fixing the leaky sieve: federal and plan solutions to churning acap ceo summit, july 15, 2009...
TRANSCRIPT
Fixing the Leaky Sieve: Federal and Plan Solutions to Churning
ACAP CEO Summit, July 15, 2009
Georganne Chapin, President & CEO
Hudson Health PlanHudson Center for Health Equity & Quality
Tarrytown, NY
Hudson Health Plan
Founded in 1985 by four Community Health Centers
85,000 members in New York’s lower Hudson Valley (North & West of NYC) Mixed urban, suburban and rural in character
Hudson Center for Health Equity & Quality
• Founded in 2005
• Focus on policy and technology
• “Promoting a humane, cost-effective, high quality health care system”
New York’s Public Insurance Programs
• Medicaid Managed Care
• Child Health Plus • Family Health Plus
“Facilitated Enrollment”
• Community-based
• Health Plan-based
• Decentralized (55 counties + NYC)
• Largely manual/paper-based
Health Plans as Enrollers
• Field-based
• “On the street”
• “Community outreach vehicles”
• Satellite offices
• Events
• Extended hours
Enrollment Challenges
• Current paper-based environment:
– Error-prone, manual application process– Inefficient administrative systems– Excessive churning (disenrollment and re-
enrollment of eligible people)– High cost to manage process
Typical Enrollment & Eligibility Cycle
• FE fills out 8-page form with applicant• FE collects identification, proof of income, and other verifying
documents• Paper application audited by health plan/FE and returned to
FE/marketer to correct/complete• Applicant re-contacted for additional/correct info• Application re-submitted for audit• Application batched and shipped to local district by messenger• Application reviewed and audited by local district• Application returned to health plan/FE for corrections/completion• Etc….
OUR GOAL: SIMPLIFY
• Speed up time between sign-up & effective enrollment
• Reduce errors
• Reduce paper (processing and storage)
• Reduce costs across the system
• Increase enrollment and retention
Facilitated Enrollment Electronic Application – The FEEA Solution
• Developed by Hudson Health Plan
• Software license transferred to Hudson Hcheq
• Now live in 13 counties + New York City
FEEA at the Health Plan
• Laptop and/or network installation• Connected and/or wireless• Password protected with role based security• Data transmission via secure VPN• Full printing and scanning capability
Easy to Use
• Windows©-based user interface• Logical data entry screens• Rule-driven data integrity• Automatic calculations• State/federal rules always on screen• Documentation check-list
Improved Quality
• Zero legibility issues• No calculation errors• Facilitates enroller/auditor communication• Provides reports and management tools• Automates NYS fraud and abuse
requirements.
The Future of Public Program Enrollment in New York State
The Future
• Customer Self Service: www.EnrollNY.org
– Sends qualified leads to participating FE’s– Provides on-line access to leads– Lowers cost of enrollment
www.EnrollNY.org
www.EnrollNY.org
• Quick and easy eligibility calculator• Quick and easy eligibility calculator
www.EnrollNY.org
• Eligibility calculator Identifies programs for which users may qualify• Easily start the online application
• Eligibility calculator Identifies programs for which users may qualify• Easily start the online application
• Eligibility calculator Identifies programs for which users may qualify• Easily start the online application
• Eligibility calculator Identifies programs for which users may qualify• Easily start the online application
www.EnrollNY.org
• Basic lead information is captured including contact information• Basic lead information is captured including contact information
www.EnrollNY.org
• User selects Facilitated Enroller in their county• Privacy policy obtains permission to send the information to the Facilitated Enroller
• User selects Facilitated Enroller in their county• Privacy policy obtains permission to send the information to the Facilitated Enroller
www.EnrollNY.org
• User can stop at this point• An option to FastTrack their application captures most other Access NY application information
• User can stop at this point• An option to FastTrack their application captures most other Access NY application information
www.EnrollNY.org
• FastTrack allows entry of additional information for each household member
• FastTrack allows entry of additional information for each household member
www.EnrollNY.org
• Users start applications online• They get connected with a facilitated enroller• The FE can retrieve qualified leads via their online inbox• Leads can be uploaded to FEEA
• Users start applications online• They get connected with a facilitated enroller• The FE can retrieve qualified leads via their online inbox• Leads can be uploaded to FEEA
Future Vision for Enrollment
• Electronic application replaces paper
• Self-service replaces reliance on government and health plan staff
• Statewide solution replaces local district variation
• Electronic transmission and storage replaces trucks and file cabinets
• People get and keep coverage
• And someday, everybody will have health care.
Fixing the Leaky Sieve: Federal and Plan Solutions to Churning
ACAP CEO Summit, July 15, 2009
Georganne Chapin, President & CEO
Hudson Health PlanHudson Center for Health Equity & Quality
Tarrytown, NY