AHS Looks For New Technology To Improve Services


By Neal P. Goswami


MONTPELIER — Katelyn Chase is very familiar with the antiquated look and limited capabilities of the state’s ACCESS computer system that is five years older than she is.

The 27-year-old benefits program specialist works in the Agency of Human Service’s Economic Services Division at the Morrisville office. Like her colleagues, she wrestles every day with the 32-year-old computer system to ensure her clients receive proper benefits and information.

The agency is looking to replace its current system, known as ACCESS, which went live in 1983, with a newer, sleeker software ensemble. 

The Integrated Eligibility Solution, or IES, that is sought would allow more than 40 state benefits programs to communicate across departments and divisions within AHS and streamline the process of determining the eligibility of Vermonters for assistance.

“It’s all about the ability for someone to have one door to go into to find services. It’s about being able to share information,” AHS Secretary Hal Cohen said in an interview earlier this month. 

“One department may not be speaking to another department and what Integrated Eligibility does for us is it gives us the ability to talk to each other in a different way,” he said. “We would be able to go and check and see where this person is receiving services in other places.”

Also, Cohen said, the state is losing out on some federal funding because it is not sophisticated enough to compile data the federal government requires.

“The current ACCESS system, because of some of its limitations, it leaves some federal monies on the table because we’re not able to supply certain kinds of data,” Cohen said. “If we were able to supply this data we might be able to get other resources.”

Into the 21st century

Chase, Cohen and plenty of others are dreaming of a system that is more efficient and effective — and less prone to errors. 

“The system that we have now … is over 30 years old. We recently had some people look at it. It’s amazing, it has the old screens,” Cohen said. “You’re talking about something that’s very antiquated and it can’t do a lot of the things that we need done.”

For Chase and her colleagues, providing accurate information and benefits is a challenge.

“Our biggest concerns from a long-term care perspective is that when you input information into ACCESS, I would say seven out of 10 times the notice that it spits out to the client is incorrect because it’s incapable of doing the kind of computing of what you just told it to do,” she said. “It doesn’t always do what it’s supposed to do.”

State workers are “constantly reaching out to our IT team to have them fix things,” Chase said, but often the system “gets to a point where it’s on overload where it locks us out of cases and you can’t do anything at all.”

Still, Chase said the aging, workhorse system does work; “it just takes a lot longer than I think we’d like with high caseloads. And it’s frustrating to the clients.”

Everyone seems to agree that replacing ACCESS is a priority. In fact, the state is moving forward with a plan to do just that. 

A request for proposals was released last year, and Dawn O’Toole, operations manager for AHS, said five firms have responded. The agency expects to select a vendor this winter and begin negotiating a contract.

But that’s where it all gets more complicated.

‘Unique opportunity’

Sarah Clark, chief financial officer for the agency, said initial estimates peg the cost of a new computer system at $129 million. The state portion of the cost is hard to determine at this point, though.

The federal government is offering to pay for 90 percent of costs related to health care through 2018, leaving just 10 percent of the cost to the state. 

“This is a unique opportunity across the country for states who are implementing these integrated eligibility systems,” Clark said.

And much of the underlying technology used for health care programs could likely be used for other sectors. The federal government is offering 50-50 matching funds in other areas, too. 

The Integrated Eligibility Solution is just one component of the four-legged Health and Human Services Enterprise system the state hopes to complete. The three other projects are:

— Vermont Health Connect health care exchange

— Medicaid Management Information System

— Health Information Exchange Technology

The total estimated cost for all four components is $470 million, according to Clark.

The Shumlin administration received about $5.46 million in the 2016 fiscal year budget for the Integrated Eligibility solution. That follows more than $10 million appropriated in the last past five years or so. The agency has about $13 million on hand for the project, Clark said.

Officials say they will have to ask lawmakers for more funding to complete the project, but they have enough to begin. The two- to three-year effort to replace ACCESS could begin early next year.

The VHC cloud

Convincing lawmakers to pony up more cash for the IES project could be difficult, though. The struggles of Vermont Health Connect, the state’s online health care insurance marketplace, have cast a pall over state technology projects.

Cohen said the agency has learned from the VHC debacle.

“What’s really important is to learn from your mistakes. On the other hand, what VHC has done is kind of put a cloud over our work, a dark cloud. So, it’s hard to gain the trust after something like that,” Cohen said.

The two projects are very different, according to Cohen. He said the state “didn’t really know the business” of health insurance. And the federal Affordable Care Act placed states under a tight timeline to complete exchanges.

“We had time constraints,” he said. “We were told we had to get it down by such and such date. Because of that we didn’t go through a full procurement process.”

But the state does know the business when it comes to the assistance programs it has provided for decades.

“We’ve been in the eligibility business since the state’s been doing this work,” Cohen said. “We know this work. That’s really important.”

He added, “These IT things are always a process. They’re complicated, but I think we’ve done the groundwork, that we’re poised for success.”

Chase, despite her desire for a new computer system, is a bit skeptical — like many lawmakers. She said she is hoping for strong oversight of the IES project to ensure success.

“We feel like we just don’t want to see a repeat of what happened to Heath Connect,” Chase said. “We want to make sure the proper steps are in place and the experts are brought in to really iron out the process before it’s put in place.”

She added, “We don’t want to see a catastrophe with our caseloads and not being able to get benefits to our clients, because that’s what we care about most.”

‘Tremendous investment’

With Gov. Peter Shumlin not seeking reelection, Vermont will see a new governor take office in 2017. Cohen said he is not concerned that a new administration will abandon the project.

“There’s been a tremendous investment already up to this point. We’re investing additional dollars over the next couple of years,” he said. “I think the 90-10 opportunity is one that any administration that comes in, if they really look and say, ‘All right, what’s ahead of us,’ it’s something in the end that I think any administration would choose to go forward with.”