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Texas converts minds first, technology second in system upgrade.

At the risk of disappointing Policy & Practice readers, the guy in charge of implementing Texas' new eligibility system insists that what he's doing isn't really a tech project.

"This is a business processes project," says Stanley Stewart, chief of staff for eligibility integration for the Texas Health and Human Services Commission. "Not even the most brilliant technology project will work if you don't address the business and human sides."

Stewart is only half serious. In his next breath he lavishly praises HHSC information technology staff for critical assistance in rolling out the Texas Integrated Eligibility Redesign System (TIERS) to six regions in the Lone Star State. But a look at his strategic method shows he's dead serious about the need to convert hearts and minds as well as hardware and software.

This mindset didn't originate with Stewart. It's been around since Texas first decided to replace SAVERR, its legacy benefits processing system that's been used statewide since 1978. With its heart of pure COBOL, its 1970s-vintage mainframe and server backbone and its DOS-era Generic Worksheet user app, SAVERR was obsolete as the AMC Gremlin.

It also was thoroughly institutionalized. One of Texas' major "people issues" was its thousands of veteran eligibility workers who'd never used any other system. They were proud of their SAVERR expertise and many even expressed perverse affection for the old warhorse.

On the tech side, one of many challenges was the state's sheer size. A land mass bigger than France, Austria and Denmark combined and a population of 25 million-plus made it daunting to change a system that included some 500 file servers and 1,500 queue and communications servers in local offices.

SAVERR's first death knell rang in 1999, when HHSC began developing TIERS. In 2003, the state started a pilot program in two Central Texas counties. By 2009, TIERS was fully rolled out in Central Texas. The process had worked locally. Now for the hard part; repeating that process statewide.

Texas Health and Human Services Executive Commissioner Tom Suehs wasn't about to leave this job to a beginner. Suehs personally recruited Stewart, who'd pulled off a similar system conversion in Michigan. Although Michigan's population was less than half that of Texas, Stewart achieved his success under extreme pressure. In a state hammered by a declining manufacturing sector and several furloughs of state workers, any disruption of benefits delivery would have been disastrous. Stewart's team made the transition in one calendar year with no major interruptions.

Suehs brought Stewart aboard in early 2010 and shifted several key executives into new roles to directly support the TIERS rollout. Their strategy would essentially be the Michigan model with a few Lone Star-specific twists. Each region would convert all of its offices to TIERS at once. But first, they'd receive waves of state-level support, including consultation from state IT staff, training in TIERS and workload-management help from state and regional SAVERR and TIERS experts.

HHSC made training a prime focus. This included multi-week TIERS training for both current employees and new hires with follow-up help in the office from state Assistance Response Team members and TIERS users from sister regions. No one was excluded. Kirsten Jumper, Stewart's TIERS rollout director, noted that HHSC provided advance training not only to eligibility workers and supervisors but office clerks as well.

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To clear the deck of outstanding SAVERR cases, the state has relied on the TIERS Rollout Support Team, a group of SAVERR experts who complete applications and reviews in SAVERR to prepare them for TIERS conversion.

This overall strategy of jumping the starter's pistol in each region was dubbed the "rolling rollout." It seems to be working. Each new TIERS conversion has gone a bit more smoothly as regions learn from their predecessors' experiences.

In the first regional rollout under Stewart's and Jumper's leadership, the Lubbock region nailed a SAVER-to-TIERS conversion match rate of 90.4 percent. "That was absolutely unheard of," Stewart said. "The best we ever did in Michigan was 80.2 percent."

Lubbock's record didn't last long. El Paso topped it next month with 91.7 percent accuracy. Beaumont, in turn, shot El Paso's mark down in August with a 93 percent. Tyler (93.3 percent) and Abilene (93.4 percent) continued the trend. Timeliness also has been strong in each region.

With four regional conversions left to go (including the large San Antonio, Houston and Dallas metro areas), Texas' TIERS conversion has earned its share of praise. Yet Stewart swiftly quashes anything he sees as premature end-zone dancing. He and his team members continue to sweat the details in each new region and spend hours listening to workers' personal accounts of what went wrong and how it could be better.

Slow network performance has been of the most common technology issues in new TIERS offices. Some employee complaints were addressed by regional and state IT staff. In other cases, employees were asked to do their part. For example, a few network slowdowns were traced to workers using Facebook, CNN and other bandwidth-devouring web sites. Special state and local communications efforts have helped reduce the problem.

One issue all share is characterized by Abilene Regional Director Jerry Flores as "the cultural adjustment."

"The outside help we've had leading up to this conversion is going away now," Flores said, "and that's kind of like taking off the training wheels."

Stewart says he's optimistic about that adjustment process working not only in Abilene but all across Texas.

"I think our plan is pretty good for the long haul. From here, it's largely a matter of tweaking and pushing, getting good management reports and fostering realistic expectations."

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By the Texas Health and Human Services Commission

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Title Annotation:technology speaks
Publication:Policy & Practice
Geographic Code:1U7TX
Date:Apr 1, 2011
Words:973
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