Download - 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
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Context and Current Practice
Enrollment Standards
User Experience (UX) Design Project
Vertical and Horizontal Integration
Q & A
Webinar Outline
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States vary…
ACA offers states opportunities
Challenges abound
Context
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We Live in a Digital Society
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Current Practice
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Where Are We Today?
However, not widespread…
Impact of the recession
Best intentions
Significant simplification efforts
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Persistent Barriers
Local control
The welfare institution
Inadequacy of systems
Complexity of rules / silos
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Disclaimer
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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
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Enrollment Standards and Protocols
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§ 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
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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
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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
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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
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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
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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
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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
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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
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Public/Private Partnership
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11 Participating States
Alabama, Arkansas, California, Colorado, Illinois, Massachusetts, Minnesota, Missouri, New York, Oregon, Tennessee
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UX 2014 Design Partner
World-class design, engineering and innovation firm
www.ideo.com
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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
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Design Phases / Timeline
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Research Phase
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Behavioral SegmentationHelps to design a system that is responsive to people’s different needs, desires and expectations.
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Initial System Flows and Wireframes
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Design Workshop
San Francisco, September 12-13
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Multiple Enrollment Channels
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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
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Preliminary Visual Design
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Design Refinement Phase
Further review and user evaluation
Publish comprehensive design specifications
Develop working functional prototype
Develop communications materials for sharing design
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Public Website
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Vertical & HorizontalIntegration
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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…
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Questions & Answers