Policy & Practice | Fall 2024

The Problem with Integrated Eligibility Systems

Setting Bold Goals for a Better Future

their customer service reputation and greatly increasing capacity. Our approach emphasizes first contact reso lution and addresses failure demand through process improvements, con sistently delivering an average 30 percent increase in capacity. Doubling no-touch processing or halving the number of calls handled by case workers is the difference between falling behind and achieving success. Our method is easier to implement and more cost effective than implementing new IE systems—and it works. Building Your Roadmap With new goals focused on service and capacity and a fresh vision for client experience, it’s time for agencies to prioritize simplicity and implement “trim tabs” that enable customized self-service, so capacity isn’t wasted on low-value tasks. This begins with eval uating an agency’s current situation and developing a roadmap, targeting specific goals, and taking delib erate steps to achieve them. Unlike developing an IE system, this effort typically involves dozens of inter related projects that drive goals. This approach offers several advantages, including the ability to spread out budgetary expenditures and tightly manage and evaluate requirements. It also allows agencies to divide the work into smaller projects or one master project, depending on the most appro priate risk management strategy. The specific roadmap will vary for each agency but should focus on process, technology, and people. administrative tasks, and a focus on engagement. Agencies must redefine the role of caseworkers and the tasks they are required to complete. Agencies should document processes, identify the steps where innovation will have maximum impact, and engage clients to gain insights from their lived expe riences, particularly when testing strategies for engagement. We help agencies begin to segment processes, recognize that not all clients should be treated the same, and identify patterns that can improve first contact closure rates for most recipients. For example, simple family Process: There will be shifts in responsibility, reductions in

The weaknesses of IE systems largely stem from the unrealistic expectation that they can be all things to all people—a nearly impossible scope. While these systems perform necessary compliance and account ability tasks, we need to shift our focus to increasing capacity and improving user experience. At Change & Innovation Agency, we are dedicated to generating capacity and creating an optimized ecosystem that includes more effective staff, better user experiences, and faster outcomes for families. This trans formation begins with setting bold goals—goals that anchor and align the effort to transform agency operations. Imagine your agency’s goal is to have 80 percent of applicants receive accurate benefits determined in 30 minutes or less and delivered through a seamless, modern experience. Now that is a bold goal. Bold goals drive focused innova tion. They shouldn’t be easy—but they should be distinct, measurable, track able, and incrementally achievable with a clear set of targets. Agencies might even have one goal per program or service component. In a world of increasing complexity, well-planned simplicity wins. Over the years, we’ve been sold on complex solutions that have led us astray. Now, we have the opportunity to get back on track by getting back to basics. Consider the user experience. Today, it is often cumbersome and one-sided. We need to meet clients where they are and how they live. By thinking of the user experience as individualized— a “Segment of One”—rather than a one-size-fits-all process, we can drive focused innovation. The experience should be interactive and supportive, anticipating client needs and offering assistance rather than waiting for clients who may be confused by the process to take action. Agencies can gain significantly by shifting their focus beyond mere compliance to include improving Moving Forward by Going Back to Basics

Integrated Eligibility (IE) Systems have dominated human services tech nology investments since the passage of the Affordable Care Act (ACA). They are a single system that supports a wide range of benefits, including Medicaid, Temporary Assistance for Needy Families (TANF), SNAP, and Child Care, and can determine eligi bility even for families with complex circumstances. It is estimated that states are spending $6.5 billion each year to maintain these systems. 1 Implementing IE systems is both a costly and complex effort, often plagued by hundreds of millions in cost overruns and years of delays. These systems must accommodate even the rarest and most specific of cases, not just the majority, adding layers of intricacies that have hindered innova tion. In fact, roughly 75 percent of the improvements currently being made to these systems are to fix deficiencies, add more logic, and comply with new legislation, not to innovate or better serve the people who need them. Since the COVID-19 pandemic, the limita tions in capacity and accuracy of these systems have led to significant delays in providing much-needed benefits. As a result, we now face enormous backlogs, high error rates, and frus trated clients crowding lobbies and waiting on phones. Despite a decade of experience since the passing of the ACA, there is no single IE solution that agencies can confidently procure to solve for current challenges. To move forward, we must consider the possibility that the situation cannot be resolved through IE systems.

Sean Toole is the Senior Vice President at Change & Innovation Agency.

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