sound fiscal investment.  Phase III CalCareNet lays the groundwork necessary for such a project.  The timing has never been more appropriate for the State to commit to and invest in providing an effective and robust client-centered long-term support information system, with the capacity to serve all Californians.

Appendix A: CAL ADRCs

In 2003, the federal Aging and Disability Resource Center (ADRC) grant program was launched by U.S. Department of Health and Human Services to create a reliable, visible place that consumers could turn to when confronting aging and long-term care challenges.  States were encouraged to develop ADRC models to achieve the following: to increase consumer awareness of and information about the full range of long-term support options; to assist consumers in understanding their benefits and making informed choices; and to help consumers access needed services.

In 2004, California received an ADRC grant award from Administration on Aging (AoA) and the Centers for Medicare and Medicaid (CMS).  The grant was awarded to the California Department of Aging (CDA), which in turn selected two counties for the grant – San Diego and Del Norte. Two versions of the ADRC model were piloted at these sites from 2004 through 2007.  In Del Norte County, a small rural county at the northern most section of the state, a “bricks and mortar” approach was adopted where key services for older adults, persons with disabilities and family caregivers could be accessed at one physical location.  In San Diego County, a large urban county in the southernmost section of the state that also encompasses suburban and rural regions, the ADRC adopted a “virtual” approach.  Enhancing and expanding the county’s aging and long-term support website, Network of Care, consumers were provided a tool for accessing long-term services and supports through a fast, easy, friendly website, which combined the aging-related expertise of the existing Area Agency on Aging’s (AAA) Call Center and the disability expertise of the Independent Living Center (ILC).  Both Del Norte and San Diego’s ADRCs represent viable models for replication.  

California’s recent receipt of a Real Choice Systems Change Transformation Grant, awarded to CHHS by CMS, offers California another opportunity to build on its successes with the current ADRCs. As part of the Community Choices Project, two new ADRCs (referred to as CAL ADRCs) will be created.  Tentative CAL ADRC contracts awards were made on February 11, 2008 to CalOptima in Orange County and the Riverside County Office on Aging.  The primary focus of these ADRCs is to develop and implement a consumer-centered, coordinated system of information and access for all persons seeking long-term services and supports, ranging from in-home services to nursing facility care.  While the CAL ADRCs are primarily designed to serve consumers and caregivers, they will also serve as a critical resource for health and long-term support professionals, both public and private, and others who provide services to older adults and to persons with disabilities

Appendix B: CalCareNet Steering Committee Members

Stakeholder Representatives

Neal Albritton
CA State Independent Living Council

Sharon Cordice
Aging & Independence Services
County of San Diego

Allan Friedman

Lisa Jackson
Housing Choices Coalition
Choices IT Subcommittee

Kathleen Kelly
Family Caregiver Alliance

Deborah Miller
SCAN Health Plan
Choices IT Subcommittee

Wesley Mukoyama           
Yu-Ai Kai / Japanese American
Community Senior Services           
Choices IT Subcommittee

Marianne Nix
Area One Agency on Aging

Bob Petty           
Alliance on Aging
Chair, Choices IT Subcommittee

Teddie-Joy Remhild           
Personal Assistance Services
Council of LA County
Choices IT Subcommittee

Laura E. Williams           
Californians for Disability Rights, Inc.
Choices IT Subcommittee

State Department Representatives

Ann Collentine
Adult and Older Adult Program Policy
Systems of Care
Department of Mental Health

Lora Connolly
Department of Aging

Paul DeMange
Independent Living Assistive Technology Section
Department of Rehabilitation

Sheryl Jakaboski
Technical Services Branch
Department of Social Services

Connie Kwan
Licensing and Certification
Department of Public Health

Andi Murphy
Adult and Older Adult Program Policy
Systems of Care
Department of Mental Health

Gregg Rice
Long-Term Care Division
Department of Health Care Service

Penny Tafoya
Information Management Services Division
Department of Alcohol and Drug Programs

The disability rights movement asserts that people with disabilities are human beings with inalienable rights and that these rights can only be secured through collective political action: the independent living movement has been an important part of this broader movement for disability rights.
(September 22, 2007;

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