Utah takes an integrated approach to human services

Software helps state agencies share information and provide benefits

Utah Cares

Utah officials are making progress in an ambitious program to promote information sharing among human and social services agencies.

Five years ago, Utah officials began rethinking how to provide benefits — such as food stamps, child welfare, job training, and other types of human and social services — through an integrated information system.

Instead of individuals going from one state agency to another to determine their eligibility for various services, state officials wanted to create an integrated system in which caseworkers could administer a wide range of services from various agencies.

By integrating information technology systems, state officials said they believed the government would save time and money; reduce waste, fraud and abuse; improve data accuracy; and provide better assistance to individuals and families in a holistic manner.

To meet those goals, Utah officials launched the Electronic Resource and Eligibility Product (eREP) project to replace the two-decade-old Public Assistance Case Management Information System, which wasn’t sharing information among agencies and programs and couldn’t keep pace with changing federal and state mandated eligibility rules and regulations. Many states face those problems.

“In the current environment, it’s a nightmare to do all of that,” said Stephen Fletcher, Utah’s chief information officer.

Utah is among a growing number of state and local governments beginning to look at modernizing and integrating systems that determine eligibility and provide better human and social services to citizens. The term for that approach is social enterprise management (SEM). Kimberley Williams, vice president of global marketing at Curam Software, based in Dublin, Ireland, said SEM is a technology and business blueprint for how organizations should do business. Curam specializes in SEM software.

“But the realities that are facing those organizations today somewhat make it difficult for them to achieve that vision of a truly integrated service delivery model that’s crossed programs, crossed agency boundaries, crossed organizational boundaries,” she said.

From the Dark Ages…
SEM enables agencies to share data and applications throughout programs and services that include unemployment insurance, worker’s compensation, employment services, Temporary Assistance for Needy Families (TANF), food stamps, child care, child welfare and child support enforcement, Medicaid and mental health.

Several experts said integrating information systems and administering services in a coordinated and holistic manner is extremely complex and difficult. Many systems are decades old, and governments must cope with replacing a retiring IT workforce capable of maintaining those systems.

State governments make heavy financial investments when integrating systems, and they must deal with federal agencies that provide significant funding for many of those programs and set down rules and regulations that states must follow.

Gene Leganza, vice president of government research at Forrester Research, said governments depend on seasoned social workers or caseworkers who know how to make those systems work, but they are also retiring in significant numbers. With the loss of the IT workforce, he said states could be left with an employee base that needs serious help.

“It’s not just bringing these Dark Ages into the modern era, [but] people are looking for a whole lot more in terms of integrated services,” he said.

Leganza said about one-third of the states are pursuing some sort of integration while the remaining states are thinking about it or setting strategies. Several states have no money, and their IT employees are exhausted by trying to keep up with federally mandated changes. “If you stay still, you’re moving backwards,” he said. “It’s a bad situation for everybody.”

Leganza, who has been researching the SEM market for about a year, said major systems integrators, vendors and others recognize the burgeoning market. Many are developing a service-oriented architecture approach toward human services software design to isolate and change business rules.

The federal government has also helped spur the market. In the past, the federal government wanted states to reuse solutions developed by systems integrators, which are referred to as transfer systems. But now federal officials have agreed that states can use commercial software, he said. Companies such as Curam, Albion and Harmony Information Systems are some of the major players providing human services software to state and local governments. Other companies such as SAP and Oracle also want to nudge their way into the market.

…to the modern era
In Colorado, state officials replaced a 20-year-old information system with the Colorado Benefits Management System, which determines eligibility and calculates benefits for TANF, Medicaid, food stamps and other self-sufficiency programs, said Stephen Swanson, chief technology officer at the state’s Human Services Department. Although the system doesn’t determine eligibility for all programs, including child welfare and child care, it does have an interface to those separate systems, he added.

He said EDS developed the system, which launched in September 2004 after four years in development. Colorado’s government supervises the system, but the 64 county governments administer the services. Local caseworkers can access the back-end Oracle database via a PowerBuilder front end, he said. “We host it out of a portal and run it using Citrix technology,” he said. “To most users it looks like the Web.”

In Utah, state officials decided to use Curam’s commercial software, which is being integrated by IBM in a multiphased project that has cost as much as $70 million to date, Fletcher said.

In October 2003, the state launched a Web site called Utah Cares, which helps individuals identify their needs and potential providers of programs and services. The state has also implemented an eligibility screening system that supports TANF and child care programs. This year, it plans to implement a medical services module.

The enterprise approach involves integrating eligibility requirements throughout the state’s human services, workforce services, health and other departments. When fully implemented, eREP will determine the eligibility of more than 260,000 individuals and families per month.

Fletcher said the system already has shown productivity gains among caseworkers who can now track the progress and history of individuals. The system has reduced caseloads errors by more than 50 percent. He said they also anticipate that caseworkers will process 50 percent more cases than they do now. Citizens find out the status of their eligibility and benefits quicker, he said, eliminating a manual process that sometimes took weeks to generate a response.

Integrated human servicesProject: Utah’s Electronic Resource and Eligibility Product (eREP).

Purpose: This integrated solution determines eligibility requirements among agencies and calculates benefits of services and programs — such as Temporary Assistance for Needy Families, child care, food stamps and Medicaid — for more than 200,000 individuals and families. Participating agencies: Department of Workforce Services, Department of Health, Department of Human Services and the Office of the Chief Information Officer.

Launch date: 2001.

Cost: Project costs have reached nearly $70 million.

Technology: The new system is Web-based, and the state is upgrading it to use Curam Software’s Business Application Suite Version 4, which delivers modules for planning, medical assistance, workflow, appeals, reporting and income support. The system uses IBM’s Rational Rose, and the application server runs on Sun Microsystems’ operating system. The database server is IBM DB2 Version 7 on the IBM z/OS mainframe for production, integration and system testing. The system uses IBM’s WebSphere for high-volume transaction processing for e-business.

Keep in mind: Stephen Fletcher, Utah’s CIO, said there were three important points for the success of the initiative:
1. Business leaders need to be involved in every step of the process, including the requirements, training, testing, and deployment phases.

2. Employees must understand that tools will enable them to do their work, but to be most efficient, they must change the way they do business.

3. Federal and state governments need to adjust how they think about conducting business to benefit all customers.

— Dibya Sarkar

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