Everybody – even the politicians – is talking about the importance of sharing health information electronically. Less discussed, but equally important, is using information technology to streamline eligibility, enrollment, and retention in public health insurance like Medicaid or the Child Health Insurance Program.
But it's not easy. For starters, enrollment in these programs is often done with pen and paper. Second, the paperwork is forensic in detail – proof of income and legal residency, proof of address and citizenship, household size, child care costs, and recent job-related insurance status.
Third, you're never done: All states review eligibility at least once a year and some require a monthly renewal process.[1] Too often, calculations are done manually, on paper, in duplicate or triplicate, and then repeatedly keyed in by government employees. Paper goes back and forth among agencies and applicants with calculation errors, illegible handwriting, or missing data, causing delays or, worse, wrongful denials of coverage.
In New York, where I'm from, nearly a million people who are eligible for public programs remain outside the system because of problems like these.[2] Now that we're finally talking seriously about universal healthcare, we have to make enrollment easier.
The big hurdle in New York is upgrading the systems belonging to various government agencies and getting them to talk to each other. Several states are moving forward with “ex parte” enrollment efforts – if you get food stamps, you're likely to need health insurance, too – but such innovations are not possible without addressing system interoperability.[3] In early May, stakeholders from New York, along with representatives of programs in Pennsylvania, Massachusetts, and California, [met] to discuss these issues and learn from each other's efforts.[4]
Until we're ready for a single national health system, we need to streamline policies to reduce the churning in public programs and adopt automated systems to speed up information exchange and give everyone access to healthcare.
Despite the difficulties, this isn't rocket science. Banks, retailing, and manufacturing have automated. We can do it in healthcare, too.
That's my opinion; I'm Georganne Chapin, President and CEO of the Hudson Center for Health Equity & Quality.
Footnotes
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Readers are encouraged to respond to the author at gchapin@hcheq.org or to George Lundberg, MD, Editor in Chief of The Medscape Journal of Medicine, for the editor's eyes only or for possible publication as an actual Letter in the Medscape Journal via email: glundberg@medscape.net
References
- 1.Kaiser Commission on Medicaid and the Uninsured. Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles. January 2008 Available at: http://www.kff.org/medicaid/7740.cfm Accessed June 6, 2008.
- 2.Cook A, Miller D, Holahan D, et al. Health Insurance Coverage in New York, 2004–2005. 2007 United Hospital Fund. Available at: http://www.uhfnyc.org/pubs-stories3220/pubs-stories_show.htm?doc_id=521121 Accessed June 9, 2008.
- 3.United Hospital Fund. Streamlining Renewal in Medicaid and SCHIP: Strategies from Other States and Lessons for New York. In press.
- 4.Building Blocks for Universal Health Care in New York: Bridging Coverage Gaps with Information Technology. Health Policy conference presented by the Hudson Center for Health Equity & Equality; May 8, 2008; New York, NY. Available at: http://www.regonline.com/hcheq Accessed June 6, 2008. [Google Scholar]
