{"id":49783,"date":"2022-05-19T09:42:08","date_gmt":"2022-05-19T13:42:08","guid":{"rendered":"https:\/\/statescoop.com\/?p=49783"},"modified":"2023-01-08T11:28:02","modified_gmt":"2023-01-08T16:28:02","slug":"tennessees-medicaid-program-is-going-in-on-process-automation","status":"publish","type":"post","link":"https:\/\/statescoop.com\/tennessees-medicaid-program-is-going-in-on-process-automation\/","title":{"rendered":"Tennessee’s Medicaid program is going in on process automation"},"content":{"rendered":"\n

For the past two-and-a-half years, the IT shop behind Tennessee\u2019s Medicaid program, TennCare, has been on a mission to automate as many things as possible, and it\u2019s automated a lot.<\/p>\n\n\n\n

So far, the newly automated processes are cutting down weeks of work for the program’s staff, said Hugh Hale<\/a>, TennCare’s chief information officer. Those changes, which cover everything from how the agency processes physical mail to how to it enrolls newborn babies into the health care assistance program, are greatly expanding the state\u2019s capacity serve its \u201cmost vulnerable population,\u201d he said.<\/p>\n\n\n\n

TennCare<\/a> processes thousands of applications and service requests each month for its 1.4 million members \u2014 nearly 21% of the state\u2019s population.<\/p>\n\n\n\n

\u201cWe\u2019re trying to do everything we can to make ourselves easier to deal with, easier to access, easier to apply for services, faster to get the services,\u201d Hale said. \u201cEverything is centered around the member.\u201d<\/p>\n\n\n\n

Baby bots<\/h3>\n\n\n\n

Among the automated processes TennCare’s using is software that scans returned mail and tries to find an accurate forwarding address. Hale said that tool has \u201cgreatly reduced\u201d the amount of physical mail his staff has to process.<\/p>\n\n\n\n

TennCare also runs machine-learning software that scans the documents recipients submit to verify details about their lives, such as birth certificates and driver\u2019s licenses. Hale said about one-third of those documents can be verified and scanned, work that previously was done by hand.<\/p>\n\n\n\n

A bot that automatically enrolls eligible newborn babies replaced a process that previously required people to fill out \u201c17 screens\u2019 worth of information,\u201d Hale said.<\/p>\n\n\n\n

\u201cIt used to take weeks to do this, now it\u2019s less than three minutes, and no human intervention,\u201d he said of the \u201cbaby bot.\u201d<\/p>\n\n\n\n

Adult enrollments are being automated, too. Hale said about 40% of applications are \u201cno-touch,\u201d meaning they\u2019re approved by a computer or forwarded to a human worker who needs to verify a detail.<\/p>\n\n\n\n

\u201cThat\u2019s huge,\u201d he said. \u201cIt used to take us two to three weeks to give someone services.\u201d<\/p>\n\n\n\n

TennCare\u2019s process for verifying assets submitted by users includes more than 140 interfaces, Hale said, providing even more opportunity to automate how the agency works. He said his team is currently developing an AI \u201cnudge bot\u201d that notifies staff when an anomaly appears in a user\u2019s profile. If a user\u2019s income fluctuates wildly each month, for example, the bot might direct a staff member make an inquiry.<\/p>\n\n\n\n

\u201cThe idea is to make sure that the people who need the services get them and those who don\u2019t don\u2019t,\u201d Hale said.<\/p>\n\n\n\n

AI QA<\/h3>\n\n\n\n

The biases that make their way into many automated technologies receive more attention in fields like law enforcement, but Hale\u2019s agency is also taking steps to ensure TennCare’s AI doesn\u2019t run amok. He said his team performs quality assurance on newly automated processes and deploys them incrementally to ensure they\u2019re working as intended.<\/p>\n\n\n\n

\u201cWe\u2019re automating everything we can, but when we automate it, we\u2019re very sure to verify integrity because we don\u2019t want to just trust the system,\u201d he said. \u201cWe QA it to death. We do extensive testing and even on roll-out, we don\u2019t allow the computer to make decisions without verifying by human for several months and we\u2019re very comfortable with it before we turn it loose.\u201d<\/p>\n\n\n\n

Hale said that change management also plays a large role in the success of the program. Offloading more work onto software allows each staff member to reach many more users in the same amount of time, but those changes to peoples\u2019 schedules can be disruptive or seem unwelcome to some. <\/p>\n\n\n\n

\u201cWe spend a good bit of time before we do anything documenting current roles of the staff and documenting their future roles with the new system and then looking at the education required, the training required and the organization that\u2019s required before we ever go into implementation,\u201d he said.<\/p>\n\n\n\n

And when the agency transitions to a new automated process, Hale said it assembles a \u201cwar room\u201d of experts who can immediately answer staff questions so that the shift is as seamless as possible. <\/p>\n\n\n\n

All about the business<\/h3>\n\n\n\n

Rather than building in-house, most of TennCare\u2019s software is designed by Hale’s team and built by vendors. Hale said a multi-vendor model allows him to rapidly scale his team up and down as needed and draw on the best solution for any given problem. He said a monthly \u201cpartner council\u201d convenes the heads of all his vendor partners and they can talk about problems they\u2019re having and who\u2019s best equipped to solve them.<\/p>\n\n\n\n

\u201cI foster an environment of collaboration even among vendors that consider themselves competitors,\u201d he said. \u201cThat works very well.\u201d<\/p>\n\n\n\n

Perhaps the automation program\u2019s most important element is the partnership between IT and the state\u2019s business leaders, Hale said.<\/p>\n\n\n\n

\u201cWe\u2019re in a very proactive position where we have business relationship managers that actually sit in our eligibility shop to form really tight relationships between business and IT,\u201d he said. “We help them develop their process roadmaps, which leads to an IT roadmap. It\u2019s the partnering with the business and the partnering with vendors that really guide our success.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

TennCare CIO Hugh Hale said he wants to automate as many of his agency’s processes as possible to make themselves “easier to deal 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