HIT Standards Committee: Enrollment Workgroup thinks big, starts small

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In welcoming individuals to the 2014 environment, setting a framework for standards that will abbreviate the enrollment process will facilitate development of a simpler process for applicants, according to an update by the HIT Policy & Standards Committees Enrollment Workgroup on June 30.

Referring to Section 1561 of the Patient Protection and Affordable Care Act as “homework,” Aneesh Chopra, chair of the Implementation Workgroup and U.S. chief technology officer, said that the HIT Policy & Standards Committees Enrollment Workgroup has been tasked with producing recommendations on standards before policy frameworks are finalized. Standards will facilitate enrollment in federal and state Health and Human Services' programs through methods that include providing individuals and authorized third parties notification of eligibility and verification of eligibility.

“We are committed to ensuring that what we do is actually in service,” asserted Chopra. “The bottom line is, we will come back to this committee over the course of the next several months because we have to issue recommendations to the Secretary by September.”

With eyes to 2014, the enrollment workgroup will begin its homework by conducting an inventory of standards already in use, acknowledging and identifying gaps between what is in use today and what is required and recommending candidate standards for federal and state Health and Human Services' programs in following areas:

  • Electronic matching across state and federal data;
  • Retrieval and submission of electronic documentation for verification;
  • Reuse of eligibility information;
  • Capability for individuals to maintain eligibility information online; and
  • Creative notification of eligibility (including in-person, online and cell phone text messaging).

Potential deliverables
The workgroup is the midst of an inventory process, observing standards-based data exchange activities used to enroll individuals in health and human services programs. In addition, the group plans to recommend candidate standards for data elements and messaging and propose process steps to fill in gaps to ensure a “rapid-fire turnaround” of identifying the need and building working prototypes to deliver eligibility and enrollment services, noted Chopra.

Potential data elements generated by the group that were offered by Chopra included name, address, residence, income and citizenship. For messaging standards, how to check eligibility and enrollment, match consumers across systems and how to communicate enrollment information to the individual as well to the entity, including the health plan, were proposed.

In addition, Chopra said that one of the main concerns of the group is how to achieve privacy and security in the transport layer while accomplishing these standards.

“We need to conceptualize standards that might be useful and work across a variety of use cases or architectures,” explained Chopra, citing front end user-facing consumer portals, which could consist of online, mail and telephone-based systems – or state or federal exchange portals.

With that in mind, Chopra offered constraints, or a “core mission” of the workgroup. “We want to ensure, as the policy committee has done, that the consumer would be at the center, making the enrollment process less burdensome and simpler, entering the information once and reusing it where necessary and to make it simpler for the consumers to move between programs, with particular emphasis on 2014.”

Other principles of the workgroup offered by Chopra included:

  • Keep it simple - Recommend standards as minimal as required to support the necessary policy objective/business need, and then build as you go;
  • Don’t let “perfect” be the enemy of “good enough,” i.e. go for the 80 percent that everyone can agree on;
  • Keep the implementation cost as low as possible; and
  • Do not try to create a one-size-fits-all standard that adds burden or complexity to the simple use cases.

A base use case for a consumer-facing web portal that “would support a number of different policy scenarios in 2014,” is currently under discussion by the workgroup, said Chopra, noting that the case has been introduced to the group this week and is still in draft.