Building Blocks for Universal Health Care in New York

1

• Building Blocks for Universal Health Care in New
  York
• Electronic Enrollment in Health Care Programs
  Utilizing One-e-App for Healthy San Francisco
• Tangerine Brigham
• Deputy Director of Health, Director of Healthy
  San Francisco
• San Francisco Department of Public Health
• May 8, 2008

2
Impetus for Change and Innovation

• Local ordinance mandated restructuring of
  indigent care health program resulted in
  creation of Healthy San Francisco
• One goal was to reduce barriers to entry and
  streamline fragmented eligibility determination
  and enrollment processes
• Less than a year to implement new program and
  systems

3
One-e-App Overview

• One-e-App (OEA) is a web-based system for
  connecting families with a range of
  publicly-funded health and social service
  programs
• OEA is not an end-user tool requires an
  application assistor
• OEA is licensed by The Center to Promote
  Healthcare Access
• In San Francisco, One-e-App is a shared system
  used by San Francisco Department of Public
  Health, San Francisco Community Clinic
  Consortium, and San Francisco Health Plan

4
San Francisco OEA Business Needs

• Simplified eligibility screening, determination
  and enrollment process for applicants
• Route applications to appropriate programs based
  on family situation
• Common eligibility and enrollment system that
  could be used by public and non-profit safety net
  providers
• Enroll applicants into its local Healthy San
  Francisco (HSF) health access program and serve
  as an enrollment database for the program
• Assign program participants unique identifier
  numbers
• Enable providers to confirm HSF eligibility in an
  inquiry manner

5
Health Programs Imbedded into OEA

• Electronic Applications
• Medi-Cal
• Medi-Cal for children and pregnant women (through
  the Single Point of Entry)
• Healthy Families
• Healthy Kids
• Healthy San Francisco
• Child Health and Disability Prevention Program
  (CHDP)
• Submission to the CHDP Gateway by CHDP
  Providers only.

• Informational Referrals
• Presumptive Eligibility for Pregnant Women
• AIM (Access for Infants and Mothers)
• Family PACT
• Cancer Detection Program
• Breast and Cervical Cancer Treatment Program

6
OEA -- No Wrong Door
DPH General Medicine Clinic
DPH Potrero Hill Health Center
One-e-App System HSF Enrollment Eligibility
Tracking
SF CCC North East Medical Center
SF CCC Mission Neighborhood Health Center
7
One-e-App Process
8
Supporting Technology
Pay enrollment fee (Only FPL gt 100)
Enroll in HSF Program
Make screening appointment
Enrollee Data
HSF Enrollee Data, Eligibility Status
Payment Status
Register for appointment
Patient Eligibility Data
Call Customer Service
Fill prescription
9
(No Transcript)
10
OEA Implementation Timeline
MAY
JUN
JUL
AUG
SEPT
OCT
NOV
DEC
JAN
FEB
MAR
APR
Customization/ Configuration
Phase I Paper Applications for HSF at two debut
clinics Phase II Go Live at 22 enrollment sites
0-100 FPL Phase III 100-300 FPL
Unit/ Interface Testing
User Training
Customization/ Configuration
User Training
Unit/ Interface Testing
Phase II Go Live
Phase II Go Live
Phase III Go Live
11
Intersection between Policy and Technology

• Pushing technology to achieve policy end
• Developed comprehensive set of eligibility rules
  and processes
• Process increases linkage of uninsured to
  existing coverage programs, prioritizing
  insurance enrollment
• Aligns with policy goal of improved customer
  service via single application process for
  multiple programs

12
OEA Administrative Efficiencies

• No formal Return on Investment analysis
• Can result in additional and a different type of
  work for staff assisting clients through the
  application process
• Administrative efficiencies include
• Integrated electronic system of record for new
  programs
• Smoother enrollment process for applicants
• Improved reporting capacity
• Data and documentation stored centrally
• Smoother program renewal process
• Assignment of unique identifier to track patients
  at multiple organizations

13
Outcomes - ApplicationsOver 22,000 submitted lt 1
year

• Note Figures reflect number of signed apps for
  Healthy Kids, Adult Medi-Cal, HSF and number of
  applications preliminary eligible for Medi-Cal
  for Children and Pregnant Women, CHDP, Healthy
  Families

14
Looking Forward

• Electronic interface with San Franciscos Human
  Services Agency
• Input State vital records data (birth for
  citizenship status) into OEA
• Implementation of a shortened application for
  special populations (e.g., homeless)
• Explore feasibility of expanding OEA enrollment
  to non-clinical community entities and settings

15
Lessons Learned

• Clearly define program needs designing program
  and developing technology simultaneously creates
  in inefficiencies
• Phase implementation pilot and get the kinks
  out
• High level of resources extensive level of
  resources pre/post implementation, particularly
  in the area of data mining and tracking/correcting
  system glitches
• Linking programs is complicated more interfaces
  ? more complex systems ? more opportunities for
  system regression ? more testing and retesting
  required
• Doing more than installing a new IT system
  significant training, retraining and refresher
  sessions are needed for staff to get them
  familiar with an entirely new system