DHS Director Gillespie: ‘Arkansas has done some really amazing things’

Cindy Gillespie heads the Arkansas Department of Human Services, a sprawling agency in charge of traditional Medicaid; Arkansas Works; and the state’s 4,900 foster children, among other areas. The Georgia native began working at DHS March 1 and will be paid a salary of $280,000, which is $119,000 more than her predecessor, John Selig.

As a senior adviser to former Massachusetts Gov. Mitt Romney, she played a leading role in the development of that state’s health reforms. She earlier helped plan the 2002 Salt Lake City Olympic Winter Games.

Gillespie sat down May 4 with Talk Business & Politics to talk about her leadership of DHS two months since coming on board March 1.

TB&P: What are your first impressions of the agency?
Gillespie: “My first impression when I got here has not changed, which is we have an incredible group of employees. …There is a great sense of mission in so many of them.”

“We’ve been conducting a very quick 60-day review of the business operation side first, and the business operation side needs work. I don’t think it’s been looked at in a number of years. For an organization of this size where you have billions of dollars flowing through it, and you have 10 different divisions, you have 7,500 employees, you have so much going on, the business structures that exist … they don’t appear to have grown as the agencies have grown and as the overall department has grown. What I see is largely divisions that are operating, and each have their own budgets. Each have their own processes. Each have their own procurement. Each have their own finance. Each have their own HR. And at headquarters level, you’ve got some overarching policies, but you don’t really have anything that pulls all that together and creates central points of accountability.”

“And then from there, we’ll go into a longer review that is in its own way far more complicated, which is then to look on the program side of the house. … We’re going to look at, as part of that, what’s actually happening in the field, how are our employees doing, what is their effectiveness rate, as well as what have we as an organization put on them that may be hindering their ability to do their job. We are still gathering data, but we know we have over a 20% rate in the last year of people who left the department. That’s huge. … That means you will always have a fifth of your people who are new at their job, they’re going through training, they’re trying to learn what to do.”

TB&P: If you could start DHS over from scratch, how different would it be?
Gillespie: “I don’t know that I can answer that because quite honestly every state department of human services is really different. If you go look at each state, you try to match anything, you can’t. Each one grew in their own way, and what you have to do then is periodically look at something and go, ‘OK … should we be changing the way we do business?’ Everything I pick up here is that everybody is ready here to take that re-look.”

“Arkansas has done some really amazing things. What’s been done on the Payment Improvement Initiative is nationally recognized. I mean, one of the main reasons I came here is because Arkansas has such an – I don’t think Arkansans realize the reputation this state has nationally for being a place of innovation. … Now that I’ve been here a couple of months, I see partly why that innovation is happening here and it isn’t in other places. It’s not just the people and the resources, but there’s also an element here of people coming together to work on things, public and private, that has been lost in a lot of other places. There’s really incredible potential here.”

TB&P: We may not have Arkansas Works this time next year. How do you plan in this political environment?
Gillespie: “In our case, we just plow ahead because we know that Jan. 1, we have to be prepared. … The chances of the program surviving are greater if we’re prepared, and we’re actually beginning to move people, and we can lay out clear processes where people can see that, yes, people who come into the system and get health insurance this way are either, A, going to stay on the employer insurance, which helps small businesses in our state, or they’re going to get referred to work, and that is also good for our state.”

TB&P: Managed care – are you tackling it yet?
Gillespie: “There’s a lot going on right now that came out of the debate around managed care that focused on some of the changes that can be made within the system, even as you begin to prepare and set up for some overarching structural changes. So part of what we are doing right now is working with the long-term care community around what kinds of reforms we could make together in that area. A number of items came through around changes that can be made in the behavioral health side that would save the state money as well as be better for our clients. And those areas, we’re working to pull together, and where we have the authority to move on them, move on them, and where they would require some sort of review by the Legislature, take them back for those sorts of reviews.”

“I don’t think anybody wants to see the state just sit and wait when there are some things that we could potentially do that can begin to save the state some money and provide more effective services. And that’s a message I’ve heard not just obviously from the governor and from legislators, but interestingly to me, that is a message I’ve heard come to us from providers as well, which is, there are places where we all know some changes need to be made.”

TB&P: You’re in charge of 4,900 of the most vulnerable Arkansans – those in foster care.
Gillespie: “The growth in that area is unbelievable. I mean, it is a tidal wave that is just coming day by day by day. So we are doing multiple things. On one level, you’ve got the kids coming in, and we’re looking to increase placement options for them, foster homes, etc. But at the same time, we have to look and see what is causing that and where it’s coming from. That is an area where right now, quite honestly, we’re doing a lot of analysis just to even break it out because when I came in and asked for a lot of that data, it wasn’t here. … We’ve literally got people in the field pulling all the case files, some national experts to try and analyze it for us and give us some idea of what’s causing it.”

“It’s a multi-pronged effort. We are moving to literally a team that is going to be meeting in my office three times a week pulling these prongs together so it stays as something that remains a high level focus of how we as a department try to work and address this.”

TB&P: This one’s a little more personal.
Gillespie: “Oh, yeah. This is the kind of thing that you lay awake at night going, ‘All right, what is happening, and what are we going to do about this?’”