Most state government health and human service agencies continue to rely on unwieldy legacy software to run their eligibility systems. Because of their complexity, updates and replacement projects often end up over budget and behind schedule. But with the encouragement of the federal government, some states have begun deploying commercial cloud platforms and a modular approach to speed up development and reduce risk.
In January Colorado announced it would move its Colorado Benefits Management System (CBMS) to Salesforce’s customer relationship management platform. More than 5,000 county and medical assistance site employees across the state use CBMS to determine citizens’ eligibility for food, cash and medical assistance. Each month, the system is used to process approximately 30,000 new client applications and 40,000 client reauthorizations. In addition, CBMS communicates with approximately 50 external systems.
Launched in 2004, CBMS has had some high-profile problems over the years. A 2011 report by two University of Denver professors titled Seven Years of Failure noted that “since 2004, there have been a series of promises and attempts under two separate administrations to fix CBMS so that it meets performance requirements. Nothing has worked.”
State IT officials point out that although CBMS is still a monolithic system with millions of lines of code, it actually has been fairly stable over the last few years. “We put a lot of work into stabilizing it, just because of the sheer importance of it,” said David McCurdy, the state’s chief technology officer. “But as we looked to the future, we had to ask ourselves if we want to maintain that code set or invest in something that is going to have a lot longer life and integration with other things in the cloud.”
McCurdy described the strategy this way: The guts of the system — the rules engine, database and enterprise service bus — are not being rewritten. “They will operate the same way they do now,” he said, “but we are moving them from the state data center and legacy IT infrastructure to Amazon Web Services.” Meanwhile, Salesforce will provide the new front-end user experience for the county-level workforce.
OIT executives believe that if they can build a more modular system and a new user experience on the front end, they can be more responsive to agency partners and make changes faster with lower risk and potentially lower cost.
The U.S. Centers for Medicare and Medicaid Services is funding 90 percent of the work. The timeline of the project, which is expected to cost approximately $25 million, calls for most of the development and design work to be done in 2018. “We plan to roll out the application initiation module this September,” said Herb Wilson, director of health information services and CBMS in the Governor’s Office of Information Technology (OIT). “The balance of the functionality will roll out in 2019.”
The system is being designed with a “micro services” approach, Wilson explained. “If we need to change the application initiation function in the future, we can change the front-end layout and change the workflow and rules just related to application initiation, and not impact the rest of the functions.”
McCurdy noted that the life cycle for changes to CBMS has been about nine months. “Our goal is to cut that down so we can iterate faster. With micro services, it is less risky and a smaller development effort, which should be faster and more positive in the longer term.”
The decision to use the Salesforce platform is an extension of previous work in other state agencies since 2011. “I think the state has around 95 Salesforce apps,” McCurdy said, “which is one of the largest pools of Salesforce apps of any state government. There is a comfort level with Salesforce as one of our standards.”
Colorado is working with Deloitte Consulting on the system transformation, as well as maintenance and operations. Deloitte principal Sanjay Shah noted that while many other states are making significant strides toward moving to the cloud, “Colorado will be one of the first to move an entire integrated eligibility case management system to the cloud and use Salesforce to give their citizens a better customer experience.”
Shah pointed out other potential benefits: “When CBMS is fully implemented, the system will comply with strict FedRAMP [Federal Risk and Authorization Management Program] security standards; it will be faster and easier to enhance; it will have automated disaster recovery features; and the cost of the infrastructure will be more predictable for state budget officials.”
The new user interface should make caseworkers’ lives easier, Wilson said. “A simple example is enhanced searching. In Salesforce, everything is indexed, which allows so many more data elements to be searchable, so the searching capabilities alone should help them be more efficient in doing their jobs,” he explained. “We are looking at how to make the layout and navigation more natural, so that it is like navigating other websites.”
Using an agile approach, OIT is bringing in representatives from the Department of Human Services, the Department of Health Care Policy and Financing, Connect for Health Colorado (the state health insurance exchange) and county representatives to participate in application design sessions three times a week. “We are striving to lay out the screens in a way that is more modern and more natural, but not change it so much that we have to completely retrain the workforce,” Wilson said.
Nicole McNeal, a director at consulting firm Public Knowledge, helped the state with strategic planning around its benefit management systems. She said Colorado’s approach is quite innovative, although a few other states also have made inroads. “The state of New Jersey has a full eligibility system in Salesforce,” she added, “and was successful in getting a fully configurable cloud-based solution deployed pretty quickly.”
In another example, Delaware has just gone live with the nation’s first cloud-based system for child-welfare caseworkers. State CIO James Collins said he saw several advantages to the platform-as-a-service approach. “Sometimes these systems take so long to build that by the time you are done, some of the technology has to be refreshed almost immediately,” he explained. “We wanted to have an evergreen technology that the users could have some control over. Part of our strategy is to leverage these platforms that are highly configurable, so that non-IT people can actually partially administer the system and make changes to it. That helps us keep cadence with the innovation demands that our agency partners have.”
Another advantage, Collins said, is that cloud-based platforms are natively mobile. “Our governor wants services pushed out to where citizens need them,” he said. For instance, Delaware is putting social workers in probation and parole offices to meet people where they have the need and wrap services around them. “That necessitates a mobile workforce,” he added, “and our applications have to be responsive.”
So why haven’t more states taken this approach? Some of it may have to do with perceived risk and procurement limitations, McNeal said. “This is such a complex environment, with lots of rules and regulations, and a limited marketplace of vendors. It is a high-risk area to play in, so I think a lot of states still play it safe.”
This change is not just about the benefits of software as a service, McCurdy stressed. It is also about attracting developers interested in learning newer programming languages and using bolt-on apps in the cloud. “We are going to be taking advantage of artificial intelligence and advanced analytics,” he said. “By going to the cloud, we can focus less on all the hardware and operating systems updates and more on core development delivered back to our customers.”