5 actions human services agencies should take now to make the most of the ACA

The Affordable Care Act (ACA) will expand health coverage in the United States by more than 35 million people. This expansion requires states to take a fresh look at eligibility and customer service operations, and develop new business processes for interacting with stakeholders. Existing IT systems are outdated, and under-resourced state agencies are challenged by the January 2014 compliance deadline.

The opportunity in this challenge is time-limited 90 percent federal matching funds for eligibility system upgrades or replacement and 100 percent funding to create HIX IT systems. This is a one-time chance for states to fundamentally transform their health and human services (HHS) enterprises.

Doing so requires a strategic vision and the will to make business process and governance changes to lay the foundation for more client centered service delivery. The pressure of the impending deadline might result in short term planning to meet minimum ACA requirements at the expense of longer term enterprise benefits. However, states can maximize available federal funding without becoming overwhelmed. The key is recognition that transformation does not all have to happen at once as long as there is long-term vision and planning. States can start now to:

Begin with the end in mind.
“What do you really think a 21st century experience could be for your clients in terms of high performing services? ACA is a catalyst to help us achieve that vision.” Rick Friedman, Centers for Medicare & Medicaid Services (CMS)

ACA stipulations for interoperability among Medicaid, HIXs and human services invite coordinated thinking about population health. The data clearly supports the inter-relatedness of human services and improved health outcomes and is a necessary component of bending the ever-rising healthcare cost curve. ACA or not, this total person understanding is the essence of truly integrated human services delivery. States should approach ACA as a tool to advance the vision to build a human services system that is an engine of human well-being. Getting there means defining aspirations—from seamless integration across agencies to family-centered customer experiences and data-driven decisions.

Think beyond the deadline.
“Focus on the goals of achieving your agency’s long-term vision. Your clients need your help today, in 2014, and afterward. Start now.” Rick Friedman, CMS

January 2014 is looming large for states. A singular focus on the deadline could mean agencies lose sight of actions they can take today and beyond the deadline. Taking full advantage of the funding window demands a broader, pragmatic view. A flexible architecture can be purchased now and configured over time so that states can achieve ACA compliance in the near team while supporting a fully integrated service delivery system. If states do nothing, or focus only on the near term, they will pay a high price, missing the chance to purchase the technical infrastructure of an integrated HHS vision for 10 cents on the dollar versus five times that after 2015.

Elbow your way to the table.
“It’s not about ACA, it’s about the people who get benefits from all of us, and how do we build systems in a networked world to try to communicate with each other?” Rick Friedman, CMS

Human services leaders must get involved in ACA discussions in their states now to maximize their ability to piggyback on funding opportunities. This demands determination and the ability to break down organizational silos and traditional ways of working. While it is easier said than done, Accenture’s survey of 2011 Human Services Summit attendees demonstrates that collaboration can happen—one third of those polled said they are highly involved in planning or developing their state’s HIX.

Find the common ground.
“The A-87 exception presents an opportunity for states to utilize these dollars in ways that promote flexibility and that ultimately will provide long term administrative and outcome-based efficiencies for them.” American Public Human Services Association

Once at the table together, Medicaid and health and human services agencies can identify shared services that are eligible for 90/10 federal funding participation. Examples of technology that can be purchased using this funding participation and leveraged for human services programs include any Medicaid-related eligibility functionality such as enterprise architecture, rules engine, security, master person/client index, data warehouse, and business and analytics infrastructure among others.

Never go it alone.
“How do we make sure that people are actually in the conversation and really connecting with their health folks to recognize that now is the opportunity?” Daniel Stein, Stewards of Change

Federal agencies have come together to express their willingness to dialogue with states to help them make the most of this unique opportunity. By acting with intentionality to maximize federal support, states can play a role in shaping a compliance effort that holds much promise for the future of human services.

The ideas in this article reflect perspectives from the 2011 Human Services Summit: The Pursuit of Outcomes, a gathering of human services leaders, industry experts and academics at Harvard University in October 2011. Special acknowledgement goes to Rick Friedman, Director, Division of State Systems, Centers for Medicare & Medicaid Services.

Julie Booth, Accenture managing director for state and local government human services


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