HRSA/MCHB 2005 FEDERAL/STATE PARTNERSHIP MEETING

PUBLIC HEALTH ACROSS THE LIFESPAN

Building Partnerships Across the Lifespan for CYSHCN

ADRIENNE AKERS: I’m gong to spend the next few minutes talking about a project that we’ve just completed. It was funded through the division of Services for Children with Special Health Needs about four and a half years ago. It was a four year integrated services grant called “Open Utah’s Doors” but the title here “Can I Get Some Help Around Here Web based Interagency Process” is just a humorous way of recognizing some of the frustrations families experience when they first approach the service system and need to find those programs they might be eligible for.

So when we started the grant, the Federal Interagency Coordinating Council had identified with the help of parents, some of the major system barriers for families and the ones that were most frequently mentioned were that the fact that children often have to have multiple assessments. There was poor coordination between early intervention and the medical home in most states. That there was a lack of shared data so parents were having to report the same information over and over and agencies weren’t collecting information in a way that could be managed easily and also that there was a lot of redundant paperwork. Families had to fill out very similar applications or forms of paperwork over and over again. So with that, part of the requirement of our grant were to address those issues and the one we were able to make some great strides on was really focusing on this idea of trying to develop a way to gather information required by agency paperwork in a way that was more streamlined.

So again when families have to fill all those out and again these are just examples of programs that families might apply for early on. Early on through the help of some young men who weren’t working with our grant but we came to know very early in the process realized that maybe using the internet might be a way to help solve this. In a way that beaurocracy hadn’t been able to come up with it up to that point in time. When we started the only mental model we really had on the grant was what Indiana had done which was a paper based big fat application that several agencies had agreed to use which was quite an accomplishment. Those of you who have been in a state system for a while may recognize that in your own states that that has been attempted and yet it is often very difficult to get agencies to agree because their wording is a little different on the application, their logo is pink and green and somebody else’s is in blue and red and how do we come up with a way to make this look pretty.

So a lot of things have distracted people from the real issue, which was to help reduce paperwork for families. So essentially what we came up with is called universal application system and the branding or the name we’re actually using in Utah is called “Utah Clicks” so you’ll see that term flipped back and forth on some of these slides. Essentially it is a web based interagency application process and it’s again designed to help families apply for multiple services and programs. It’s available in English and Spanish and because it’s on the internet it is available twenty-four seven. Why develop it? More children are entering the service system at younger and younger ages.

There are many federal and state mandates that are encouraging or mandating that we organize services so families can use them more easily. Also the budget cuts that we are all facing require cost efficiency so that we don’t duplicate any more administrative costs than absolutely necessary as well as many states have a trend toward E government and paperless application so again it just sort of is the right time and one solution that can address this. One thing that I want to clarify here if I can get this to pop up. Okay, here we go.

Anyhow, I want to clarify two definitions because many states already have maybe an online screening but it doesn’t allow for families to actually apply for programs or in some states they have a single agency application process but if all the different agencies have their own online application then families have to fill out all of them separately. It’s not much better than the current system other than having to drive around to the programs to pick up and drop off the applications. What I’m differentiating here is what “Utah Clicks” or universal applications helps families do is with the application process. That’s up front information that families have to provide before they actually receive the service. What we don’t do with the universal application system is that bigger piece which is to determine eligibility. That’s what the agency does. The agency intake worker, eligibility worker does once the family provides that basic information. Right now we are not attempting to do that. That we want to leave with the human beings who can actually meet the family and find out what their special circumstances are that I don’t want to say that will allow them to bend the rules but might also help them to identify other programs in the community that they might be eligible for even if their service isn’t available because of some eligibility guidelines.

So some of the guiding principles that we used with “Utah Clicks” is that we allowed families to help us identify those application forms that they wanted and needed and those ones were the ones that were targeted first. A concept of screening families in resident screening them out and by that I mean the screening guidelines that are used are fairly broad so that the idea again is to identify families that have a high probability of being eligible for services. Not necessarily narrowing it to such a small definition that we are too quickly screening families out. Also so that the current paper based intake process is mirrored as closely as possible so then agencies don’t have to change too much too quickly and that seems to have been a good fit. Also that the intake process is streamlined for the intake worker so they can focus more on helping than on completing paperwork. Again, that is something we’ve already found people enjoying.

So here’s the applications that are currently on “Utah Clicks”. It’s our Early Intervention Program, our Part C called “Baby Watch” in Utah. Baby your Baby is a presumptive eligibility for low-income pregnant women to get into Medicaid more quickly to get their pre-natal work. CHIP is on now. CSHCN program, Medicaid and the WIC program is also part of the process in Utah. We have a few more that are waiting in line and just looking to find funding and a way to do it.

We did pilot it and just go ahead Diane and just get them up there. In our pilot survey, our original pilot was for about eighteen months in three Utah communities. Ninety four percent of the families were able to complete it in one session. If you look at that second item, how long it took them, again this represents families who might have been filling out one, two, three or four applications. You can see there that only ten percent it took longer than an hour. Most people took less than an hour to complete it if you want to look at it that way. This one really surprised us. Sixty-four percent of the families completed it from home.

So that again, we thought people would be having to come into an agency and sit next to a middle age caseworker who showed them how to do it and of course young families know how to use the computer better than many intake workers. Also ninety-four percent would recommend it to others. Then again, the high preference for it. Here’s a quick overview of how it works. Again it is a little bit difficult for you to see but the handout I passed out; you can go on and see a live demo of “Utah Clicks”. What this is is a fairly clean; we don’t try to overload people with too much information. I guess if you can see the cursor over there it just lists the programs and some very brief information and even though this is live if I went ahead and clicked to get started what this next page does is give very brief definitions of each of those programs. Everybody kind of chuckles because it’s the shortest definition of Medicaid in the world. Utah Medicaid helps families pay for medical bills. We don’t need to overload people. Now you can see there is a link right next to it. If people want more information they can have it but we try to keep it simple. This just demonstrates, there is a brief application process and so here’s the Simpson family and Homer’s already been entered over here but we are entering Marge’s information. When you click it the family can see who has all been entered. When we finish the parents then we add all the children and here we are adding Maggie but Bart and Lisa are over here.

Again very simple, the only basic information is essentially the individual’s name, the birth date, gender and relationship to other family members. Once the account is set up, now all the family members are listed here and it asks them do you want to screen everybody? What we learned in the pilot, our original goal was to design a system so that a family who had a child with special needs could apply for services. But we never stopped to think of is what if they’ve got two kids. What if multiple family members needed to apply. We only designed the system initially to allow for one person at a time to proceed and so in partnering with the Utah Department of Health, they gave us additional funds to not only develop a more robust system but to develop the electronic submission to the agencies which was not part of the original pilot. What this demonstrates though is families have the opportunity to unclick who they don’t want to be screened.

So, if there is only one person you want to go through the screening process it leaves it totally up to the family to be able to make that decision. Again these are hard to see but what now happens is a brief screening process that clearly eliminates those programs that you’d never be eligible for. For instance they wouldn’t offer Part C to a child who is four or five years old because by regulation they can only serve children up to the age of three. Here’s asking Marge whether she is pregnant which would again trip the Medicaid program. Very simple questions. Then at that point this now lists the programs that the family members might be eligible for. Even if it says they might not be eligible they can go ahead and click any of these boxes and activate those applications if for some reason they feel like they have a special circumstance. We don’t want to prevent any body from applying too quickly.

Here’s the beautiful thing that these young men that were working for non-profit. The idea that they came up with that was so brilliant is now rather than filling out the individual applications they want to apply for, the system is smart enough to gather all the common types of information across the Medicaid, the WIC, the CSHC and applications and group them under similar categories so all the demographics are collected in a logical sequence. All the health information is collected in a logical sequence. So there are a number of pages of this depending on the total number of applications. At this point they are done with the process and they hit view and print what you now see is the CHIP application populated with the family’s information. This is the CSH application for Utah. Here is the Medicaid application and then the family can then electronically submit those and the system does that by zip code to the local office so the intake workers can pull those up and process those appropriately.

The other thing is does is, whoops you need to hit that for me. Try it now. What does the family do once it goes off into cyberspace? There is a little what to do next sheet here that tells families that you need to call and make an appointment or you will receive something in the mail but they are informed on what the next steps are. I’m going to stop there because we are running out of time but essentially it is sent electronically it is sent to those agencies.

As we are talking about partnerships, they were critical for us in this project. Initially throughout the grant we had nine layers of support from different state agencies and programs willing to partner. When it really got down to actually piloting it and developing the system we had five very strong partnerships at that moment in time and again we used this kind of pre-school model where even though we had a large players we could have included, what we did was work with those who were ready to participate at that point. If there were a couple of them wandering off there, we tried to grab them and make them sit down to quickly we’d probably lose everybody else’s attention. So we worked with those partners that we had the strongest relationships with. Families were critical in this because again they were really the ones who were saying we really need this for this particular application and I think really helped many of those stake holders stay at the table because they recognized how important it was for families to have this work. Because the pilot indicated the families were so pleased with it and I think that is one of the greatest reasons we’ve had good successes if that the consumers are finally getting something that they can say why hasn’t somebody figured this out a long time ago.

When the state agencies can see that, it is very appealing to them to want to continue to move it ahead. Oregon has already contracted with us to come up with “Oregon Clicks” and I think we are negotiating with Indiana tomorrow to see if we can bring it up in Indiana. Several other states are interested so I’ll wrap it up with that.

RICHARD ROBERTS: I’d like to add one point to this because Adie is a little modest. This is actually a very revolutionary system and when you look at it you think, gee you think of all the technology that has gone into it. In reality the technology was the easy part. I mean you know, we bought a couple of graduate students and people who graduated and they stayed with us from the IT program and they did the programming for us and kind of continued to work out the bugs. That part was fairly systematic and easy. The hard part was getting, it wasn’t too hard because this is a cool thing but it is still complicated, is getting the partners to the table. Getting them all comfortable, getting them in line, keeping them in line, moving it along. It looks like, you’d think well gee the technology would be the difficult part but actually it’s the same old stuff with just a new application to it. It goes to show you no matter what you are doing that the basic human connection has to be there to make it work itself out.

One of the things that Adie has down over the last three years on that is to nurture that along in a very systematic way from really its inception which was a very, very early stage of something that we got when we worked with the graduates students to what we now have. Having the partners and getting the states excited about it and interested in it and seeing the possibilities of it. Our state is building a eight million, I don’t know, eighteen million dollar set up with Medicaid that is doing a few more things than our three hundred and fifty thousand dollar view is but not that many more. So it’s the personal relationships that really made this thing work. When you’re thinking about partnerships, what Adie has done so well and Diane does as well and Jennifer does is develop those partnerships so that they connect and they stick. That they really stick over time. That’s what really made this happen.