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Web-based human services software helps state serve growing needs

The state of Arizona is seeing benefits from the use of web-based software that allows patients to apply for and enroll in government health programs online.

The state of Arizona has used Web-based human services software for several years, but it's been the recent economic downturn that has demonstrated the real value of the system. Instead of waiting in line, residents can apply for such assistance programs as Medicaid and food stamps at home, in the office or at the library. State employees, meanwhile, have an easier time processing those applications and checking for errors. Read more about the benefits of Web-based human services software in this case study.

At the same time the nation's economic woes force more people to apply for federal assistance, state agencies often see their budgets and employee numbers slashed.

The state of Arizona was far from immune to this malaise, but its Web-based human services software is helping the Department of Member Services (DMS) and the Department of Economic Security (DES) cope with the ongoing influx of assistance applications.

The DES manages public assistance, such as food stamps and welfare payments, as well as about 75% of Medicaid determinations, said Linda Skinner, assistant director of the Phoenix-based DMS. In turn, her agency oversees the remaining 25% of Medicaid, long-term eligibility for those with disabilities and the Children’s Health Insurance Program (CHIP). DMS also is responsible for enrollment, she said.

All Arizona residents are thus insured, whether privately or through the state's managed care programs, Skinner said. "We've been demonstrating now, for almost 26 years, that we can do a good job, very cost effectively, by putting them all in managed care plans and overseeing the programs," she said.

One reason the agencies can manage the growing number of people seeking government-funded health care is their adoption of Web-based human services software that cuts administrative chores and paperwork, and speeds up the enrollment process.

One human services software application for all

Health-e-Arizona is based on One-e-App, a Web-based software for human services that connects families to publicly funded health and human service programs.

The California HealthCare Foundation developed One-e-App in the late 1990s and, in conjunction with The California Endowment, funded the development of the core One-e-App technology and created a pilot program in Northern California in 2003. Since its first pilot, more California counties, as well as departments in Arizona and Indiana, have adopted the Web-based human services software, according to The Center to Promote HealthCare Access, the Oakland-based organization now responsible for developing, maintaining and expanding One-e-App.

One-e-App uses an interactive, interview approach to simplify data collection and entry, according to The Center. For example, as Arizona DMS and DES employees enter applicants' data, the software performs routine error checks, delivering real-time notification if information is lacking or incorrectly entered.

"As long as the data doesn't meet some contradictory information, it flows right in. It can save 30 minutes each time," said Skinner.

The Web-based human services software can also toggle between English and Spanish, and allows applicants to select a provider and health plan immediately. Those features make it more cost-effective, efficient and user-friendly, according to the vendor.

Since adopting One-e-App in 2001 and launching Health-e-Arizona in 2002, the state has expanded its use of the system, Skinner said. The program is now used by Medicaid, KidsCare (CHIP), Medicare Cost Sharing, county access programs for low-cost health coverage, food stamps, Temporary Aid to Needy Families, and health center and hospital-based sliding fee programs.

Implementation as a dual initiative

Health-e-Arizona marked the first combined effort by DMS and DES, Skinner said. Previously the two departments used separate software programs, each with its own database. That setup resulted in dual entries, mismatched data and operational inefficiencies.

"It's been a big challenge for us to collaborate. We've always developed our systems separately, and developed what we wanted to do," Skinner said. "Now we have to collaborate. It's a good test of a relationship."

"We've always developed our systems separately, and developed what we wanted to do. Now we have to collaborate. It's a good test of a relationship.

Linda Skinner, assistant director, Arizona Department of Member Services

Arizona's implementation includes two main components -- a public access system and a subscription system. The subscription system, which came first, involves working with local hospitals and clinics to help patients apply for and enroll in government health programs. First launched in 2001 by the El Rio Health Center and Community Health Center Collaborative Ventures Inc., in partnership with DES and the Arizona Health Care Cost Containment System, or AHCCCS, the public access system now includes 47 subscribers and more than 150 locations, Skinner said. The number of subscribers has nearly doubled in three years, she added.

“The people who access the [subscription] service really well have a lot of success in collecting applications and collecting on their bills,” Skinner said. “These organizations are following through on patients' behalf, helping them get on Medicaid, and they then can bill Medicaid rather than charging the consumer a fee for service."

The public access offering, meanwhile, lets residents apply for and enroll in benefit programs wherever they have access to a computer. (According to a survey that enrollees fill out at the end of the online application process, about 75% of online Health-e-Arizona applicants log in from home, 15% access the Web-based human services software from a friend's house, and the remainder use Health-e-Arizona from such locations as work or the public library.)

"People are so grateful that they don't have to stand in line in an eligibility office, which can [take] hours and hours right now," Skinner said. They're filling [applications] out 24 hours a day. They're calling our help line at all times of day and night."

Spreading by word of mouth

Health-e-Arizona applications are growing quickly, without any large marketing push. DMS initially projected 17,000 online Medicaid applicants for 2009, but received 206,738 in the first eight months alone, Skinner said. DES, meanwhile, is receiving 40,000 to 60,000 more applications per month than in previous years, she added.

"We don't advertise it. We're not out hunting for people to apply," Skinner said, because "the growth in our program is costing our state dearly."

Like many state agencies, DMS is unable to add employees to handle its increased workload. In fact, Skinner's group has lost personnel, going from 812 employees in October 2007 to 640 today.

"Both DMS and DES are in dreadful shape employee-wise, that's why we're hanging on with tools like Health-e-Arizona and constantly trying to build in new efficiencies," Skinner said. "I continue to redeploy staff from one area to another."

Personnel's shifting responsibilities, coupled with the growing emphasis on applicants' self-input data, underscore the software's ease of use, Skinner said. During the pilot program, personnel provided only minimal help to homeless residents using the Web-based human services software, she said.

"We tried to not give people much information when they used it in the field test, to see if it was intuitive enough," Skinner added.

Building on the success of Health-e-Arizona, the state is in the very early stages of considering how to expand into mental health services, Skinner said. DES uses an eligibility system that dates back to the mid-1980s, and DMS' mental health eligibility system is more than six years old, she said. The state is discussing with One-e-App the feasibility of having both departments share the same database, which could save taxpayers money and improve service to residents.

As the number of applications grows and Arizona expands its network of subscribers, the state will continue to explore how to serve its growing client base with a shrinking number of employees and dollars -- a scenario many states can empathize with.

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