enrollment standards and user experience

Enrollment Standards and User Experience

Sam Karp, VP of ProgramsOctober 6, 2011

Implications for Human Services Integration

Work Support Strategies Webinar

CALIFORNIA HEALTHCARE FOUNDATION

Context and Current Practice

Enrollment Standards

User Experience (UX) Design Project

Vertical and Horizontal Integration

Q & A

Webinar Outline


States vary…

ACA offers states opportunities

Challenges abound

Context


We Live in a Digital Society


Current Practice


Where Are We Today?

However, not widespread…

Impact of the recession

Best intentions

Significant simplification efforts


Persistent Barriers

Local control

The welfare institution

Inadequacy of systems

Complexity of rules / silos


Disclaimer


Single Application Process

Medicaid CHIP SNAP TANF WIC EITC LIHEAP

County Indigent Care Programs

California Kids Healthy Kids Kaiser Permanente Child

Health Plan Child Health and Disability

Prevention Program Child Tax Credit Low-Cost Auto Insurance

Program


Enrollment Standards and Protocols


§ 1561. HIT Enrollment, Standards and Protocols

Not later than 180 days after the enactment, the Secretary, in consultation with the HIT Policy and Standards Committees, shall develop interoperable and secure standards and protocols that facilitate enrollment in Federal and State health and human services programs.

Affordable Care Act


Enrollment Workgroup

20 members representing various stakeholders

Integrated into CMS regulations and ACA guidelines

Held eight pubic hearings and “listening session” with State representatives

Developed 10 recommendations

Recommendations adopted by Secretary Sebelius on September 17, 2010

http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3161


Enrollment Standards & Protocols

1. Consumer-Centric Approach

2. Core Data Elements

3. Electronic Verification

4. Business Rules

5. Transmission of Enrollment Information

6. Privacy and Security


Core Data Elements

Reviewed 34 programs in 10 states

Variation in data name, format and definition

Standardize to increase interoperability

National Information Exchange Model selected as standard

Implementation approach

Range of complexity in data harmonization


Electronic Verifications

ACA §1411 requirement

o Citizenship SSAo Income IRSo Legal status DHS

Additional interfaces to Federal, State or other widely-available data sources

Federal reference software model

Standardized Web services exchange

CMS building Federal Data Services Hub


Business Rules

Express in consistent, clear and unambiguous language

Transparent to consumer by providing understandable eligibility determinations

Federal government establish repository of business rules needed to administer ACA health insurance coverage options


Transmission of Enrollment Information

Utilize existing HIPAA transaction standards — from health insurance coverage options to public and private health plans and to other health and human services programs


Enroll UX 2014 Project Objectives

Provide federal and state governments with a human-centered design to support enrollment

Help achieve a first-class user experience that promotes informed enrollment decision-making

Help ensure that large numbers of eligible consumers successfully enroll in and retain coverage


Public/Private Partnership


11 Participating States

Alabama, Arkansas, California, Colorado, Illinois, Massachusetts, Minnesota, Missouri, New York, Oregon, Tennessee


UX 2014 Design Partner

World-class design, engineering and innovation firm

www.ideo.com


Project Overview

Individual market and SHOP

All insurance affordability programs (Medicaid, CHIP, tax credits, cost sharing reductions, BHP)

Full eligibility, enrollment, plan selection and retention experience

Multiple pathways

Designing for diversity and ADA compliance

Vendor / system neutral


Design Phases / Timeline


Research Phase


Behavioral SegmentationHelps to design a system that is responsive to people’s different needs, desires and expectations.


Initial System Flows and Wireframes


Design Workshop

San Francisco, September 12-13


Multiple Enrollment Channels


Immediate Mobile Opportunities

ACTIONABLE ALERTSRenewal remindersPrompt to submit missing infoStatus changes/updatesSecure messaging

MOBILE HELP/SUPPORT TOOLVoice/TextLocation-based support services

ENROLLMENT TRACKER FOR APPLICATION STATUSText / EmailAutomated phone messages

MOBILE UPLOADData upload with photo support


Preliminary Visual Design


Design Refinement Phase

Further review and user evaluation

Publish comprehensive design specifications

Develop working functional prototype

Develop communications materials for sharing design


Public Website


Vertical & HorizontalIntegration


Considerations for States

Does it makes sense to leverage interest, focus and resources on ACA enrollment modernization efforts?

What level of integration? What programs? Phased approach?

How or whether to conform eligibility rules?

Cost-allocation implications / August 2010 OMB Circular A-87 Exception Letter

Planning today for tomorrow…


Questions & Answers

enrollment standards and user experience

Documents

state health

standards committees

secure standards

private health plans

state representativesdeveloped

repository of business

states opportunitieschallenges

aca guidelinesheld