Policy & Practice June 2015

The Promise of Digital Transformation

health insurance exchanges, which are regulated marketplaces for indi- vidual health insurance. Each state was required to either create its own exchange or use the federally provided exchange. These new health care exchanges were designed from the ground up to be modern and engaging, enabling customers to research and purchase insurance in a self-service fashion. Many states recognized that the same business rules engine could be used for both eligibility and health insurance exchanges. With a business rules engine, states have been able to more easily share federally mandated business rules with other states and vice versa, while also having the flexibility to easily localize the rules where needed. Powerful features automatically ensure the logical integrity of the rules, which improves system quality and ensures consistent results. Using a business rules engine, the rules are easy to understand and manage, reducing the cost of development and maintenance.

business rules engines to guard against ongoing regulatory changes.

As a society, we have long yearned for faster, leaner, and more accurate decision-making capabilities. These modernized, self-service applications can change the focus of how human service resources are applied. Instead of spending the majority of time chasing down missing data and fixing errors, employee resources can be redirected to better serve citizens who need one-on- one attention, support, and guidance. The end result: a digitally trans- formed experience for the customer, and human service employees who can now devote themselves to the agency’s mission of improving the quality of life for its constituents. Mark Allen is the chief technology officer of Progress. For additional information, please visit www. progress.com/corticon or https:// www.progress.com/products/ corticon/solutions/public-sector-and- government.

DigitalTransformation: Online Eligibility Systems and Health Insurance Exchanges As a result of the successful modern- ization of Medicaid eligibility systems, many states are expanding use of business rules engines across other benefits programs, providing “inte- grated eligibility” that reuses common architecture and business rules across programs. Leading states are also beginning to offer their citizens self-service, web-based, and mobile- ready application processes that provide guidance, screening, and immediate eligibility. These new applications are becoming a win-win as they reduce the operational costs for states, and offer a far better customer experience. One very important requirement of the ACA was the creation of new

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