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Meeting the October Affordable Care Act deadline can ignite new opportunities to achieve integrated service delivery.
It may feel like time to take a breather after the first challenging enrollment for the Affordable Care Act (ACA), but the clock is clicking on an important opportunity for states. Agencies need to take action now to access enhanced federal funding for client-centric integrated service delivery. State agencies only have until December 2015 to put their 90/10 dollars to work.
States have invested more than $4 billion in technology systems to meet the Affordable Care Act mandate.1 That expenditure is significant, and so are the opportunities to extend Medicaid funding to improve outcomes and drive efficiency across other programs that benefit individuals and families.
This short paper outlines three of the ways in which agencies can leverage mandated functions and capabilities into enterprise-level improvements.
Download the full point of view piece for more detail on actions to take toward integrated service delivery. [PDF, 1 488 KB]
1 The Henry J. Kaiser Family Foundation – State Health Facts – Total Health Insurance Exchange Grants - http://kff.org/health-reform/state-indicator/total-exchange-grants/
You offer self-service options for ACA, now maximize automated processes to create capacity and optimize operations. States have established online portals for citizens to manage their benefits through self-service. There are no limitations on how far you can take self-service functions. According to Accenture research, no-touch processing could increase capacity by at least 37 percent.
Offering innovative self-service options increases performance for the agency and optimizes casework activities. For example, mobile phones are increasingly becoming the “device of choice” for many families. Consider new ways to engage clients through mobile access. Send pre-populated forms and ask clients to update their information. Not only does this ensure more timely and accurate information, it eliminates the need for a caseworker to update, scan and validate the information.
States already are achieving results. Idaho has used no-touch processes to go from manually handling 5,000 redeterminations per month, to 200-300—a more than 90 percent reduction in manual effort.
Read more about recommendations when you download the full point of view. [PDF, 1 488 KB]
You’ve integrated your infrastructure for ACA, now use it to run analytics. The Centers for Medicare and Medicaid Services (CMS) Seven Conditions and Standards2 support the development and funding of robust data management. States can use this funding to prevent loss and minimize risk of improper payments.
According to Accenture research, between two and 15 percent of healthcare spend can be attributed to fraud and non-compliance. Medical billing fraud, such as services not rendered, different services/product delivered and other billing schemes cost states millions each year. Embedding analytics into control activities can both prevent fraud and improve investigations by more than 40 percent.
Analytics can also support improved service management, identifying opportunities to improve care quality, reduce risk and lessen cost within defined category groups. States can make adjustments to care management in response to the trends. Published studies show that coordinated care can reduce cost associated with caseloads by 60 percent.
2 Department of Health and Human Services, Centers for Medicare & Medicaid Services, “Enhanced Funding Requirements: Seven Conditions and Standards,” http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/Downloads/EFR-Seven-Conditions-and-Standards.pdf [PDF, 186 KB]
You’ve integrated your data for ACA, now use it to drive customer-centricity across programs. States have spent money integrating data from across programs. With drivers’ licenses and verification records, you can get creative about how to use a single client view to enable a higher level of support and coordination. By automating certain interfaces, states can leverage the data they have to run verifications based on up-to-the minute information. For example, the C-IV System used by 13,000 staff in 39 California counties to determine eligibility, issue benefits and manage caseloads has captured more than $75 million in uncollected payments through its automated tax intercept interface.
In New York City, the HHS-Connect program links more than 10 health and human service agencies, helping to serve more than 2.5 million city residents. HHS-Connect is increasing accessibility of information, improving accountability, and utilizing modern and flexible technology. The overall client experience is improved and worker effectiveness is optimized.
Connect with us to learn more on delivering public service for the future on Twitter @AccenturePubSvc.
December 23, 2013
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