enrollment modernization can radical incrementalism get us there? child health policy research...

Enrollment ModernizationCan Radical Incrementalism Get Us There?

Child Health Policy Research SymposiumMarch 2, 2009

CALIFORNIA HEALTHCARE FOUNDATION

“Modernization”

Change the culture, organization and structure of how program eligibility is determined and how enrollment activities are carried out…

to make it more efficient, consumer-friendly and comprehensive.

No Wrong Door or Single Stop approach to enrollment.


Key Barriers to Modernization

Categorical nature of of programs

Welfare Reform’s missing “de-link”

Outdated and disparate systems

Reliance on manual processes

County vs. statewide enrollment

Medi-Cal, CHDP, Healthy Families, Healthy Kids & WIC

Community Clinics

Medi-Cal, Food Stamps & Family Planning

Social Services

Breast Cancer Referral &CHDP

Physician Offices

Indigent CareWIC & CHDP

Public Health

Indigent CareWIC & CHDP

CountyClinics

CHDP &Medi-Cal (School Lunch)

Schools

Breast & Cervical Cancer Treatment

HospitalsER

Medi-Cal, Healthy Families

Health PlansMedi-Cal, Healthy Families &Healthy Kids

Maze of Local Health Program

Referrals


“Is this by design or what?”

What most applicants experience…


Real World Example

30,000 applications / month at Single Point of Entry for Healthy Families and Medi-Cal for Children programs

50% submitted on paper by applicants

20% submitted on paper with assistance from Certified Application Assistors (CAAs)

30% submitted electronically via Health-e-App with assistance from CAAs


Single Point of Entry Enrollment Process

Station #1Open Envelopes

Station #2Remove Staples,Paperclips, etc.

Station #3Feed High-Speed Scanner

Station #5Call FamilyFor MissingInformation

Station #4Manually EnterApplication Data

Station #6Apply EligibilityRules

Health-e-App


Preliminarily Determined Applications

Healthy Families Application

Medi-CalApplication

Final Eligibility Determined

Batch PaperApplications;Mail to Counties

County WorkerManually EntersApplication Data

Enrolled in Health Care Coverage


Incremental Improvements

SPE, mail-in application and presumptive eligibility

Application simplification efforts

Express Lane Eligibility

CHDP Gateway / improved newborn enrollment

County / health plan call-in / continuation centers

Other policy and administrative changes

SetbacksSetbacks

Setbacks

DRA requirementsMore frequent re-certification

Loss of outreach funds


Key realization along the way…


Future State*: Vision

Strong leadership, sustained sponsorship

Adequate funding

All-inclusive governance structure

Comprehensive IT solution

State-level approach that uses integrated technology and shares information to streamline eligibility, enrollment and retention.

* Recommendations from Modernizing Enrollment in California’s Health Programs: A Blueprint for the Future, Eclipse Solutions, November 2007

Requirements include:


Future State: Technology

Enterprise approach that uses shared services and shared information, including:

Common, web-based front-end that is publicly accessible, allows applicants to be screened for many programs, from many locations and transmits completed applications.

Common messaging infrastructure on which to build secure common back-end services.


Enterprise Enrollment Project (EEP)

Led by Health & Human Services Agency

Established formal governance structure

Developing requirements for a single statewide enrollment process

Conducting cost–benefit study

Workgroups to standardize data elements and harmonize and privacy and security policies

Plan to be complete by July 2009


Initial EEP Programs Available through a Single Application

Medi-Cal Healthy Families AIM CHDP

County Medical Services Program Breast and Cervical Cancer Treatment Program Cancer Detection Programs: Every Woman Counts

WIC TANF Food Stamps Family PACT


Programs Not Yet Included

Local Health Programs

County Indigent Care programs Healthy Kids CalKIDS Kaiser Child Health Program

Earned Income Tax Credit Low-Income Energy Assistance Program Child Care Tax Credit California Low Cost Automobile Insurance Program Voter Registration

Other Supplemental Programs


How will it actually work…


Service Oriented Architecture

Enterprise Service Bus

Search Ordering & Payment PersonalizationGift-Wrapping &

Fulfillment

Common Shared Services

Amazon Store(Purchase)

Rare Book Dealers(Purchase)

Toy Stores(Purchase)

Health & Beauty(Purchase)

Common Business Processes

Messaging Interface for Data Exchange


Consumer

Web-basedapplication

Amazon.com Example


Service Oriented Architecture

Enterprise Service Bus

EDD(Income Verification)

DMV(ID Verification)

MEDS(File Clearance)

Vital Statistics(Birth/Death Records)

Common Shared Services

CHDP(Program Enrollment)

Single Point of Entry(Program Enrollment)

SAWS Systems(Program Enrollment)

WIC Program(Program Enrollment)

Common Enrollment Business Processes



Consumer

Web-basedapplication

Source: Modernizing Enrollment in California’s Health Programs: A Blueprint for the Future, 2007

A Prototype to Modernize Public Program Enrollment


Questions & Answers

For more information:

Sam [email protected]

mailto:[email protected]

enrollment modernization can radical incrementalism get us there? child health policy research...

Documents

c alifornia h ealth

f oundation slide

app slide

caas slide

way slide

statewide enrollment

f oundation modernization

f oundation future state