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The Affordable Care Act (ACA) is expected to make health coverage available to an estimated 32 million people nationwide and to enable consumers to be screened simultaneously for private coverage as well as Medicaid, CHIP and tax-based subsidies. To accomplish this, the federal government and some of the states have been justifiably focused on standing up operational Health Insurance Exchanges working against near impossible deadlines.
Exchanges will have many moving parts – all of which must come together to create an integrated online marketplace for shopping for and purchasing health coverage. The implementation of Health Insurance Exchanges represents promising movement toward streamlining access to health coverage. However, there are important services and programs which arguably impact the health and well-being of families that are not making their way into the Exchange mix.
As states and the federal government work through the planning, design and development of the health coverage components of the Exchange, they may be missing an important opportunity to expand the Exchange to include access to other critical support programs such as SNAP (Supplemental Nutrition Access Program, formerly known as Food Stamps) and cash assistance (known as TANF) that contribute greatly to the overall health and well-being of families in need.
If there were ever a time to focus attention on the efficiencies of the screening and enrollment process for low-income families into a variety of public benefits, now is the time. In 2010, 46.9 million people were living in poverty, up from 37.3 million in 2007 -- the fourth consecutive annual increase in the number of people in poverty, according to statistics from Feeding America. The 2010 data (the most current available), also shows that 48.8 million Americans lived in food insecure households; 32.6 million adults and 16.2 million children . The economic crisis has worsened since this data was made available, meaning these numbers are likely much higher today.
IT systems play a critical role in streamlining eligibility across public benefit programs. As states retrofit and build systems to handle the eligibility and enrollment requirements for Exchanges, they must consider broader enrollment reform. By removing the ‘silo phenomenon,’ which currently requires consumers to apply for each individual program or service through a different process or system, states can provide low-income individuals and families streamlined access to all services available while at the same time achieving greater administrative efficiencies for government.
Unfortunately, while states have been busy designing their Exchanges to address health care reform, human services agencies in most states have not been engaged in the process. Without this connection, low-income families will miss out on opportunities to secure needed services such as food stamps, child care, housing assistance and other supports for which they are eligible. When access to health coverage is administered using IT system silos, we miss opportunities to address the socio-economic needs of the nation’s most underserved population.
This is an opportune time to address this pressing issue. In August 2011, federal agencies issued guidance indicating that funding available to states for Exchanges could also be used to enhance and improve computer systems and applications that are used by both health care programs and other programs. In other words, states now have resources to establish horizontal eligibility and enrollment systems that cut across programs, thereby removing the silo phenomenon. A follow up letter issued by the same Federal agencies in January 2012 reiterated the availability of funds for this purpose.
One of the key tenets of ACA was to create a health care buying experience that is consumer-moderated. Think about the things consumers do online – banking, buying, registering, applying, shopping, shipping, tracking, blogging – all without leaving their chair. If you are buying an airline ticket and you want to rent a car, the airline websites make it easy to do so – all from the same system. Health care should be no different. We as a nation now have the opportunity to bring such efficiencies into the realm of health care. It is time to replace the highly inefficient systems currently in place. We now have the opportunity to enable low-income families, struggling in a relentless economic crisis, to find help when they need it.
This approach will improve the consumer experience, decrease administrative costs by removing duplication and manual processes, and ultimately ensure people who are eligible receive all the needed services for which they qualify. Only by modernizing eligibility and enrollment systems across the full scope of support programs will we be able to fully address the needs of the nation’s most vulnerable.
Claudia Page leads policy, advocacy, and strategic operational activities at Social Interest Solutions. For over 20 years, Ms. Page has worked to improve public health and to reform health care access on both the operational and policy fronts. Ms. Page has authored language in both federal and state legislation, including Section 1561 of the Affordable Care Act.