the healthmatch project (insert conf. name & date)
TRANSCRIPT
The HealthMatch Project
(Insert Conf. Name & Date)
Agenda
Discuss HealthMatch business cases Explain HealthMatch system goals Discuss potential changes to business processes Provide project status update Present HealthMatch timeline Get a sneak peak at HealthMatch screens Preview county implementation plans Review the changes that clients may see
Why HealthMatch?
Present systems not originally designed to automate health care eligibility MinnesotaCare was never automated Manual interfaces result in gaps in coverage and
uncompensated care costs More than 100 health care eligibility types,
complex policies and processes lead to: Administrative inefficiency Increased eligibility error rates
HealthMatch System Goals
Improve customer service: Automate eligibility determinations, allowing staff
to focus more attention on clients’ needs Provide more options to consumers, allowing them
to determine the best way to access services Increase efficiency:
Control administrative costs Standardize major processes Improve speed and accuracy via uniform
determinations Improve health care program integrity:
Reduce eligibility error rates
HealthMatch Will Support Multiple Business Processes
Technology is just a tool HealthMatch will provide flexibility to support
unique needs across the state County and partner staff have provided valuable
input into system design and process improvements
Gaps and loss of coverage
Processing delays
Best benefit set at lowest cost Expedited enrollment
Today Tomorrow
HealthMatch
One Program Minnesota Health Care
Program (MHCP)
Three Programs MA, MinnesotaCare,
GAMC
HealthMatch Status
Workflow design is complete. Construction and testing are under way.
Notice design is complete. Construction has begun.
Client Partner Website design is complete. Construction has started.
Alerts design is nearly complete.
HealthMatch Status
Work on most complex designs continues Rules for eligibility engine
Nearly 15,000 rules identified Interfaces
External & internal interface designs are being worked on
Conversion 80% data mapping of MMIS/MAXIS completed
Counties participating in data clean-up continues
Continued
HealthMatch Project Review
Comprehensive project review in April and May lead to timeline adjustment Complexity of Minnesota’s health care programs Inclusion of elderly and disabled programs Added time for beta test and implementation support
HealthMatch Timeline
02/01/07 - 11/30/07Statewide Implementation
08/01/06 -09/25/06
Beta Testing
01/01/2006 01/01/200705/15/2005 11/30/2007
11/07/03- 03/31/06System Design
09/13/04 - 03/13/06Eligibility Rules - Design & Construction
11/10/04 - 11/10/05Interfaces Design
09/01/04 - 03/10/06HealthMatch System Construction
01/03/05 - 03/30/06MMIS Legacy System Construction
10/13/04 - 05/08/06Integration Testing
06/01/04 - 06/22/06Conversion Design & Construction
05/01/04 - 05/08/06UAT Preparation
05/08/06 - 09/25/06User Acceptance Test
09/01/04 - 06/30/05Client/Partner Website Design
11/07/03 - 08/30/05All Other Designs
2005 2006 2007
10/2/06 -12/31/06
PilotImplementation
System Features
Goes beyond eligibility determination to include: Accounts receivable functionality Internal and external interfaces
System designed with workers’ needs to include: Screen navigation Point and click Drop down menus Online help Workflow
System Features
Public website provides access to information for clients, advocates, and business partners Apply and renew online View eligibility statuses, notices, obligations, etc. Pay premiums
Continued
HealthMatch Eligibility Engine
Goals are to: Consistently apply policy statewide Rapidly calculate results based on data provided Determine information and verification needed Automate mailings of notices, forms, and
verification requests to clients
Public Web Site Features
Information and referral Questions-based application Self-service web site
Eligibility pre-screening tool Electronic payment of obligations Health plan selection Completion of renewals
English and Spanish languages
New client applying online
MHCP Member Viewing Information Online
Note:
Each client’s main menu will only include options that apply to them.
Data Cleanup
Identify data elements that may impact the conversion of a case into HealthMatch
Develop strategies for resolving discrepant data Report discrepant data for resolution Provide effective support during data cleanup Reduce discrepant data prior to HealthMatch
conversion
Data Cleanup Update
0
100
200
300
400
500
600
Privileged Cases Needing MAXIS Coding
Sep-04
Mar-05
May-05
Jun-05
Jul-05
Aug-05
0
10
20
30
40
50
60
70
80
90
PMIs with MAXIS Immigration Code Discrepancies
Nov-04
Dec-04
Jan-05
Feb-05
Mar-05
Apr-05
Aug-05
0
10
20
30
40
50
60
70
80
90
MAXIS Cases Missing Required Review Dates
Nov-04
Dec-04
Dec-04
Jan-05
Feb-05
Mar-05
Apr-05
Aug-05
0
5000
10000
15000
20000
25000
30000
35000
PMIs with Major Program or Eligibility TypeDiscrepancies
Mar-05
Apr-05
May-05
Jun-05
Jul-05
Aug-05
Internal Interfaces MMIS
Recipient subsystem Managed Care TPL
MAXIS PRISM SMI EDMS IVR DataWarehouse
External Interfaces SVES BENDEX BEER COLA DEED IRS
Interface Challenges and Goals
Reduce duplicate entry across systems while allowing each system to function efficiently and effectively on its own; and
Automate as much functionality as possible in the initial rollout and still meet development timelines and budgets
HealthMatch Implementation Training
Training will consists of two parts: Part I: Online course
An introductory course to the HealthMatch system
Part II: Classroom course A hands-on course offering practical
case scenarios and system entries
Online User Guide will be available
Introduction toHealthMatch Online
Online course: Is designed for self-pace learning Contains eight modules Provides an introductory lesson to
portlets, screen layout and system navigation
Is a prerequisite to classroom training
HealthMatch Classroom Training
Provides two days of practical, hands-on learning experience
Scheduled at the regional lab sites Offers separate training for workers and
support staff Offers specialized LTC training
HealthMatch User Guides
User Guide for workers Provides screen navigational tips Contains step-by-step system entry procedures for
common situations Will be available to workers after completion of
system training User Guide for managers
Contains reports, statistics, and daily administration procedures
HealthMatch Conversion
Conversion will occur at renewal Reports will be run for cases exempt from six-
month renewals Manual data conversions will occur Processes are being defined for conversion of
pending, denied, closed, withdrawn, and reinstated cases
Clean cases ― clean conversion!
Household-based, rather than person-based One notice per household Sent to one designated adult family member
Simple, easier to read and understand Written at 7th grade reading level or lower
Client NoticesContinued
Household Information Summary Family’s data, income, assets, insurance, etc.
Benefit Package Summary Each enrollee will have a benefit package type,
A – P A = covered services under the Medical Assistance
Program Health care services covered, co-pays, limits, and
access services information, if applicable
Client NoticesContinued
Types of Notices Combined
Pending, approval, denial, suspensions, closures FYI/informational
Change Change in benefits, spenddowns, or premiums
Client NoticesContinued
Freeform Workers write the message
Pre-selection of text that is already written Translated
Worker Memos
Renewals
Redesigned to be a pre-populated Renewal Form Enrollees must:
Review data on form Update data and add new information Sign, date and return form
For More Information
Julie Skoy, Health Care Eligibility & Access Supervisor
651.297.4344
[email protected] Cristy Hong, HealthMatch Information Manager
612.772.6033