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 TodayTomorrow 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

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

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 to HealthMatch 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 Notices Continued

 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 Notices Continued

 Types of Notices Combined  Pending, approval, denial, suspensions, closures  FYI/informational Change  Change in benefits, spenddowns, or premiums Client Notices Continued

 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  Cristy Hong, HealthMatch Information Manager