Policy & Practice June 2015

technology speaks

By Mark Allen

Digital Transformation The Promise of Greater Efficiency and Customer Service

D igital transformation is here. It promises great efficiencies, yet offers little clarity. This advanced technology has already had an impact on how human and social service agencies operate. Driven partly by the Affordable Care Act (ACA) and other legislation and policy, but truly building long before, increasing amounts of data and technology have already been pushing us toward an inflexion point in how public service agencies interact with their clients— it’s all for the better. A Slow Start to the Technology Evolution In the not too distant past, clients visited human service offices to apply for benefits. Multiple forms were filled out at lengthy appointments—and then applicants waited. And waited. Days or even weeks would pass as over-burdened agencies worked to manually determine eligibility. While automation was taking place in the background, it was mostly related to data storage, and to potentially some front-end desktop capabilities as the Internet became more secure and accessible. Meanwhile, decision-critical data necessary to determine eligibility remained in silos; an individual’s tax information in one database, employ- ment history in one place, and Social Security data in another. In addition, and equally important, the business rules and logic guiding these eligi- bility decisions were mostly written in COBOL, or Common Business Oriented Language, and embedded in the code, requiring information

into a business rule that developers would implement—a process that took weeks. Today, with its business rules engine, DPW business managers and developers easily create and manage eligibility rule changes in an iterative process that takes hours to implement, ensuring that determinations are quickly made and based on the latest rules and regulations. So what took so long? Forced Modernization: Affordable Care Act and Medicaid Eligibility The ACA mandated changes to Medicaid eligibility requirements, which, in turn, forced massive changes to the eligibility deter- mination rules within each state’s supporting software applications. Rather than modifying the existing systems, most states determined that it would be more cost effective to rewrite the systems using modern

technology (IT) assistance to make any changes. With rules and regulations frequently changing, and developers having to write new code for each change, implementing those changes dragged on for weeks or even months. Pulling all the necessary information together to make a benefits determi- nation or track changes to eligibility remained time consuming and cum- bersome—and kept the customer waiting. Game-changing technologies were coming of age, facilitating data acces- sibility to business rules management systems (BRMS) that separate eli- gibility rules from the application’s logic code. A few forward-thinking states began to modernize legacy mainframe applications with great results. Pennsylvania’s Department of Public Welfare (DPW) installed its business rules engine as part of an update. Previously, modifying one rule required business analysts to translate the slightest policy change

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