Progress business rules management software is an effective tool for managing rules-based systems like health care benefits eligibility. Dr. Mark Allen shares how it has saved states like Maryland both time and costs.
On August 30–September 2, Progress sponsored the APHSA ISM Conference, in Philadelphia, PA. ISM (IT Solutions Management for Human Services Conference) brings together the top IT leadership from Health & Human Services (HHS) departments across most US States, as well as the federal government, software vendors and systems integrators.
HHS departments are responsible for administering a number of citizen benefits programs, including healthcare, TANF (Temporary Assistance for Needy Families—for cash assistance), SNAP (Supplemental Nutrition Assistance Program), child care and aging. In addition, HHS departments administer programs for child welfare (preventing child abuse) and child support.
Each state must build and manage systems to determine eligibility for each benefit program, administer the benefits programs and enforce other regulations within their domain. Each system is governed by complex, regulatory rules, which change based on new legislation passed from the states or federal government. An example is healthcare benefits, which underwent massive legislative change due to the Affordable Care Act—AKA Obamacare—passed in 2010. This new legislation necessitated massive changes to existing systems, as well as the development of new systems.
Today, most states have separate systems for each program, which is costly to maintain, and frustrating for citizens, who must apply for a number of different programs individually. Additionally, the application process for many benefits programs takes weeks, requiring manual processing. Some of the more advanced states have integrated the benefits eligibility process across multiple programs—called Integrated Eligibility. Other forward-thinking states are working to deliver real-time eligibility determination, and allowing citizens to apply for and manage their benefits online via the web and mobile devices.
Progress Corticon has experienced great success in this market. Currently 26 states use Corticon Business Rules Engine to automate eligibility determination and other tasks governed by rules and regulations.
This year, the focus of our ISM conference presence was developing more Corticon business. One of our customers, the state of Maryland, was recognized with an ISM Collaboration Award for their work on the Maryland Health Benefit Exchange. After an initial failed project, Maryland transferred a system from Connecticut, significantly reducing the time and cost to go into production. The Maryland system, built by Deloitte Consulting, uses Progress Corticon to manage their rules.
As more and more governmental organizations across the country modernize and consolidate systems to simplify benefits eligibility determination and administration, they can enable a better user experience for citizens, while saving governmental resources. Most importantly, these solutions will enable faster and more accurate distribution of benefits to the people who need them.
Dr. Mark Allen is a Progress General Manager, dedicated to advancing business automation and passionate about applying technology to improve the world. In 2000, he founded Corticon, later acquired by Progress in 2011. Under his leadership, Corticon became a leading independent business rules platform with hundreds of customers in diverse industries such as financial services, government, healthcare and insurance. Prior to founding Corticon, Dr. Allen developed rules-based systems to help physicians make better patient care decisions. Dr. Allen has a B.S. in Applied Physics from Columbia University, and an M.D. from the University of California Los Angeles.
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