Love it or hate it, the Patient Protection and Affordable Care Act (PPACA) is having a profound impact on the U.S. healthcare system. Of particular interest to me is the impact it is having on the IT landscape of the systems, agencies and governments that are responsible for providing the U.S. with healthcare services.
All U.S. states are mandated to provide both health and human services to their residents. Health services are dominated by Medicaid and Medicare, human services by such benefits as nutritional, cash and living assistance. Some of the existing systems in operation to manage the determination and disbursement of these benefits are over thirty years old. Built before the concept of a Services Oriented Architecture (SOA), without the benefit of enterprise level integration services and in some cases with only minimal technical maintenance support, these systems desperately need to be replaced.
PPACA Beyond Health Insurance Exchanges
It is widely known that the PPACA requires states to implement their own, or link to Federal Health Insurance Exchanges providing a marketplace for residents to shop for insurance programs. What are less publicized are the programs to update, enhance and improve the health, and by extension human services, benefit eligibility and management systems. Medicaid eligibility, enrollment and verification processes are being streamlined. States must comply with the new federal procedures.
Client portals offering the ability for clients to submit one application for multiple benefits; document imaging and workflow management allowing caseworkers to share and streamline processing tasks; data verification with state and federal hubs; and identity management utilizing a master client index are just some of the shared services being built by each state to create an Integrated Eligibility System (IES).
Time is short.
There are three basic facts to comprehend:
- All states must provide health and human services to their residents.
- PPACA mandates changes to the health services that states offer.
- If planned strategically, the changes to the healthcare services infrastructure can be utilized by the human services programs at minimal incremental cost.
The implementation timelines specified in the PPACA are aggressive to the extent that some states may find themselves able only to implement the mandatory aspects of the act. Such states will miss out on the opportunity to avail themselves of federal funding to upgrade their human services IT infrastructure.
SEI is proud to be involved in the strategic planning and replacement projects of some of these systems. Creating and executing implementation programs maximizing the benefit of federal resources while serving local populations efficiently to ensure that the finite financial resources available to benefit end-clients are not consumed creating the very systems that will serve those clients.