Displaying topic: "General Interest"

December 27, 2010

Some Challanges of Health Benefit Exchanges

Despite recent court rulings the ACA will likely be implemented substantially intact (one of the most rational analysis we’ve seen is here). This means many of our clients are beginning work on a Health Benefit Exchange (HBE) – a kind of super store for insurance shoppers. Over the next few months we’ll examine the challenges our clients face in planning and implementing HBEs and the solutions they find to those challenges. We’re going to start with just a few of the obvious challenges:

  • Many of these initiatives are falling on state insurance commissions to implement because of their knowledge of state insurers. The interface for an HBE is required to determine eligibility and enroll eligible participants on the spot. This part of an HBE makes it more like an entitlement or grant program (Medicaid, TANF/SNAP etc). There are two technical challenges here. First, insurance commissions don’t have experience running large scale eligibility and enrollment programs. Second the IT staff of insurance regulators is typically quite lean, i.e. they don’t have the staff necessary to build and run the infrastructure required for such programs.
  • States will need to make a decision early if they will support a single solution for all HBE needs or have separate solutions for individuals and small businesses. The needs of these two groups are different and alternatives must consider requirements for both groups.
  • Developing an effective user interface (UI) to compare plans will be difficult. Insurance plans are not developed in a manner that promotes easy comparison. Different insurance companies often use variations in the way plans are presented to market their strengths. In addition to the policy implications associated with this there are also technical development considerations: How can plans be displayed and prepared? Should there be other features on an HBE site (e.g. health education information)? And, what are the best ways to design sites focused on consumers?
  • The Federal Government recommends that states have a common web based front end for HBE Subsidies, CHIP and Medicaid programs (section 1413 and 2201 of the ACA). This includes both determination of eligibility and enrollment for these programs. Developing effective web front ends for any application is challenging. Finding an effective means of utilizing other state information services (eligibility determination and enrollment for these other programs) represents a challenge few states have conquered. Collaboration between agencies running entitlement and grant programs and the insurance agencies technology divisions will be a must to make an HBE work.
  • Related to eligibility and enrollment, the volume of potential enrollees in an HBE supported plan will dwarf the current number of Medicaid users in a state. They will enroll over a relatively short time period. Insurance providers will need to be in the system. HBE projects need to plan an approach that gets insurance providers in the system and can screen a large number of applicants in a short time.

We are working with our clients to address these challenges. As common solutions emerge we’ll share those with you (along with other challenges we find!).

November 24, 2010

Happy Holidays

The crew at Public Knowledge wishes all of you a happy holiday season.

Thanks to all our clients who have helped make this one of the best years ever for us.  We appreciate you and the work you have entrusted us with.  We look forward to continuing to serve you in 2011.

October 12, 2010

Client Survival Guide: Short Written Reports Are Better

OK We’ll be honest. As consultants we often fall in love with the constructs and solutions we derive on your behalf. We will explain the beauty of our solution in intricate detail to anyone who will listen (and many that don’t want to be listening!) Generally, in order to get paid, we transcribe these solutions into large complex written reports (we’ve all heard the jokes about “paid by the pound”). Most of the time these documents end up sitting on a shelf collecting dust. No one ever reads them. The results are never used.

From a consultant’s perspective it’s much easier to write a long complicated document than a concise one. Simplicity is hard. But by providing clear, concise, and short reports we’ve found the odds of adopting and implementing the results of a consultants work significantly improve. It’s a sign your consultant really understands the material they are presenting (it’s easy to hide flaws in a big complex document) and you are getting a well thought out solution. Further, a report written clearly and concisely can be shared with broad audiences without a lot of accompanying explanation.

The take away here is pretty simple. Sit down with your consultant and discuss your expectations for written reports. Think about who will be reading the report. Will it be the Governor, legislature, governing council members, senior or mid level agency executives? Will they read a 300-page document? Doubtful. Simple and concise will win the day here.

Should every report be simple and short? Of course not. System requirements or design documents will tend to be long and fairly complex (though they should be as clear and concise as possible). But a greater level of detail is expected by and required for the audience of these types of documents.

This is part of a series of articles designed to help clients and their consultants have more effective and efficient engagements.

August 27, 2010

Health Management: Improve Outcomes and Reduce Costs.

Health management is a system of coordinated health care and outreach activities targeted at disease focused populations with conditions where patients have significant self-care efforts.  The goal is patients become better-informed consumers of health care and gain an understanding of how to better manage their health care needs.  Health management often results in cost savings from the more efficient and effective use of healthcare.   The approach involves supporting patients and the physician/practitioner communities through care plans and evidence based practice guidelines, patient education, and disease monitoring support services.

Public Knowledge has a history of assisting its customers with the planning and development of Health Management Programs that improve quality of care, improve health outcomes, lower total costs, and better-educate providers and Medicaid clients.

Recently, we helped a State implement a unique Health Management program for its entire Medicaid population.  The program included even healthy Medicaid clients, who are usually ignored in traditional disease management programs.  The program itself consisted of:

  • A Disease Management component for certain chronic diseases such as asthma, diabetes, and others;
  • A preventive education and outreach component for all Medicaid clients; and
  • A comprehensive case management component for catastrophic/high risk medical cases.   The broad scope of this program is unique.

So what have the results been?  In its first 6 months of operation the program saved the State’s Medicaid program more than $15 million.   Greater savings are being realized in its first few years of operation.  Further, based on our regular reviews of the program, the quality of care to clients has improved.  Pretty much a win/win.

August 16, 2010

Client Survival Guide: Be Honest About Barriers

No one likes to show off their warts. However, on a project, it’s critical to get the warts on the table so they can be managed. Take time before your consultant starts a project and think about all the factors that might be a barrier to the success of the project. Write these down and share them with the consultant as soon as they come on board. Together you can identify how you’ll deal with these barriers.

How do you define “barriers?”. Barriers are anything that could impact the scope, cause the schedule to change, effect resources, or impact the successful outcome of the project. To spur your thoughts on barriers here are some questions you might ask yourself:

  • Do we clearly know all individuals or groups that have an interest in the outcome of the project?
  • Do we know the “scope” of the project?
  • Are there any individuals or groups that are problematic (unsupportive)?;
  • Are we communicating adequately with everyone?
  • Is the schedule realistic (or do you know)?
  • Do we clearly know what defines “done” on the project?
  • Are there funding issues?
  • Is the project organization clearly defined?
  • Are project team roles and responsibilities clearly defined?

Most people know the top barriers facing their project but often feel awkward about discussing them – particularly with a consultant new to the project. Likewise your consultant may notice things that they are reluctant to bring up (being the new kid on the block). But doing so (discussing the barriers) will open up the relationship with your consultant and allow you to mutually identify solutions. This, while not eliminating the warts, allows you to manage them.


July 28, 2010

HIT & HIE Resources

With the July 13th release of the Final Rule on Meaningful Use and the Medicare / Medicaid Provider Incentive Program we’ve been pretty busy around here. Here are a few resources we’ve found valuable in helping States learn about the final rule and HIT and HIE in general. We thought you all might benefit from having them gathered in one place:

HHS Webpate on HIT (this includes a link to the final rule document)

CMS Factsheet on Meaningful Use

CMS Fact Sheet on Medicaid EHR incentive Programs

We’re working on an overview for clients that we’ll post soon.


July 7, 2010

Client Survival Guide: Are we doing the right things?

The Project Management Institute (PMI) defines project scope as “The work that needs to be done to deliver a product, service or result with specified features and functions.”   One of your jobs as a buyer of consulting services is to make sure your consultant stays within scope.  That is, they are doing the work they need to do to give you what you require and no less or more.

Why no less?  This one is kind of obvious.  If your consultant is doing less than you need you won’t get what you require.  Consultants will do this consciously if they are behind schedule and/or over budget.  We see it when we are providing QA for large system projects.  For example, the development vendor is behind schedule/over budget and they try and convince the client that they don’t need as much system testing or that the bugs can be fixed after the system is implemented.

Why no more?  There are really a few reasons here.  First if your consultant is being paid by the hour – it’s costing you money!  The more subtle but important reason is even if your consultant is on a fixed price contract doing more costs time.  Your projects won’t finish on time.  Allowing your consultant to do more may also distract them from doing their best on more critical tasks.

How do you make sure your consultants are within scope?  Here are a few simple suggestions that will go a long way to making sure what you need is delivered on time and within budget:

  • First every project no matter how small should have a work plan.  This can be something as simple as a to-do list or as complex as a full blown task plan identifying task, task dependencies, timing, work effort, staff assignments etc.  Don’t worry the technicalities; your consultant should make their task plan available to you.
  • You should review the plan before work begins and clearly understand how each to-do or task contributes to the end product you need or want.  If there are tasks that don’t appear to contribute ask your consultant why they are in there.  If something appears missing ask why it’s not there.  Remember every work step should contribute to the end result you hired the consultant to produce.  Be persistent until you get an answer you can understand.
  • You should review the progress against plan on a regular basis with your consultant.  Regular status meetings are a good place for this.  Get them to tell you what they’ve done from the plan.  Be careful they’re not doing work that isn’t listed on the plan.  If they do things not on the plan ask them “why?”  If they are skipping tasks on the plan ask them “why?”  There may be very legitimate reasons.  Perhaps they forgot something that should be in the plan (have them add it to the plan) or there are things in the plan that really don’t need to be done (have them explain why and then remove it from the plan).  If there is work you think should be on the plan but isn’t raise the issue with your consultant.
  • Last, as your project closes an easy way to verify your consultant has done what they promised is to review the plan to verify that each task is complete.  This doesn’t guarantee what they did meets your needs – just that they did what they said they’d do.

Shouldn’t managing the work plan be the consultant’s responsibility?  Absolutely.  We’re not suggesting you manage your consultants plan – what we are saying is you need to continually verify the work being performed will get you what you need.  Believe it or not consultants don’t always think about whether the work they are doing is leading to the result you want.  Many consultants get bogged down in the day-to-day work and loose sight of the big picture.

It is prudent for you as the buyer of consulting services to verify the project scope will lead to the result you want.

This is part of a series of articles designed to help clients and their consultants have more effective and efficient engagements.

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