U.S. Health Care Reform

With 32 million individuals poised to enter the insurance eligibility market in 2014, state leaders are struggling with legacy systems ill prepared to handle the onslaught.  Many present day insurance infrastructures cannot handle the streamlined eligibility process required by the Patient Protection and Affordable Care Act (ACA).  Additionally, the citizen-centric, program-agnostic approach that the ACA recommends is a new concept to many.  Coupled with the  movement across programs, “the Churn”, the challenge is mind-boggling.

Cúram for Health Care Reform is designed to help states confidently meet the challenges of healthcare reform – offering states a clear roadmap for addressing the ACA’s specific mandates and recommendations while supporting overall modernization efforts.

This comprehensive, cost-effective solution introduces new capabilities to address the ACA’s unique challenges:

• Cúram for Citizen Self-Service automates front-end processes to ensure high levels of customer service and supports compliance with the ACA’s usability and accessibility requirements
• Cúram for Common Intake improves caseworker effectiveness and helps states to meet requirements for streamlined Medicaid eligibility
• Cúram for Medical Assistance automates the rules, evidence, and streamlined eligibility requirements mandated by the ACA
• Supports qualification of individuals who may be eligible for tax subsidies to offset the cost of insurance – those in the 200-400% of Federal Poverty Level range
• Pre-built adapters and standards-based architecture support integration with the exchange vendor chosen by the agency
• Cúram for Income Support coupled with Cúram for Medical Assistance creates a true “no wrong door” environment by automating the enrollment of Medicaid, Children’s Healthcare Insurance Plan (CHIP) and other medical assistance programs with income support programs such as Temporary Assistance for Needy Families (TANF) and the Supplemental Nutrition Assistance Program (SNAP).

• Provides a proven and cost-effective solution to help states meet 2014 healthcare reform mandates while taking incremental steps toward enterprise modernization
• Supports retroactive changes in data and automatically reassesses client benefits with change-in-circumstance processing
• Supports citizen-centric “no wrong door” approach to programs
• Ensures the correct application of complex eligibility policies with evidence entities, rules, and business processes
• Helps to ensure the accuracy of client information and reduce fraud with integrated verification and evidence management tools
• Enables access to and operation by people with disabilities
• Ensures high levels of customer services and improves employee productivity
• Guides new workers through decision analysis and eligibility determination
• Delivers extensive configuration and rule-definition capabilities, reducing the need for costly and time-consuming customizations and accelerating deployment and return on investment
   

• Software built specifically for human services and social services
• Domain-specific business content (rules, evidence, business processes) out of the box for rapid deployment and lower costs
• Outcomes-based and client-focused solution
• Easy-to-navigate interface with common intake for improved user productivity
• Enterprise approach – not a siloed or single-program approach – for optimal visibility and coordination
• Phased implementation options to support an Incremental Modernization and Transformation (IMT) approach
• Collective expertise of market and thought leader in Social Enterprise Management (SEM)
   

• Cúram for Citizen Self-Service Datasheet
• Cúram for Common Intake Datasheet
• Cúram for Medical Assistance Datasheet
• Cúram for Eligibility Datasheet