Online Enrollment (Easy as 1-2-3) Oklahoma Health Care Authority.
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Online Enrollment (Easy as 1-2- 3) www.mySoonerCare.org Oklahoma Health Care Authority
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Transcript of Online Enrollment (Easy as 1-2-3) Oklahoma Health Care Authority.
Online Enrollment
(Easy as 1-2-3)www.mySoonerCare.org
Oklahoma Health Care Authority
What’s In a Name?
What Is Online Enrollment?ComprehensiveWeb App For
For State Sponsored
MedicalPrograms
Real-time Eligibility,
Enrollment, and ID
Generation
SoonerCare
Concept submitted to CMS in summer of 2007. Work began after approval December 2007 Launched: Sept. 7, 2010 - www.MySoonercare.org
Streamlines Policy,
Processes, and Access to Services
• Over 500,000 Non-Insured Oklahomans
• 22% Of Uninsured Live In Rural Areas- Limited access to OKDHS offices
• Oklahomans Are Unsure If They Qualify- It’s Healthcare, Not Welfare- Private, real-time determination available 24/7
• Enrollment Process is Broken- Dependency upon Legacy Mainframe- Client Numbering - Streamline enrollment and verification- Intuitive application with editing controls
Why Did We Do It?
What Were the Goals?
Empower and Equip the Members
Expand Enrollment to Service Locations
Develop Multiple Program Application
Remove Barriers that Prevent Enrollment
Increase Effectiveness/Efficiency of Process
Was State Policy Affected?
Date Specific Eligibility
Rolling Redetermination
Changing the Way We Do Business
Medical Home at Application
PaperApplication
Home View
Agency View
Applying at Home Computeror Community Partner
Applying at Agency Partner
Completing Paper FormMail to HP For Scanning
Why No Wrong Door?
Notification of DOS NODOS App
Behavioral Health DMH App
Newborn Registration e-NB-1 App
Agency Electronic
Comprehensive Applicant at Welfare Office
Who was Affected?
• Initial Phase Children, Pregnancy, Families Family Planning waiver Behavioral Health Services
• Phase II Insure Oklahoma (Premium Asst) Oklahoma Cares (BCC) Women, Infants, & Children
Nutrition• Phase II.5
Affordable Care Act
Where To Start?
Other Programs
Call Center
Data Exchange
Unique ID
PCP ChoiceRules Engine
Letters Notices
Partners
Verifications
Real-time Enrollment
Date Specific
Rolling Reviews
Appeals Security
Adding Newborns
PERM/MEQC
Paper Mailed
Home View
Agency View
RealTime
LettersID Cards
MMISRecipient
Ru
les En
gin
e
Yes
Reason/ MemberNo
DenialLetter
Mem
ber ID
A
ssign
ed
Scan-Data Entry
OKDHS NON-OE (ABD)
Simplification Is Not Simple
OKDHS Agency Electronic
ID #
NODOS
E-NB1
MM
IS E
ligib
ility S
ub
systemBH App
What About Verifications?
SSN
Agency PartnersPregnancy
Social Security Administration
Income
CitizenshipOSDH, Electronic Verification of
Vital Events, Systematic AlienVerification for Entitlements
OK Employment Securities Commission (OESC)
Manual Verifications
Coversheet
Due Date ATN Name
Case #
Mailed
HP
Scanned to Workflow
Entered into System By Call Center Rep
(From Website)
How Does One Apply?
PaperApplication
Home View
Agency View
Applying at Home Computeror Community Partner
Applying at Agency Partner
Completing Paper FormMail to HP For Scanning
Comprehensive ApplicantPresents at County Office
Agency Electronic
Programs AffectedWhat is NeededFAQ’sIncome Guidelines
SoonerCareSoonerPlan
Review BenefitsCheck StatusUpdate Information
Tell Me More
Apply Now
Manage Account
At-Home & Community Partner Options
PregnancyCitizenshipIdentity
Certification EndingDomestic Violence
Review BenefitsCheck StatusUpdate Information
View/UpdateVerifications
Eligibility Alerts
Manage Member
Agency Partner Options
Search & Submit SoonerCareSoonerPlan
Mail Paper To HP
Scan and Data Entry
Rules Engine
Paper Application
Letter-Notices-ID
Agency Electronic OKDHS Interface
HTML
Ru
les E
ng
ine
DHS Mainframe
Eligible?
Update Recipient
Welcome Letter
Yes
NoDenial Reason
Approval
Processing Continues
for Additional Benefits
Data Gathered
Ru
les E
ng
ine
Electronic Notification of DOS
NODOS
ID #
Application
Patient on App?
Yes
NoCertify For Date of App
15 days NODOS?
Certify For Date of
NODOS –5 days
No Yes
What Got Better?
NEW WAY
Real Time Eligibility
Policy Uniformly Applied
Medical Home - Enrollment
Streamline Business Process
Normalized data
Apply 24hrs/7daysAvailable: M/F, 8am-5pm
20-30 Days For Results
Individual Policy Interpret
No Primary Care Provider
Process Differs By County
Imprecise data
OLD WAY
Yeah…We’re Kickin’ Apps & Takin’ Names
Opened/Extended 196,597
New Application 108,795 Recertification 87,802
Denied 35,930
New Application 33,805 Recertification 2,125
April – September 2011
232,527 Applications Received
Source Average (6 months) April – September 2011
Source Trend (6 months) April – September 2011
Blizzard In Oklahoma
Application Status Feb 1st Feb 2nd Total Denied 33 29 62 Opened 198 239 437 Total 231 268 499Health Program New Apps Recert Total STBS 4 0 4 SoonerCare 354 378 732 SoonerPlan 32 12 44 Total 390 390 780
HOME INTERNET
87% Agency Electronic 10%
Agency Internet 3%
“The Days the State Stood Still”
THE DAYS THE STATE STOOD STILL
OE Enrolls 780 in SoonerCare with Virtually
Every County Office in the State Closed! (Or Did It?)
February 3, 2011
Blizzard in Oklahoma!
Governor Fallin declares
Online Enrollment Days!
Be Careful What You Wish For
• eMPI – Client Numbering and Normalization
• Confusion – Applicants/Members/Partners/Co-workers
• Human Services – County Coordination is Imperative
• Call Centers – Staff Up!
• Organization – Enrollment Operation Structure
• Automation – Data Driven System (the good, the bad & the ugly)
• Conversion – Auto-populate what you don’t have
• Compatibility – Browsers and Pop-up Blockers
• Staffing – You’re going to need some experts!
• Design Outside Box – Generic Family & Optional Denial Letter
We Got Some Phone Calls
May-10Jun-10 Jul-10 Aug-10Sep-10Oct-10 Nov-10Dec-10 Jan-11 Feb-11Mar-11 Apr-11May-11Jun-11 Jul-11 Aug-11Sep-110
20000
40000
60000
80000
37460 42616 39452 47167 49682 51282 49203 50401 5143840078
61951 58635 59100 61177 5921970716
62678
1268 1018 1588 7635508
1902825667
1759121954
793116683
45148519 7810 6153 9420
4033
SoonerCare Calls -- Answered v Abandoned
Calls Answered Calls Abandoned
May-10 Jun-10 Jul-10 Aug-10Sep-10 Oct-10 Nov-10Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11Sep-110
100
200
300
400
SoonerCare Calls -- Answer SpeedIn Seconds
Online Enrollment -- Answer Rates
Sep-10 Oct-10 Nov-10Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11Sep-114000%
5000%
6000%
7000%
8000%
9000%
10000%
7690.0%
6320.0%
5140.0%
5890.0%
9130.0%9470.0%
7850.0%
9240.0%
8706.0%8848.0%
9037.0%8786.0%
9359.0%
Online Enrollment Calls -- Answer Rate
Online Enrollment Effect on Total Calls
30000
40000
50000
60000
70000
80000
90000
38728
4363441040
47930
55190
70310
74870
67992
73392
48009
78634
63149
676196898765372
80136
66711
Telephone Calls Total
Where Do We Go From Here?
• Phase II – Additional Populations Insure Oklahoma (Premium Asst) Oklahoma Cares (BCC) WIC
• Phase III - Health Insurance Exchange Affordable Care Act
Partnership with Insurance & Health Department
Rules Engine Modifications
• Phase IV – Enrollment Data Exchanges Other Agencies and Programs
Future – Gather and Verify Data, Rules
Gather Family Demographics
Future – Apply Rules, Evaluate, Enroll
Ru
les En
gin
e
Clien
tN
um
berin
g
Real-time Decision
and Enroll
Real-time Decision
and Enroll
Future – Enroll, Distribute
Real-time Decision
and Enroll
Real-time Decision
and Enroll
Native American
Tribes
Community Partners
State DeptOf Health
OKDHS
RecipientDatabase
InsuranceExchange
Did We Learn Any Lessons?
• It Really Does Take a Village Build Partnerships Keep Them Alive
• Design Tool – HP Wireframe Focus Groups/Application Flow
• A Variety of Approaches Are Critical
• Like “Esurance”, technology when you want it… people when you don’t.
As A Matter of Fact…We Did!
