Look who’s updating those data dinosaurs
Nearly a dozen states are focused on reducing the costs of presenting benefits eligibility information to caseworkers using different approaches, including service-oriented architecture
- By John Pulley
- Oct 16, 2006
Unwieldy mainframe systems have been the electronic backbone of states’ social services programs for decades. Now, those outdated systems are lumbering toward the scrap heap of technology. Eager to improve the delivery of health and human services, states are replacing their mainframes with more powerful, more nimble systems that incorporate sophisticated service-oriented architecture (SOA).
The transition is akin to replacing a two-toed sloth with an ocelot — the DNA is fundamentally different. Bridging the gap between technological obsolescence and best-of-breed information technology is made more challenging because demands on states’ resources often require social services programs to do more with less. In addition to the scarcity of funds, few states have the political wherewithal or the risk tolerance to replace their decrepit processing systems in one fell swoop.
Instead, states are seeking to manage political risk and financial concerns by balancing the high cost of keeping older mainframes on life support against the high cost of decommissioning and replacing them. Often their goal is to deploy new hardware in phases, reduce redundant business practices, employ rules-based interfaces that are easier to use, and provide information to beneficiaries and caseworkers via the Web.
Early efforts to rush some systems into place have resulted in high-profile setbacks that have tempered the go-fast approach of other states, most of which are expected to take an iterative approach to modernization for the next few years, IT experts say.
“This isn’t rip and replace,” said Bill Cooper, vice president of sales and business development at Teradata, a division of NCR Government Systems.
The transition costs will be about $1.3 billion through fiscal 2009, with individual projects in the $25 million to $100 million range, according to a recent report on states’ efforts to integrate eligibility application processing for social service programs. Those projections were made by Input, which provides market research that aids companies that work in the government sector.
“Right now, the primary goal is to drastically reduce the cost of presenting information to caseworkers,” said Chris Dixon, a senior industry analyst at Input.
Impetus for change
Retiring aging mainframe systems is long overdue, experts say, but a lack of funds to replace them has kept them creaking along for years. Now, however, the financial sting of buying new systems is finally becoming more tolerable than the chronic pain of continually patching up antique technology. Not only are the old systems costly to maintain, they hamper states’ abilities to improve the efficiency of delivering social services to people who need it, observers say.
J.D. Hickey, former director of the TennCare system, describes the challenge of extracting useful information from antiquated systems, such as the one Tennessee relied on for many years, as a hostage situation.
TennCare has oversight of the state’s Medicaid program and a separate program that insures residents who lack medical insurance but do not qualify for Medicaid. When Hickey became director two years ago, TennCare employed 400 people, including 200 IT workers to keep the old system running.
Patching it together with the metaphorical equivalent of bailing wire, duct tape and Popsicle sticks cost the state in excess of $10 million annually — a bargain of sorts. “It’s not unusual for these to be $100 million bidding situations for a multiyear [maintenance] program,” Hickey said.
For all the resources the state poured into maintaining the old system, it provided useful data grudgingly and often only because of sustained and deliberate effort by the IT staff.
“You had to have a negotiated settlement to get the most basic management report,” Hickey says. “Everything you do ends up being a custom analysis.”
The Tennessee scenario is not unusual. Poorly funded social services departments in many states continue to rely on mainframe systems that “tended to get built in a rambling way,” Dixon said, incorporating millions of lines of Cobol code inserted over several decades with little or no documentation.
“The bottom line is that states, as a general rule, have not done a good job of refreshing technology over time,” said Glenn Davidson, who leads the government practice at EquaTerra, a company that advises organizations about outsourcing IT functions. “They haven’t had the capital to make that investment.”
States’ obsolete computer systems have become increasingly inadequate at a time of rising health care costs, swelling rolls of uninsured residents, and legal mandates to increase the efficiency of health care and other benefits programs.
In addition, the call to share data among federal and state programs and a paradigm shift in the health care world that is moving the focus of medical attention from treatment to prevention have affected systems.
The change is “forcing agencies to turn to computational sophistication to deal with huge volumes of data,” Cooper said. “Pulling it all together transforms data into knowledge.”
Among the first integrated eligibility projects to use client/server and expert systems technology was Nebraska’s N-Focus system. It consolidated seven or eight unsophisticated payment and tracking systems, each of which maintained databases with unique protocols that made them inaccessible to the other systems.
Before the state installed its new system, frustrated caseworkers developed paper files from which they manually entered data into disparate computer systems that managed information for the state’s social services programs. Clients receiving benefits from multiple programs were identified by redundant and inconsistent beneficiary profiles. Sometimes workers were required to include a decimal point when entering financial data. Other times the decimal was not needed. A beneficiary designated as a “homemaker” in one system would be classified as a “housekeeper” in another.
“Users were driven crazy by it,” said Margo Gamet, applications service manager for the Nebraska Health and Human Services System. “The state was paying for redundant storage and paying for programmers to build the same stuff over and over again.”
N-Focus, which was implemented from 1996 to 1998, consolidated the administration of multiple social services programs, including food stamps, service vendor payments, public assistance and foster care.
In phase two of the implementation, the state’s child welfare program was incorporated into the new system after an analysis determined that two-thirds of the data collected during intake for other programs was being recaptured in child welfare files. Nebraska remains the only state to consolidate its child welfare system with an integrated eligibility system.
“For the first time, we could see all the services given to any family,” Gamet said. “The hard part is we have had to maintain about 35 unique user profiles that allow people to see only certain pieces of data inside the system.”
A person working on a family’s food stamp benefits, for example, can see that there is a child welfare case on file, but that person can’t read the narrative of the case.
“It’s based on the need to know,” Gamet said.
The system now incorporates about 40 programs, including health, social services, juvenile justice, services for the elderly, the Medicaid waiver program, programs for people with developmental disabilities, and early intervention and refugee resettlement programs. But less than a decade since going live, the system has reached a level of maturity that qualifies it for assistance.
“We used to be the greatest thing on the block,” Gamet said. “Now we’re looking to upgrade what is now a legacy system. The technical platform we are on is aging.”
Even as states move to acquire new systems for managing social services, recent missteps in Texas have tempered the march to modernization, if only temporarily.
The Texas Integrated Eligibility Redesign System (TIERS) was conceived to modernize out-of-date 1970s technology used by the state’s Health and Human Services Department. Employing a browser-based system to integrate the application process for more than 50 health and human services programs in Texas, officials had hoped to save money and improve service delivery, said Ted Hughes, a spokesman for the Texas Health and Human Services Commission.
The implementation of TIERS has not gone as planned. Problems with a two-county test program have delayed a statewide deployment of the new system. Call centers that a private vendor established to handle claims have performed poorly, and plans to eliminate 1,000 caseworker positions and realize cost savings have been put on hold. The state has offered bonuses to retain employees whose positions had been identified for elimination.
In addition, applicants for food stamps have had problems receiving benefits, and thousands of children were inadvertently dropped from the state’s health insurance program.
“The Texas example is not going to embolden a lot of states to go down that road,” Dixon said of massive one-shot overhauls that he calls the big-bang approach.
“There is a pause in the market,” said Thomas Stucke, chief technical officer at Qualifacts, an IT company. “Everybody is looking and deciding how to make the first move. Our outlook for the industry is more commonality going forward and less customization.”
If Texas took a jackrabbit approach to integrated eligibility, California’s CalWorks Information Network (CalWIN) system is the tortoise. The network recently concluded implementation of a new integrated eligibility system throughout an 18-county consortium by bringing one jurisdiction online every month for 18 months.
The California consortium and its partners “designed and developed a state-of-the-art, modern, robust eligibility determination system designed against SOA principles,” said John Petraborg, welfare and benefits expert at EDS, a vendor in the CalWIN project. “They went from 1960s technology to current state.”
The core application was designed to allow either the consortium or its individual counties to add new programs when they are ready.
“If you can break [implementation] up into manageable pieces, the chances of success are better,” Petraborg said. “That is enabled by service-oriented architecture.”
Pulley is a freelance writer based in Arlington, Va.**********