contract with ACS. They practically guarantee the system won't remain static in terms of technology. "We did not want to get stuck with the system we bought today and in 2010 find ourselves woefully unprepared, running software that's not supported anymore," explained Miller.
To avoid that problem, DCH stipulated that ACS and its subcontractors provide the agency with a yearly technology refresh of new upgrades for all existing software in the system. ACS must also provide the agency with a yearly report on what's new and improved in the health-care administration software marketplace, so DCH can choose to use the new technology.
Since DCH owns the license rights to the software program that will run the health-care system, the agency has required that ACS provide it with any upgrade that occurs, if and when the vendor implements another version for a different state.
All of the proposed system features and contract clauses are expected to provide DCH with the means to revamp health-care administration and deliver a number of benefits to members, providers, staff and the state. First and foremost, DCH will gain administrative efficiency by having all health-care programs under one roof. Second, the state will save money by purchasing just one system, not four separate ones, Redding pointed out.
The new system will bring powerful forces of automation to bear on what has been a labor-intensive process for handling the health-care claims of two million Georgians. It also will give DCH a mother lode of data on the billing practices of providers, as well as other actions that have been difficult, if not impossible to track in the past.
"With all the providers under one platform, we can analyze things and take a look at patterns of practice from the standpoint of what we get billed for," said Redding. "If we see some irregularities, we can have our utilization review people take a look at them."
But providers will benefit too, Redding added. The largest ones will see a vast reduction in the amount of paperwork they must process in order to get paid. And Redding promised that response time for inquiries will be much quicker. Costs that once varied from program to program will now be standardized, making it easier for providers to anticipate payment for different services they give members.
But all those benefits have yet to be realized, and Redding knows implementing the massive system won't be a cakewalk. Making sure the contractor is staffed in a timely fashion, as well as dealing with the cultural changes agency staff face, are just a few of the challenges he must overcome.
"We're blazing a new trail; it's a new day here," he pointed out.
Redding went on to describe the retooling, retraining and rethinking that occurs when the agency converts a system that is currently entrenched in paper and manual processes into one that is Web-based.
"It's going to take people time to adjust and get used to the change," he added.
At the same time, Redding and his staff must contend with many small providers who still don't have access to the Internet and aren't excited about spending the effort, or money, to change over to the new system.
"That's going to be a huge push for us," he said. "We've got to get them to see the benefits of moving into the 21st century with this technology."
Like other government officials who have tackled large IT projects, Redding and Miller have to walk a fine line between expectations and reality while continuing to meet the needs of members and providers.
"The goal is to serve those two million folks who depend on us for their health-care coverage," said Redding. "It's hard to think about that when you are in the trenches sometimes. But we need to keep our eyes on the prize."