Online Enrollment (Easy as 1-2-3)

1. Oklahoma Health Care Authority Online Enrollment (Easy as 1-2-3) www.mySoonerCare.org

2. What’s In a Name? What Is Online Enrollment? Comprehensive Web App For For State Sponsored Medical Programs Streamlines Policy, Processes, and Access to Services Real-time Eligibility, Enrollment, and ID Generation SoonerCare • Concept submitted to CMS in summer of 2007. • Work began after approval December 2007 • Launched: Sept. 7, 2010 - www.MySoonercare.org

3. Why Did We Do It? • Over 500,000 Non-Insured Oklahomans • 22% Of Uninsured Live In Rural Areas - Limited access to OKDHS offices • Oklahomans Are Unsure If They Qualify -It’sHealthcare, Not Welfare -Private, real-time determination available 24/7 • Enrollment Process is Broken - Dependency upon Legacy Mainframe - Client Numbering - Streamline enrollment and verification - Intuitive application with editing controls

4. What Were the Goals? Empower and Equip the Members Develop Multiple Program Application Expand Enrollment to Service Locations Remove Barriers that Prevent Enrollment Increase Effectiveness/Efficiency of Process

5. Was State Policy Affected? Changing the Way We Do Business Date Specific Eligibility Rolling Redetermination Medical Home at Application

6. Why No Wrong Door? Applying at Home Computer or Community Partner Home View Applying at Agency Partner Agency View Completing Paper Form Mail to HP For Scanning Paper Application Comprehensive Applicant at Welfare Office Agency Electronic NODOS App Notification of DOS Behavioral Health DMH App Newborn Registration e-NB-1 App

7. Who was Affected? • Initial Phase • Children, Pregnancy, Families • Family Planning waiver • Behavioral Health Services • Phase II • Insure Oklahoma (Premium Asst) • Oklahoma Cares (BCC) • Women, Infants, & Children Nutrition • Phase II.5 • Affordable Care Act

8. Where To Start? Unique ID Call Center Other Programs Data Exchange Letters Notices Rules Engine Partners PCP Choice Date Specific Verifications Real-time Enrollment Adding Newborns Rolling Reviews Appeals PERM/MEQC Security

9. Simplification Is Not Simple OKDHS Agency Electronic OKDHS NON-OE (ABD) ID # Letters ID Cards Agency View Home View MMIS Eligibility Subsystem Rules Engine Yes MMIS Recipient Paper Mailed Real Time Scan-Data Entry Reason / Member No Member ID Assigned BH App NODOS Denial Letter E-NB1

10. What About Verifications? SSN Social Security Administration Agency Partners Pregnancy Income OK Employment Securities Commission (OESC) OSDH, Electronic Verification of Vital Events, Systematic Alien Verification for Entitlements Citizenship

11. Manual Verifications Coversheet (From Website) Mailed Due Date ATN Name Case # HP Scanned to Workflow Entered into System By Call Center Rep

12. How Does One Apply? Applying at Home Computer or Community Partner Home View Applying at Agency Partner Agency View Completing Paper Form Mail to HP For Scanning Paper Application Comprehensive Applicant Presents at County Office Agency Electronic

13. At-Home & Community Partner Options Programs Affected What is Needed FAQ’s Income Guidelines Tell Me More SoonerCare SoonerPlan Apply Now Manage Account Review Benefits Check Status Update Information

14. Agency Partner Options Search & Submit SoonerCare SoonerPlan View/Update Verifications Pregnancy Citizenship Identity Eligibility Alerts Certification Ending Domestic Violence Manage Member Review Benefits Check Status Update Information

15. Paper Application Mail Paper To HP Scan and Data Entry Rules Engine Letter-Notices-ID

16. Agency Electronic OKDHS Interface DHS Mainframe Rules Engine HTML Data Gathered No Denial Reason Eligible? Processing Continues for Additional Benefits Yes Update Recipient Approval Welcome Letter

17. Electronic Notification of DOS ID # Rules Engine Application NODOS Certify For Date of App No Patient on App? Yes Certify For Date of NODOS –5 days No 15 days NODOS? Yes

18. What Got Better? OLD WAY NEW WAY Available: M/F, 8am-5pm Apply 24hrs/7days 20-30 Days For Results Real Time Eligibility Individual Policy Interpret Policy Uniformly Applied No Primary Care Provider Medical Home - Enrollment Process Differs By County Streamline Business Process Imprecise data Normalized data

19. Yeah…We’re Kickin’ Apps & Takin’ Names April – September 2011 232,527 Applications Received Opened/Extended 196,597 New Application 108,795 Recertification 87,802 Denied 35,930 New Application 33,805 Recertification 2,125

20. Source Average (6 months) April – September 2011

21. Source Trend (6 months) April – September 2011

22. Blizzard In Oklahoma Application Status Feb 1st Feb 2nd Total Denied 33 29 62 Opened 198 239 437 Total 231 268 499 Health Program New Apps Recert Total STBS 4 0 4 SoonerCare 354 378 732 SoonerPlan 32 12 44 Total 390 390 780 HOME INTERNET 87% Agency Electronic 10% Agency Internet 3%

23. “The Days the State Stood Still” February 3, 2011 Blizzard in Oklahoma! THE DAYS THE STATE STOOD STILL (Or Did It?) OE Enrolls 780 in SoonerCare with Virtually Every County Office in the State Closed! Governor Fallin declares Online Enrollment Days!

24. Be Careful What You Wish For • eMPI – Client Numbering and Normalization • Confusion – Applicants/Members/Partners/Co-workers • Human Services – County Coordination is Imperative • Call Centers – Staff Up! • Organization – Enrollment Operation Structure • Automation – Data Driven System (the good, the bad & the ugly) • Conversion – Auto-populate what you don’t have • Compatibility – Browsers and Pop-up Blockers • Staffing – You’re going to need some experts! • Design Outside Box – Generic Family & Optional Denial Letter

25. We Got Some Phone Calls

26. Online Enrollment -- Answer Rates

27. Online Enrollment Effect on Total Calls

28. Where Do We Go From Here? • Phase II – Additional Populations • Insure Oklahoma (Premium Asst) • Oklahoma Cares (BCC) • WIC • Phase III - Health Insurance Exchange • Affordable Care Act • Partnership with Insurance & Health Department • Rules Engine Modifications • Phase IV – Enrollment Data Exchanges • Other Agencies and Programs

29. Future – Gather and Verify Data, Rules Gather Family Demographics

30. Future – Apply Rules, Evaluate, Enroll Real-time Decision and Enroll Rules Engine Client Numbering

31. Future – Enroll, Distribute OKDHS Community Partners Real-time Decision and Enroll Recipient Database Insurance Exchange Native American Tribes State Dept Of Health

32. Did We Learn Any Lessons? As A Matter of Fact…We Did! • It Really Does Take a Village • Build Partnerships • Keep Them Alive • Design Tool – HP Wireframe • Focus Groups/Application Flow • A Variety of Approaches Are Critical • Like “Esurance”, technology when you want it… people when you don’t.

33. Dustin Oxford Enrollment Automation Oklahoma Healthcare Authority 405-522-7141 Dustin.Oxford@okhca.org