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Officials are assessing results of a one-month pilot test of Health-e-App, the nation’s first effort to use the Internet to enroll low-income children and expectant mothers in public health insurance programs.
The pilot was conducted in a variety of settings in San Diego County, CA, including community clinics and community-based organizations that conduct outreach and enrollment at schools; Women, Infants, Children program sites; and other enrollment locations, Oxana Smith, deputy director of the San Diego County Health and Human Services Agency, tells State Health Watch.
Efforts to develop an Internet application process started in October 1998 when the Medi-Cal Policy Institute released a report on improving the Healthy Families/Medi-Cal application process. The report provided guidance to the state on simplifying the original 28-page joint Healthy Families/Medi-Cal application and streamlining the enrollment process for both programs. In November 1998, the California HealthCare Foundation issued a request for proposals for development of an automated system for enrolling women and children in Medi-Cal and children in the Healthy Families program. In January 1999, Deloitte Consulting was awarded the contract to build an interactive, interview-style web-based application.
Program sponsors say automating the enrollment process can have a number of benefits, including:
• a more consumer-friendly way to apply for public health insurance programs by providing applicants with real-time preliminary eligibility determinations, confirming submission and receipts of applications by the state, and offering on-line selection of health plans and providers;
• reduced error rates on applications by improving the accuracy and completeness of applications;
• improved efficiencies in the enrollment process by eliminating manual data entry and unnecessary handling of applications, removing the need to mail applications, and speeding the time it takes for eligible applicants to receive health benefits;
• reduced enrollment costs;
• increased enrollment in Healthy Families by word-of-mouth promotion of the consumer-friendly enhancements, especially real-time notification and instantaneous application submission, and an electronic mechanism for counties to transfer qualified share-of-cost Medi-Cal cases to Healthy Families, which has an enhanced federal match;
• improved accountability by creating an administrative system for government agencies to track and report payments to enrollment entities and to track application disposition and payment status;
• on-line selection of providers and health plans for Healthy Families applicants;
• more complete and accurate enrollment data, which will improve the quality of Health Plan Employer Data and Information Set and other reports that use encounter data in Medi-Cal and Healthy Families.
When fully implemented, Health-e-App will offer families the ability to apply for Healthy Families or Medi-Cal from anywhere they have access to the Internet, whether at home, in a library, at a school, or while visiting a community health clinic. While individuals can access and use the application themselves, its greatest use may be in locations at which trained staff are available to assist families.
Health-e-App initially has been made available in English, Spanish, and read-aloud text for the visually impaired. The program prompts applicants on the specific information needed and ensures that essential information is not left out. Families receive immediate, on-line feedback about their eligibility, and the complete application is submitted electronically to the state with an electronic signature. Applicants also can select physicians and health plans on-line based on criteria important to them such as language, medical specialty, and how far they are able to travel to see a doctor.
Ms. Smith says there was an initial two-week pilot at one San Diego site last year to find and resolve bugs in the system. The one-month test at six sites began January 2001.
Where assistors were available in community settings, applicants were given a choice of using the on-line application or the traditional paper form. Most people, Ms. Smith says, chose the on-line form. "From what we can see so far in a fairly small pilot in limited applications, we’re getting many more applications back. It seems to be achieving the purpose of getting people more engaged in the application process. The on-line form is pretty faithful to the paper application. Edits and controls are in place to be sure the information is cleaner and more legible than we get with the paper application."
She says Health-e-App appears to have proven itself to be "better, cheaper, faster," and notes the applicants particularly like "learning pretty quickly if they are eligible." Once the pilot data have been analyzed, she says, officials will be "thinking about how to finance, fund, and make the process happen at thousands of sites statewide."
[Contact Oxana Smith at (619) 685-2577.]