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Enrollment Work Group Gets Down to Business

Last week, the Health IT Policy Committee’s Enrollment Work Group held its inaugural meeting in Washington, D.C.

The work group was created last month in response to Section 1561 of the Patient Protection and Affordable Care Act, which tasks HHS Secretary Kathleen Sebelius and the Health IT Policy and Standards committees to “develop interoperable and secure standards and protocols that facilitate enrollment in federal and state health and human services programs.”

Such work could include:

  • Electronic matching across state and federal data;
  • Retrieval and submission of electronic documentation for verification;
  • Reuse of eligibility information;
  • Capability for individuals to maintain eligibility information online; and
  • Notification of eligibility.

The work group is chaired by Chief Technology Officer Aneesh Chopra and co-chaired by Sam Karp, vice president of programs at the California HealthCare Foundation. CHCF is the publisher of California Healthline.

In addition to Chopra and Karp, the work group includes 21 members, who represent a variety of state, federal and private stakeholders. Chopra said the panel aimed to bring all perspectives to the table.

Timeline, Tasks

Chopra said the work group must be “very focused in [its] work” because the panel is tasked with an “aggressive timeline.”

According to Karp, the panel will work from now until July 16 to:

  • Conduct an inventory of standards-based data exchange currently used in health and human services enrollment;
  • Develop new candidate standards for data elements and messaging; and
  • Identify a strategy to address potential gaps.

From July 16 to Aug. 27, the work group will tackle standards development, and the panel will finalize standards recommendations for the Policy and Standards committees by Sept. 31, Chopra said.

Principles To Guide Work

Chopra stressed that the work group should not attempt to develop policy through standards, but instead should ensure that standards and technologies support the work group’s policy goals, such as:

  • Putting the consumer at the center;
  • Making the enrollment process less burdensome and simplifying the eligibility process;
  • Entering/Obtaining patient information once and then reusing it for other purposes;
  • Making it easier for consumers to move between programs; and
  • Focusing on 2014, when the health reform law’s health insurance exchanges will launch.

At the end of Chopra and Karp’s initial presentation during Monday’s meeting, they offered the following list of principles, which they said could help shape the group’s work.

  • Keep it simple — Think big, but start small: Recommend standards as minimal as required to support necessary objective/business need, and then build as you go.
  • Don’t let “perfect” be the enemy of “good enough”: Go for the 80% that everyone can agree on.
  • Keep the implementation cost as low as possible.
  • Do not try to create a one-size-fits-all standard that adds burden or complexity to the simple use cases.

Meeting Takeaways

The work group’s inaugural meeting featured comments and presentations from a wide range of experts. The meeting was divided into three panels on:

  • Eligibility and Enrollment in 2014;
  • State/Local eHuman Services Efforts; and
  • Internet/Web Services/Consumer Data Platforms.

The meeting participants seemed excited and eager to get down to business, but they were realistic about the challenges that lie ahead, especially with such tight deadlines.

Several speakers emphasized the need to ensure that the enrollment standards developed are consumer-centric.

Bryan Sivak, Washington, D.C.’s chief technology officer, said, “From a technology perspective, I’m confident applications can be built that will make it easy and convenient for consumers to manage data in a secure environment. However, to make consumer self-management workable across broad populations, we will have to address challenges such as interaction and collaboration between the consumer and the health professional, security of sensitive information, protection of certain information from access by health insurers and other issues.”

Several work group members and experts also stressed the need for interoperability among states, while recognizing that states have limited resources. 

Karp said, “States are all very different.” He noted that there are actually more than 51 jurisdictions because in some states, health and human services enrollment is done at a county-level.

Alice Weiss, program director at the National Academy for State Health Policy, recommended that the work group:

  • Promote methods for states to easily adopt new system protocols;
  • Bring states together and listen to their concerns directly; and
  • Provide support for appropriate and timely funding and other resources to help states implement the adopted protocols.

Another recurring recommendation at last week’s meeting was for the work group to keep its work simple and practical.

The work group is scheduled to meet again on June 25.

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