Automation in 3rd-party plan renewals streamlines process, report says

Georgetown University's Health Policy Institute released a report lauding automation as a means to streamline 3rd-party renewals. Photo by Wikipedia

The Affordable Care Act requires states to conduct third-party reviews of Medicaid eligibility before renewing coverage, but a new report by Georgetown University Health Policy Institute has found that legacy technology and a lack of communication can make that difficult.

On the other hand, states that do the best job in renewals use an automated system, the report said.

Automated renewals are important to avoid gaps in Medicaid coverage and disruption in care that can lead to poorer health outcomes, according to authors Tricia Brooks, associate research professor at Georgetown, and Eugene Lewit, consulting professor from Stanford University's Department of Health Research and Policy.

Eliminating gaps in coverage can enhance a state's ability to measure the quality of healthcare for children and adults in Medicaid, the report said.

[Also: One in four Americans faces health coverage gaps]

The Affordable Care Act requires states to renew coverage every 12 months and to replace outdated paper renewals with electronic processes. Efforts to transform the system took a backseat when new states were dealing with the ACA's expanded coverage options in 2013, the authors said.

Many states finally took up the task in 2015.

The authors studied six states to see how they fared: Alabama, Colorado, Idaho, Louisiana, Massachusetts, Maryland, Ohio and Rhode Island.

They focused on the states' implementation of renewals through the "ex parte" process, or third party data sources.

The critical test was whether eligibility could be renewed without the enrollee having to take any action or submit paperwork, the authors said.

[Also: Automated payer contract management will boost revenue for medical groups]

While giving no breakdown by individual state, the states studied showed difficulty in following the mandate, the report said. They were developing specifications for an untested business process that existed in regulation and not in practice, the authors said.

In particular, states that operate their own state-based marketplaces had difficulty using integrated systems geared for both the marketplace and Medicaid, the report said. The systems were designed to address the needs of the marketplace, rather than Medicaid.

The report found that for some states, the solution was to process renewals outside of the primary integrated eligibility system.

[Also: Automated staff messaging tools seen as boon by some, others not sold on their effectiveness]

Some state officials were dealing with decades-old Medicaid mainframe computers, and all expressed a desire for more collaboration and sharing of experiences among states.

The report recommends hiring IT professionals who can aptly manage vendor contracts, getting the design right on paper before starting to build the system and fixing problems rather than using workarounds.

It also said states should hire in-house IT experts rather than handing off the design, testing and troubleshooting to vendors.

Twitter: @SusanJMorse