Health Plus FEEA Implementation

1
Health Plus FEEA Implementation

• Presented By
• Charles Ottomanelli
• Health Plus
• Chief Information Officer

2
Health Plus

• Health Plus is a not-for-profit health care plan
  established in 1984 located in Brooklyn, NY and
  licensed to operate in all five NYC boroughs and
  Nassau County
• Medicaid, FHP and CHP
• Enrollment at 270,000

3
A Little history lesson

• Started at Health Plus in August of 2006
• Prior to Health Plus I was VP of Software
  Development at another Health Plan
• October 27, 2004 I attended meeting hosted by
  United Hospital Fund.
• Using IT to Improve Public Enrollment In New
  York City Health Plan Roundtable
• Meeting was attended by Health Plus, Affinity,
  Healthfirst, HIP, Hudson Health, PHSP Coalition,
  American Express TBS, United Hospital fund.

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Agenda and Topics

• Bringing Simplification and IT innovation to NYs
  public health insurance programs
• Potential impacts of EDITS on Medicaid
  applications in New York City
• Health Plan IT Initiatives related to enrollment
  in public coverage
• Potential for collaboration on IT enrollment
  initiatives.

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What is EDITS?

• Eligibility Data and Image Transfer System
• EDITS will replace the current paper flow between
  providers and the Medical Assistance Program
  (MAP) with electronic transfer of data, images
  and eligibility determinations.
• Instead of sending hard-copy application
  packages, the healthcare providers electronically
  transmit (in approved formats) data streams of
  application information and images of
  verification documents.

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EDITS contd

• EDITS will receive, track, and manage Medicaid
  applications and images throughout the
  application process, while integrated with the
  State of New Yorks Welfare Management System
  (WMS).
• Participating providers will receive an immediate
  acknowledgement for each application received
  with the pass/fail indicator and an explanation,
  along with a timely electronic return of the
  eligibility response information.
• The time consuming and error prone dependency on
  the cumbersome paper process will be eliminated.
• EDITS now (Sept. 2004) ready for user testing!

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E-application

• American Express Tax Business Services (Amex)
  conducted a study of an e-application for
  Lutheran Medical Center Sunset Park Family Health
  Center Network that involved the participation of
  multiple health plans, city and state agencies
  and community based organizations
• A conceptual design included a web-based front
  end process, application submission and tracking,
  recertification and reporting as well as a
  central data store for use by all health plans.
• E-application Development Collaboration?????

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What happened next?

• Each plan went back and developed their own
  E-application.
• No plan reached the Test Phase with EDITS???

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Jump ahead 4 years

• Started at Health Plus and assumed enrollment
  scanning/automation project at Health Plus
• Two solutions on the table
• Scanning and workflow solution
• Facilitated Enrollment Electronic Application
  (FEEA)

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Why Health Plus was looking to Automate the
Application Process

• Reduce or eliminate paper
• Simplify the Enrollment process and reduce the
  amount of time it takes to complete the
  application process
• Remove Redundancy from data entry process
• Reduce or eliminate calculation errors
• Reduce application processing time
• Increase accuracy of applications
• Reduce or eliminate Quality returns
• Increase Employee and Enrollee/Member satisfaction

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We picked FEEA

• FEEA Facilitated Enrollment Electronic
  Application
• Hudson Health Plan (HHP) is a not-for-profit
  managed care organization that serves the health
  care needs of low-income individuals and families
  in six counties in the Hudson Valley.
• HHP realized that information technology was the
  key to improving the FE process and in 2000 began
  the development of The Facilitated Enrollment
  Electronic Application (FEEA). FEEA is a software
  application that was designed by HHP using funds
  from a federal Healthy Community Action Program
  (HCAP) grant.

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FEEA

• FEEAs primary purpose is to automate the
  eligibility verification, enrollment, and
  recertification processes for subsidized managed
  care programs in New York State.
• HHPs distributes FEEA through the Hudson Center
  for Health Equity and Quality (Hcheq), a division
  of HHP

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EDITS

• We negotiated our contract with Hcheq and during
  the negotiations interfacing with EDITS came up.
• Wouldnt it be great if FEEA interfaced with
  EDITS?...
• Hcheq agreed to include it in the implementation.
• We were off!

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FEEA at Health Plus

• Project started in 3rd Quarter 2007
• Health Plus
• ITS
• Enrollment
• Sales/Marketing
• Retention
• Regulatory
• Training
• Hudson Health Plan Hcheq
• HRA

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Milestones

• Install FEEA and Configure
• FEEA was rolled out to one of the Health Plus
  satellite sales locations in 4th Quarter 2007.
• Interface FEEA with existing Health plus systems
• The interface between FEEA and the existing
  Health Plus enrollment system is targeted to be
  completed in 2nd Quarter 2008.
• Develop EDITS interface
• The EDITS interface is currently being tested at
  Health Plus and the hope it to be certified as an
  electronic submitter by the end of 2nd Quarter
  2008.
• FEEA Training of Sales, Enrollment and Retention
  Departments
• 130 staff members have been trained to use FEEA.
• Roll FEEA out to Sales Staff (Out in field and at
  Satellite locations)
• Starting in 2nd Quarter 2008, FEEA is being
  rolled out to the remaining satellite sales
  offices (desktop users).
• The next phase is to roll out FEEA to the Health
  Plus field reps utilizing wireless technology
  (laptop users).

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Challenges

• Modifications were needed to both the FEEA
  application and the interface to accommodate the
  needs of Health Plus and NYC requirements
• Knowledge transfer from Hcheq to Health Plus
• Implementing FEEA into a larger health plan.
  Changing habits and established processes.
• Coordinating information exchange between Health
  Plus, Hcheq and HRA

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Challenges contd

• EDITS
• Meeting HRA guidelines and regulations
• Hcheqs interface between FEEA and EDITS
  underwent intense testing with HRA.
• Any regulation changes made by HRA must be
  reflected in the FEEA / EDITS interface.
• Additional inputs had to be added to FEEA to
  accommodate NYC and WMS data requirements
  (PRUCOL, Alien ID, Document Type)
• Communication The initial process was for Hcheq
  to read the file spec and submit accordingly.
  This put us in a submit and fix loop that was
  time consuming. Once telephone and e-mail
  communications with the HRA team were opened we
  were able to move things faster and with better
  results.
• Document types Mapping EDITS document
  categories and types to FEEA document categories
  was difficult. There are over 3000 document
  types in the list HRA sent us. They continue to
  represent a challenge to FEEA users.
• Codes WMS has quite a few lists of codes that
  had to be mapped to FEEA codes (income types for
  example). The matches are not always clear.
• Sending applicant-only data but documentation
  (images) for most persons on an application.
  Certain CHP documentation is not sent to HRA but
  family income and resource documentation are
  (even for CHP B persons). This required
  extensive programming logic.
• Some of the field rules were NYC specific. Hcheq
  is not a NYC plan so some things were not
  immediately clear to Hcheq.

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Application Process with FEEA and EDITS
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Feedback and Statistics from Beta group at 48th
Street

• FEEA is projected to reduce Enroller application
  processing time by about 40 per application.
• Currently handwritten applications that are sent
  to HRA take 60 to 90 days to turnaround after
  receipt by HRA.
• In a sample of 150 applications entered into FEEA
  these applications were processed by HRA within
  20 days of receipt and the applicants became
  members the following month.
• Once we are live with EDITS the turnaround time
  should get shorter.
• Positive feedback from trained staff
• I cant wait to use it.

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Current and Next Steps

• Currently Health Plus will start EDITS testing
  within weekson our way to EDITS Certification
• We are already live with FEEA at one site. Next
  steps are to deploy FEEA to all Health Plus
  sites, go live with the EDITS Interface and
  Health Plus systems interfaces
• Full integration with Health Plus systems and
  EDITS should occur by beginning of 3rd Quarter
  2008
• Once FEEA is live in all locations we will roll
  out to Field Staff using Laptops and Wireless
  Technology.