Fixing the Leaky Sieve: Federal and Plan Solutions to Churning ACAP CEO Summit, July 15, 2009 Georganne Chapin, President & CEO Hudson Health Plan Hudson 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: –Sends qualified leads to participating FE’s –Provides on-line access to leads –Lowers cost of enrollment

Quick and easy eligibility calculator

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

Basic lead information is captured including contact information

User selects Facilitated Enroller in their county Privacy policy obtains permission to send the information to the Facilitated Enroller

User can stop at this point An option to FastTrack their application captures most other Access NY application information

FastTrack allows entry of additional information for each household member

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 Plan Hudson Center for Health Equity & Quality Tarrytown, NY