The Next Revolution: The Role of Informatics in Improving Health Care
Health e-app: Electronic Application for Health Families/Medi-Cal for Children and Pregnant Women
Slide Presentation by Sandra Shewry (Text Version)
On July 26, 2001, Sandra Shewry, made a presentation during the Web-assisted teleconference, The Next Revolution: The Role of Informatics in Improving Health Care entitled "Health e-app: Electronic Application for Health Families/Medi-Cal for Children and Pregnant Women."
This is the text version of Ms. Shewry's slide presentation. Select to access the PowerPoint® slides (1.3 MB).
Slide 1
Health e-app: Electronic Application for Health Families/Medi-Cal for Children and Pregnant Women
Agency for Healthcare
Research and Quality (AHRQ)
User Liaison Program
July 26, 2001
Sandra Shewry, Executive Director
Managed Risk Medical
Insurance Board (MRMIB)
Sshewry@mrmib.ca.gov
Slide 2
Medicaid and State Children's Health Insurance Program (S-CHIP)
- Reduce the number of children without health insurance coverage.
- Medi-Cal (MC) for Children and Healthy Families (HF) programs are jointly
marketed.
- Applicants complete a mail-in application that serves both programs.
- All applications are sent to the State's Single Point of Entry for income
screening.
Slide 3
Application
Process
- Applicants apply on their own or with assistance from Certified Application
Assistants (CAAs).
- CAAs are paid $50 for each application resulting in an enrollment.
- A PDF (printable) version of the application is available on the MRMIB
Web site; it is mailed to the single point of entry (SPE).
Slide 4
Single
Point of Entry
- The SPE utilizes an automated business logic to screen applications for
Healthy Families (S-CHIP) and Medi-Cal (Medicaid).
- Logic screens for family composition and income.
- Healthy Families applications electronically forwarded to the Healthy Families
enrollment contractor.
- Medi-Cal applications mailed to the appropriate county for processing (58
counties).
Slide 5
Health-e-App
- Health-e-App [HeA] is a Web-based, paperless application process.
- Application data, supporting documentation and signatures are transmitted
to appropriate entities through electronic interfaces or channels.
- Used by CAAs in clinics, schools, and community-based organizations to
help families apply for HF and MC (CAAs use notebook computers w/ wireless
Internet connectivity to conduct enrollment in community—even in app's
homes).
Slide 6
Data Flow
This slide features a diagram of the data flow in the Health e-app process. Data flows from the CAA/Applicant to the Single Point of Entry, and then
to either Healthy Families (S-CHIP) or Medi-Cal (58 counties). Disposition flows from both Healthy Families (S-CHIP) and Medi-Cal (58
counties) into the Single Point of Entry, and finally back to the CAA/Applicant.
Slide 7
"Real
Time" Features
- Preliminary eligibility determination.
- Instantaneous error checking to improve data quality.
- Online selection of health plans and provider.
- Automated computing of income/calculations.
- Electronic signatures.
- Generation of an application summary for applicants.
- Application tracking.
Slide 8
Development & Testing
- Public/Private Partnership between State and California HealthCare Foundation
(CHCF contracted with Deloitte to develop, and worked with MRMIB and the Dept. of Health Services [DHS]
to design & test).
- Development effort took 2 years and cost $1M.
- Successful Pilot Test completed in February (Partnership with Department of Health & Human Services [HHS] and State
agencies; 6 sites in San Diego County. School, clinic, Women, Infants, and Children [WIC], church. Pilot
sites still using HeA today.).
- Independent Business Case Analysis conducted by Lewin Group (to measure
HeA performance and quantify efficiencies and user impressions).
Slide 9
Business
Case Analysis
- Quality—Application errors were reduced by nearly 40 percent.
- Speed—The time between application submission and eligibility
determination decreased by 21 percent.
- Satisfaction:
- Ninety percent of applicants would
rather apply online using Health-e-App and 95% of CAAs preferred using
Health-e-App.
- Applicants liked confirmation that
their application was received and the immediate "official" decision, even
if preliminary.
- CAAs took to Health-e-App quickly,
even those with little or no computer experience.
Slide 10
Challenges
- eSignature (concern about fraud).
- Healthy Families Premium Payment (Premium must be mailed, does not always
get sent; manual match up with the electronic data).
- Matching faxed documentation to electronic submissions (Matching documentation
sent after the application has been problematic. Expensive (!) solution
underway. Would remove barrier if documentation reduced or self-cert permitted).
- Design—States may need intermediary to help design and implement.
Slide 11
Next Steps
- Add parents to automated application in conjunction with S-CHIP 1115 Waiver.
- Automate Healthy Families Premium Payment.
- Web-based Training for CAAs.
- Rollout statewide to CAAs.
- Incrementally bring on the Counties (interfaces will need to be built between
SPE and the 58 counties to allow for electronic transmission of data and
supporting documentation).
Slide 12
Electronic Signature
This slide displays a page on the Health e-app Web site where applicants
sign their digital signature
Slide 13
Faxing Documentation
This slide displays the documentation fax cover sheet on the Health e-app
Web site. Applicants can fill in personal information such as name, address,
phone number, and a checklist of attached documents
Slide 14
Login
This slide displays the login page on the Health e-app Web site where applicants
must enter a username and password to gain access to the site.
Slide 15
Provider Selection
This slide features the
Provider Search and Selection page on the Health e-app Web site that allows
individuals to search for providers by name, specialty, gender, language,
location and proximity.
Slide 16
Map/Directions
This slide displays the map/directions feature of the Web site, which can
provide door-to-door directions to providers' offices.
Slide 17
Error Checking
This slide illustrates the error checking feature of the Web site, which
ensures that entered information is accurate so as to prevent delays and
confusion later in the process. On this particular page, an error message
appears after an applicant inadvertently entered "today's date" in the
"date of birth" field.
Slide 18
Real-Time Determination
This slide illustrates the real-time nature of the Web site. After an applicant
completes the online forms, the following message appears before one can
proceed and click the "continue" button:
"You have successfully completed the application. To see which programs
you and your children may be eligible for, click the button below. This
is a preliminary calculation—your application is NOT being submitted
at this point."
Slide 19
Real-Time Determination
This slide displays the Web page that lists preliminary eligibility of
members for certain programs. On the screen is a table with members' names
and the program they may be eligible for, such as Health Families or Medi-Cal.
Slide 20
Printable Application Summary
This slide features the application summary that appears on the computer
screen at the end of the Health e-app process. The summary includes the
members' names, contact information, and additional applicants (children,
for example) if applicable.
Current as of August 2001
Internet Citation:
Shewry, S. Health e-app: Electronic Application for Health Families/Medi-Cal for Children and Pregnant Women. Slide Presentation (Text Version) presented at The Next Revolution: The Role of Informatics in Improving Health Care, Web-Assisted teleconference, July 26, 2001. Agency for Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/news/ulp/informat/shewrytxt.htm
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