Gary B. Redding has been on the job for less than a year and already he's tackling the biggest assignment he'll probably face working for the Georgia Department of Community Health, and possibly of his career.
As the new DCH commissioner, Redding faces the daunting task of guiding the agency as it consolidates claims and administration of four state health-care plans into one program, which will be operated by outsourcing giant Affiliated Computer Services (ACS).
It's by far the largest state health-care integration project involving information technology, according to several sources. Certainly, it's one of the most unique. Never before has a state put the claims administration of its Medicaid, children's health care and state employees and teachers' health care under one IT roof.
"I've told the staff that this is probably the most important project they will work on for quite a while," said Redding. "It's priority number one for us."
Leaving a Legacy
The five-year, $351 million contract with ACS will vault DCH into the 21st century, replacing green-screen terminals and legacy mainframes with client-server technology, Web portals, electronic commerce and much more.
More importantly, the new system will standardize how state-financed health care is administered, creating the potential for tremendous economies of scale and cost savings.
The contract, announced in July 2001, replaces one held by EDS, the largest Medicaid claims processor in the country. Under the new terms of agreement, ACS will design and implement a new system that will provide claims processing, customer service and administrative support for all of Georgia's public health benefit programs. ACS, a $2 billion IT outsourcing firm which handles Medicaid claims processing in 25 states, will also operate the system for DCH.
The new system will be built using technology and services from a number of vendors, including IBM, Inktel, Computer Sciences Corp., GovConnect, ABSS, Hypercom and PrimeWire. Current plans call for deploying the Medicaid and PeachCare for Kids modules by Dec. 1, 2002; the state health benefit plan by July 1, 2003; and the teachers' health plan by Jan. 1, 2004.
Redding and Chief Information Officer Wade Miller realize they are blazing a new trail. With no other project like it in the public sector, they have little to model it after. But they clearly understand the goal.
"We've brought all [the plans] together to gain some measure of administrative efficiency and to simplify the process as much as possible, not only to save money, but also to ease the burden on the providers," explained Redding.
For the first time, providers will be able to review up-to-the-minute information about the status of members, claims and payments through the system's Web portal. They will be able to look at payment histories, check a member's eligibility, even enroll online as a provider.
The state's 2 million members will have access to similar features over the Internet. Everyone will be able to check the status of a referral, a claim or prior authorization. The same goes for inquiries about eligibility and current benefits. State employees will be able to enroll and change or drop coverage online. Teachers will be able to submit change of address information. And all members will have access to a database of available medical and agency services in their community.
The system is HIPAA-compliant and will be ready to handle all claims filed under the new standards by the October 2003 deadline. ACS has also agreed to construct a mail processing facility in one of Georgia's "tier one" counties, where poverty and unemployment is higher than the state average. The facility will eventually employ about 70 workers who will open mail, scan documents and convert them into computer-readable text using optical character recognition software.
Perhaps what's most intriguing about this project are the unique clauses in the