Application Service Provider the way to host services data.

The issue is control. Who has it, consumer/citizen or government/supplier? Can it be effectively shared by more than one interested party at a time? Is it simply a matter of policy or is it something that transcends into the realm of inalienable civil rights? Can costs be lowered when control is shared? In the public service arena, what is the effect of managing control on systems and technology?

The emergence of self-direction in health and human services is well past the proof of concept stage. From the Patient Bill of Rights legislation to the cash and counseling concept adopted by Medicaid, the benefit of increased consumer/citizen control is good social policy in both social and data-driven terms. Documented studies show that this approach tends to yield much higher self-reporting of consumer/citizen satisfaction and lower costs for necessary services compared with traditional provider contracting methods.

The growing challenge for federal and state policy-makers and state health and human service agencies is the ability to document and ensure that the stewardship of public resources is not compromised. Scarcity of resources demands not just that the cost is decreased but also that consumption follows the "no more-no less" allocation principle.

[ILLUSTRATION OMITTED]

What do states need that they don't have to effectively manage in this new environment, one that proliferates placing the consumer/citizen as the employer of the people providing their services and supports? After all, this is not your grandmother's case management system.

1. The advantages of using an Application Service Provider, or ASP, to host government services data are greater than ever. Using a "software as a service" approach provides the security of a contractual partner responsible for both current and future business practice modifications within predictable and reasonable cost parameters. The result is a pristine data environment and the agility to rapidly respond to new program and operating requirements.

This is doubly important as the state government information technology workforce and available budget have been shrinking over the last decade. Costs can be greatly minimized when a web-based solution is available to all the participants in the delivery of state services: consumer/citizens, care providers, service coordinators/case managers, billing agents, claim managers and program administrators. IT purchasing and operations costs are negated as the only requirement is a web browser. Field staff and others can directly put in required information while still in the field and all information access is secured through the web portal security.

2. State Medicaid Management Information Systems were not developed with employer-side tax reporting capabilities. Yet when a self-directed care model is used, the claim must include units, rate and employee tax obligations. It is not effective for states to purchase and manage accounting engines to produce the payroll reports needed both for accurate claims submissions but also for IRS tax reporting forms and processes. The best solution is to have a competent payroll/tax industry service that has the capability to import a unit/rate payroll report, perform the needed tax calculations, and export the new information back into a claim management system for utilization reporting and claims processing.

3. Many Medicaid waiver programs feature individualized budgets that promote increased consumer/citizen responsibility to manage allocated resources to address their medically necessary support requirements. The current MMIS is not the best way to manage individual account utilization and balances. A hosted data structure that functions directly through service authorizations contained in the plan of care meets this need. Both service pre-authorizations (as delineated in the approved plan of care) and post-authorizations (evaluation that services provided are within the plan of care service authorization and the resulting claim can be paid) are most efficiently and accurately managed in this way. Post-authorizations are fully compliant as the data structure directly links the approved provider to the goal, service code, budget, rate, and even any required treatment or progress documentation.

4. Required paper work and time paid to perform non-treatment functions (recording, signatures/permissions, submitting, etc.) are minimizing advancements in treatment and support methods. An external ASP provider can be tasked with analyzing and implementing automation opportunities throughout the business process.

5. A great deal of cost (time and resources) is consumed by reporting functions. Paper-sourced information is gathered/input and event/monthly/ quarterly reports are produced long after the service has been rendered and paid (rightly or wrongly so). If all parties are connected through a web-based platform that includes business intelligence that associates and limits information access appropriately, action alerts, reports (individual and program level), and activity notices can be universally available in real-time. The program management benefits can be extraordinary.

The rewards for government agencies that invest in an ASP relationship will be lower program operating and fraud/abuse/error costs and much more active, responsible and satisfied consumer/citizens.

Scott C. Pelham is consulting services director at Greystone Consumer Empowerment Systems.