Healthcare Access, Eligibility & Enrollment Unit (HAEEU) and 1 more...less...

Integration

# of VHC carrier errors greater than 10 days old

0Sep 2020

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Partners

DVHA-HAEEU partners with its three carrier partners (BlueCross BlueShield of Vermont, MVP Healthcare, and Northeast Delta Dental) as well as the State's systems integrator (Optum) to send new customer cases and changes to cases from the State's system to the partners' systems. Integration teams at DVHA-HAEEU and the partners work together to clean up errors, identify the root cause of defects that cause errors, and deploy fixes to defects to reduce the occurrence of errors in the future.

Story Behind the Curve

This metric measures the inventory of integration errors between the State of Vermont's system and the insurance carriers' systems that have been open more than ten days as of the last Thursday of every month.

The State's system is the system of record for Qualified Health Plans (QHPs) and dental plans, while the insurance carriers' systems ensure that providers and pharmacies can see coverage and bill for service. In order to deliver a smooth customer experience, changes that are made to customers' accounts must promptly be integrated across systems, and errors that do occur must be resolved in a timely manner in order to avoid customer impact. 

And yet, for the first few years of the Vermont's health insurance exchange, DVHA-HAEEU lacked the ability to resolve many errors through the system. Hundreds of cases lingered in error status for weeks at a time, resulting in billing problems, customer confusion, and Access-to-Care escalations. 

In March 2016, the State and VHC Systems Integrator Optum deployed their final major release to enable the processing of Medicaid renewals. With the completion of major system development work, the teams no longer had to manage continual cycles of major code changes. Instead they could focus on identifying and remediating defects and making process improvements within a stable system. This effort came to be known as the Maintenance and Operations (M&O) Surge. The M&O Surge began in March 2016 and continued into the summer of 2016.

The results of the M&O Surge were clearly visible by late spring 2016. Escalated case inventories fell 80% from March levels. Integration errors were also cut 80%. Progress continued into the fall.

For 2017, DVHA-HAEEU set a goal of having less than one-tenth of one percent of cases sit in error status for more than ten days. With more than 31,000 subscriber cases across the three carriers, that equated to an inventory of 31 or fewer errors open more than ten days.

In the spirit of continual improvement, DVHA adopted a more ambitious target for 2018 by aiming to have less than one-twentieth of one percent of cases sit in error status for more than ten days. This equates to an inventory of 15 or fewer errors open more than ten days.  DVHA met this new target in 11 out of 12 months in 2018, finishing seven months (March, April, May, June, August, September, and December) with zero cases in error status for more than ten days.

Strategy

DVHA HAEEU's Maintenance & Operations (M&O) team works closely with systems integrator Optum to monitor error reports, then reach out to associates at DVHA's insurance carrier partners and payment processor to quickly address any errors that do occur and conduct root-cause analyses as needed. 

 

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy