In January 2010, at the White House Forum on Modernizing Government, President Obama noted that, “Improving the technology our government uses isn’t about having the fanciest bells and whistles on our websites – it’s about how we use the American people’s hard-earned tax dollars to make government work better for them.” Now, six months later, the newly formed Enrollment Workgroup of the Health IT Policy and Standards Committees has begun the discussion of how to bring eligibility determination and enrollment in health and human services programs into the 21st century.
What we critically need—and what these standards have the promise to support—is an eligibility and enrollment system that will make applying for health insurance and other human service programs as easy as using the Internet to pay your bills or file your income taxes. It should be possible to apply for programs online, easily obtain the documents and information needed to confirm eligibility, and re-use this information to apply for a variety of programs, and re-certify your eligibility when the time comes. We need your help to uncover the examples, insights and best practices that will make this effort successful.
As background, the Enrollment Workgroup, authorized by the Affordable Care Act (ACA), has been tasked to recommend a set of standards to facilitate enrollment in Federal and state health and human services programs, including standards for:
- Electronic matching across state and Federal data
- Retrieval and submission of electronic documentation for verification
- Re-use of eligibility information
- Capability for individuals to maintain eligibility information online
- Notification of eligibility
To follow up on the June 14th Enrollment Workgroup’s first meeting and public hearing and to elicit further public comment, the FACA Blog is open for comments until July 1st. Comments can be submitted online on the blog website or emailed to: judy.sparrow@hhs.gov (use “enrollment workgroup” in header)
Specifically, the Workgroup would like public comment on:
(1) Federal, state, local or tribal government initiatives to simplify and streamline eligibility and enrollment in health and human services programs.
We would appreciate your insights on:
- How should this work support health reform goals, including simplified and streamlined eligibility?
- What standards are currently being used by state health and human services programs to determine eligibility?
- In what areas would additional standards create clear progress towards the goal of a seamless eligibility system for consumers?
- What standards or technology principles would enable rapid innovation in this space?
You might also describe your efforts, including use of standards and technology to simplify eligibility and enrollment, for:
- Front end check of eligibility/enrollment across multiple programs:
- How do you check eligibility/enrollment across programs at the front end? Which programs are included? Standards used?
- Approach and standards for data linking/matching? Is the matching probabilistic? What level of accuracy is required? Collecting information to determine multiple program eligibility
- What interfaces do you use to obtain electronic verification information? What standards used?
- Consumer entry of eligibility information, what data elements? Consumer authentication?
- What standards are used for messaging?
(2) Alternatively, if you are not in the healthcare sector, how have you solved challenges similar to those found in simplifying and streamlining eligibility and enrollment? In other words, how can we move towards 21st century practices?
- For example, share your perspectives on:
- Opportunity to move towards a web-services model
- Viability of a platform-based or enterprise service approach
- Role of consumer in managing own data
- Where we need standards to accelerate progress and consumer participation
Your responses will help form the agenda for the on-going work of the Enrollment Workgroup, and assist us as we work toward a September 30th deliverable deadline as mandated by ACA.
Thank you for your contribution!
– Aneesh Chopra, Chair, Enrollment Workgroup
– Sam Karp, Co-Chair, Enrollment Workgroup
Tags: Enrollment Workgroup, HIT Policy Committee, HIT Standards Committee
Over a decade ago (well ahead of our time) I was part of a team working on advanced electronic medical records technology that ultimately was acquired by GE Medical Systems. I knew then as I know today the importance of accuracy, transparency, trust, and security in health information. The two things that continue to matter most to people in a digital age: their health and their wealth. And financial services and health informatics are two of the greatest opportunities in an always-on society. Both have powerful implications on our general well being.
Like or Dislike:
5 
2 (+3)
Yes they need to modernize the system, but we are talking about the government. How long will it take and how screwed up will it be before they get it right? But what else can we do? Enjoyed the article.
Like or Dislike:
2 
0 (+2)
I hope they do modernize the system and use open source to do it for the most part. The risks are things like data theft and making fraud a lot more convenient at the same time. Medicare has a 3 percent overhead vs. 30 percent with an insurance company, something has to give. The Internet is so accessible and cheap, this system is really in need of an overhaul.
Like or Dislike:
2 
0 (+2)
As a mother with four preschoolers any move by local and state Government to improve the current enrollment system is fine by me.
Like or Dislike:
2 
0 (+2)
One of the biggest challanges here is going to be timely exchange of data. Working on even a smaller scale I have seen issues with connectively and an ability to synchronize files. There is also going to be an issue of COB across areas. We have found that the rules at the federal level do not always match the rules at the state level.
Like or Dislike:
3 
0 (+3)
Many of the Local, State and Federal agencies have conveniently forgot that our Government was formed for the “Health, Safety and Welfare” of our citizens. Having worked in the Military, DOD and Local government you rarely see this mentioned in government offices today – it is as if we have forgotten the basics of the Constitution and Bill of Rights in only 334 short years.
You are right on track when you say “it’s about how we use the American people’s hard-earned tax dollars to make government work better for them”. Sometimes huge amounts of money are spent on medical initiatives well little or no results.
Openly sharing ideas, formulating an appropriate plan and being accountable are the only way to get everything back into shape.
Is that still possible to achieve in the medical community where we are today?
It is clear that it would be to everyone’s advantage to do as Gregory mentioned and make it an open source platform so that recommendations can be made by individual agencies and then applied across the entire system. There should be a very organized document management, search and retrieval system and users should be allowed (once verified appropriately in person) to go in and modify/update their details. It would also be helpful if the entire system utilized a CRM type of platform so that service could be rated.
Like or Dislike:
3 
0 (+3)
Below I suggest there may be learning from another open source project int he elections and voting space. But first, I want to express to Aneesh and Sam how excited I am to see this work progressing.
Over a decade ago (well ahead of our time) I was part of a team working on advanced electronic medical records technology that ultimately was acquired by GE Medical Systems. I knew then as I know today the importance of accuracy, transparency, trust, and security in health information. The two things that continue to matter most to people in a digital age: their health and their wealth. And financial services and health informatics are two of the greatest opportunities in an always-on society. Both have powerful implications on our general well being.
We witnessed enormous challenges back in the late 90s with regard to enrolling patients in our 98point6 system and Logician EMR. Healthcare records have an interesting challenge: authenticating an individual for enrollment purposes and then ensuring anonymity to enable update of their related health history.
In American public elections we have a very similar challenge: on the on hand we must be able to verify the identity of a citizen for purposes of their registration to vote and check-in to a polling place to cast a ballot. However, once their identity has been confirmed, the system must ensure that it is impossible for that voter (or anyone else) to ever be able to prove how that voter cast their ballot. In other words, the ballot casting must be completely anonymous. This is fairly similar in concept to the health enrollment and health history dichotomy.
I call the Enrollment Workgroup’s attention to the Open Source Digital Voting Foundation’s (http://www.osdv.org) TrustTheVote Project (http://www.trustthevote.org) and its ground breaking work to create a standard voter registration data layer, digital voter registration, and verifiable audit-ready ballot casting services. For a look at the technology framework, please see this diagram: http://bit.ly/c3rNHD
The key: its all open source, and the design philosophies being employed there may have applicability to the efforts of the Enrollment Workgroup. One aspect for certain may be a very important consideration: and that is the open source nature of the TrustTheVote Project. We consider this “critical democracy infrastructure” and imperative to restoring trust in how America votes. Similarly, the infrastructure for healthcare coverage is important enough to consider what must be done to ensure its integrity; that is its accuracy, transparency, trust, and security. It must be transparent to the point of how individuals are enrolled and treated equally, and yet, trustworthy and secure to ensure data this vital is properly privatized. The motivation is simple: the two most important things in life are our health and our wealth. Let’s act accordingly.
Congratulations again, and I hope the Workgroup can find some learning from the critical democracy infrastructure work of the Open Source Digital Voting Foundation.
Like or Dislike:
2 
1 (+1)
As a member of the Oklahoma Department of human services. I can personally testify that these changes are going to benefits many people across our state. It will make available for services for family that are in need of them.
Like or Dislike:
3 
0 (+3)
Thanks Judy. I work in San Jose in California like the above poster and I agree with what Kate wrote.
Like or Dislike:
3 
0 (+3)
Thank you for letting us provide feedback to the Enrollment Workgroup. I also work in Santa Clara county in California and have very similar input and issues as comments earlier by Sabrina Valade.
Agree or Disagree:
4 
0 (+4)