Using Information Technology to Enroll in Health Coverage: Sophisticated Systems Can Simplify Enrollment

By Guest Blogger

The following blog was written by Elisabeth Rodman, Health Policy Analyst at Families USA.

I once heard the metaphor that state exchange websites can best be described as ducks swimming in a pond. From the shore, the ducks appear to be peacefully coasting along the surface; but when you look under the water, it becomes clear that the ducks can only coast along peacefully because their legs are paddling furiously, just out of sight. This duck metaphor is very appropriate when thinking about designing information technology (IT) systems to make enrollment in health coverage easier. By 2014, enrolling in coverage is supposed to be fast and easy for consumers on the “front end,” but this is only possible through the creation of a sophisticated IT system on the “back end.” The “back end”—hidden from the consumers’ views—is where the complex eligibility determination process takes place, ensuring that consumers receive accurate and timely information about their coverage options.

It will take a lot of work to design an IT system that is simple and intuitive for consumers and yet highly intelligent behind the scenes. The Centers for Medicare & Medicaid Services (CMS) recently offered some guidance on what an ideal IT system should look like in Guidance for Exchange and Medicaid Information Technology (IT) Systems Version 2.0. This “IT guidance 2.0” builds on initial IT guidance released in November 2010 and offers (or reiterates) some key pieces of information for states engaged in the process of designing online applications for health coverage:

  1. There should be a high-quality user experience, similar to retail websites, where applicants can easily apply online and, when necessary, seek readily-available online or telephone assistance from an eligibility worker or a customer service representative.
  2. There should be a fast enrollment process, taking no more than 15 to 20 minutes for most applicants to complete an application and receive a program placement.
  3. With the help of advanced technology, there should be a maximum level of automation, allowing applicants to be enrolled quickly and requiring the applicant to provide minimal to no paper documentation or verification.
  4. There will be a federal data services hub to provide highly secure applicant information so that applicants do not need to provide paper proof, such as pay stubs or proof of residency.
  5. There will be multiple pathways to apply for coverage. If an applicant does not want to apply online, he or she can apply by phone, by mail, or in person.
  6. There should be seamless coordination between all types of health coverage, plans, consumers, and those who assist with enrollment, such as providers and community organizations. Seamless coordination will help to enroll applicants and their family members in appropriate coverage and prevent them from losing coverage if their income changes.

Exchange and Medicaid IT systems designed with these principles in mind will do the behind the scenes “paddling” to ensure that enrollment websites can float along peacefully, providing a simple, user-friendly experience.


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