Fixing the Leaky Sieve: Federal and Plan Solutions to Churning ACAP CEO Summit, July 15, 2009 Georganne Chapin, President & CEO Hudson Health Plan Hudson.

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  

[email protected]

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  

[email protected]