Hawaii Extends Medicaid Eligibility System's Reach to Handle Data Analytics

Hawaii is squeezing everything it can out of KOLEA, its Medicaid integrated eligibility system.

by / January 5, 2016

Hearing that a large project was completed on time and on budget is becoming increasingly rare in government. But Hawaii made it happen on Oct. 1, 2013, when it completed its $144 million integrated Medicaid eligibility system, called KOLEA. Contracted chiefly through vendor KPMG, the system now automatically processes about 60,000 beneficiaries each month — and the state is looking to extend the system's reach to process big data in other state agencies and help inform decisions made by the Legislature.

About 90 percent of the project's funding was provided by the federal government, but the Affordable Care Act (ACA) made the Oct. 1, 2013, deadline unmovable — and sooner than the state wanted. Still, the state and its vendors managed to transfer about 275,000 Medicaid files from the legacy system and immediately enrolled an additional 30,000 Medicaid clients when ACA expanded eligibility.

They were able to complete the project on time for two main reasons, said Craig Grivette, principal at KPMG. First was cooperation from the state and hard work from everyone on his team, many of whom relocated to Hawaii for the project, he said. Second was the fact that KPMG built KOLEA using off-the-shelf IBM and Oracle products, rather than building an entire system from scratch.

"I think the lesson out of that is one that many states can learn from, which is that the need for large customized solutions is a very dated perspective," Grivette said. "The market has matured and the opportunity for simpler, more configuration-based solutions, versus large custom software solutions, is upon us."

Using a non-custom solution is also what is allowing the state to expand the system's reach, using it for other analyses. General tools, Grivette said, allow for a broader range of solutions.

During the system's development, there were two main challenges. The first, he said, was the short timetable; the second was confusion and scrutiny around the project. The state's ill-fated ACA portal was being developed at the same time by an independent nonprofit, and though the Medicaid system was not related, many in the marketplace and the media didn't understand that, Grivette explained.

"They didn't really have time to stop and think about it, but it was a little demoralizing I think for our client at the time," he said. "It showed their character and the strength of their leadership that they were able to power through it."

Hawaii's project leaders largely attributed KOLEA's success to the cooperation and interdepartmental partnerships. Getting buy-in is often challenging with projects that span many interests. But everyone was on board with KOLEA, said Aileen Hiramatsu, KOLEA's project manager.

"Even within the department, there was support by the leadership," Hiramatsu said. "I also had support by the division administrator and the department head because to get something done of this magnitude, you really need a lot of people working together."

Despite the cooperation, getting through everything on such an aggressive timeline was difficult, she said, because with many large projects, there's always a contingency plan in pushing back the deadline — but they didn't have that option with KOLEA. The state had to develop the technology, make operational and programmatic changes, and train staff on the new way of doing things all at the same time.

Hawaii faced a lot of scrutiny in KOLEA's development because such projects are so expensive, said Hawaii Department of Human Services (DHS) Director Rachael Wong. But the state has a lot to be proud about, because following procedure resulted in a favorable outcome.

Wong, who joined the state Jan. 1, 2015, is helping the Office of Enterprise Technology Services to apply the system toward new analytics functions.

There are two main goals with KOLEA, Wong said.

"One is that the individual or family in the community has a better experience, being able to log onto a single portal or access point and determine if they're eligible for these different public assistance programs," Wong explained. "And then on the government side of it, what we're doing is streamlining efficiencies. So instead of having different divisions within our department having to do things separately, it's one integrated system."

In the coming months, the state will look at applying its integrated database toward the improvement of public health, education and employment. Officials can perform analysis and predict what the outcome of different decisions will be, Wong said.

"We're trying to take advantage of a platform that's already been built," said Hawaii CIO Todd Nacapuy. "We're being smart as a state and seeing if there are ways to access all the hard work that the team has put in from DHS on this very large, engineered solution — to use it to do larger big data or data analytics within our environment."

The state will first apply the system toward financial and budgetary questions, Nacapuy said, adding that it also wants to answer questions the state Legislature might have so decisions can be made based on empirical data, ultimately ensuring that money being spent is in accord with what the budget allocated.

Systems like KOLEA and the opportunities it's now giving the state are born from cooperation, Nacapuy said.

"For big projects and implementations, there needs to be a partnership and an understanding throughout the entire state of what the goals are," Nacapuy said. "And whether centralized or decentralized, either way, that the organization can support the individual agency. That's really the big message here in why other projects have failed and why this one has become a bigger success — we are truly partnering together to ensure that this project is successful instead of working against each other."

Colin Wood former staff writer

Colin wrote for Government Technology from 2010 through most of 2016.