DHHS Adopts Strategic Vision for Eligibility Processing
By David Blocher, OIT
The Department of Health and Human Services (DHHS) recently adopted a common Vision Statement for Eligibility Processing to guide future systems development among its many state assistance programs. The purpose of this effort was to paint a high level “to-be” picture of how the department would like to operate in the future as a way to help improve service access to clients and enable data and functions to be shared across many departmental assistance programs. This strategic planning tool worked well and is likely to be used in future long-range planning efforts.
DHHS formed an Applications Governance Team in late 2007 to begin investigating ways to improve services to clients, leverage money spent on application development, and reduce the on-going costs of operations. Just as they were getting started, a major project to out-source the operation of Medicaid claims processing was awarded to a fiscal agent, Unisys Corporation. This called for a clear separation of eligibility determination functions that will be staying with DHHS from benefits determination and claims processing that will be performed by Unisys using their own off-site computer applications.
The Applications Governance Team commissioned a team of business and technology experts to come up with a definition of “eligibility determination” and a vision statement that would describe what is needed to support future business processes including the outsourcing of Medicaid claims processing.
The team met four times in February and March. Significant effort was devoted to developing a common understanding and definition of the term “eligibility determination”. Given the diversity of programs in DHHS, “eligibility” had taken on multiple meanings over the years and staff currently uses the same words to describe differing processes. Simultaneous with the definition effort, the team began high level descriptions of the business processes that would support eligibility determination in the future. These include using a client-centered intake process that shares information collected among multiple assistance programs, defining a common hierarchy of terms and processes consisting of “eligibility determination criteria”, “eligibility determination factors” and “eligibility determination results” and creating a common repository of the eligibility determination results that can serve as an authoritative historical record of client eligibility across programs and time.
The resulting Vision Statement is currently being used as a direction-setting document to guide detailed planning for the partitioning of business functions between the DHHS and the fiscal agent and the eventual retirement of a legacy mainframe application called WELFRE. It is also being shared with other strategic planning teams in DHHS, including the Executive Leadership Team, the Fiscal Agent Governance Team, the Systems Transformation Grant Team, and the LEAN Team who are working on business process improvements for the department.