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Meet Balancing Incentive Program (BIP) RequirementsA comprehensive set of frameworks and tools to help state Medicaid agencies meet BIP requirements and achieve BIP benefits
• Cognizant Government Healthcare Solution Overview
Taking advantage of the Balancing Incentive Program (BIP) funding offered under the Affordable Care Act can help states better manage their healthcare costs while increasing access to non-institutional long-term care services and support (LTSS). States must meet a variety of BIP participation requirements, however. These chal-lenging pre-requisites include:
• Ability to create a single point of entry tostreamline program enrollment and datacollection for consumers among services andfunding delivered under BIP through multipleprograms managed by different entities.
• Educating consumers about the full range ofcommunity care options available to themfrom different entities.
• Making more meaningful care and servicedelivery decisions by breaking down data silosacross care agencies for more comprehensivedata correlation.
• Supporting appropriate use of non-institution-alized forms of care delivery with standardizedpatient assessment tools to prevent unneces-sary nursing home admissions.
Cognizant offers a comprehensive BIP solution suite that provides state Medicaid programs with
the tools they need to meet these BIP require-ments and successfully manage their BIP partici-pation.
Cognizant: Streamlining Your BIP ParticipationAt Cognizant, we offer you a comprehensive BIP solution of prebuilt frameworks, templates, best practices and start-up kits to ensure fast, smooth implementation and ongoing streamlined management of your BIP participation require-ments.
Cognizant’s Unified Access FrameworkCognizant’s Unified Access Framework supports the BIP technology, process and reporting requirements by providing a complete ecosystem to make states’ LTSS programs more connected, agile and responsive towards consumers, commu-nity-based organizations, state employees and management.
• Customer-centric, fully integrated one-stopshop portal
• Seamless integration offering a 360° view ofconsumers and easy exchange of informationacross departments /agencies
cognizant government healthcare solution overview
2government healthcare solution overview
Unified Access Framework
Self-service
Staff Consumers
Agency Directors and Owners
Management
Infrastructure Information & Analysis Social, Mobility User Experience
Busi
ness
Pro
cess
Driv
en
Service Oriented
Unified Access Framework
Eligibility Counselors, Case workers, Claims investigators
Individual/Families, Community-Based Organizations
n
Integrated program view
Screening tools to determine
eligibility
Virtual office for better customer
support
Dashboard for business metrics
Enforce conflict free policies Decision making
Assessment eligibility, enrollment
Collaborate and communicate
Appeals/grievances
Standardized program literature
360° view of consumer
Seamless experience through multiple access channels
Communication modes and collaboration platforms to engage with consumers
Unde
rlyin
g IT
En
able
rs
• Robust analytics platform for dashboard view of metrics and real-time reporting
• Social and mobile integration strengthen customer responsiveness and collaboration with consumers
• Start-up kit for rapid development of ‘No Wrong Door/Single Entry Point’ (NWD/SEP)and a tool for standardized assessment
Universal PortalCognizant’s Universal portal enables integration of all relevant LTSS information resources and data entry points for consumers and providers to help establish the NWD/SEP with initial screening, eligibility and enrollment.
• Single gateway with standardized program content for all community LTSS programs
• Seamless self-service access including program information queries, check status update, screen, apply, upload scanned documents, renew.
• Enables ‘person flow,’ with consumer details seamlessly integrated with all state systems
• Multiple access channels (portal, mobile, mail, chat integration)
Standardized Assessment Tool KitOur BIP solution offers a tool kit that enables rapid prototyping and building of standardized assessment instruments deployable on mobile
platforms. This tool kit also includes a core data set for areas such as daily living, instrumental, cognitive, medical and behavioral.
• Core data set to support level 1 screening
• Mobile integration enables creation of a virtual office for easy access to a wide range of self-service features
Analytics at the CoreAt the core of our BIP solution is our analytics framework enabling timely data collection, aggregation and reporting. With our powerful algorithms and predictive analytics, state agencies can gain deeper insights into care delivery patterns, population health and wellness, and the data needed to transform LTSS care delivery. Our analytics framework encompasses all the entities in the LTSS ecosystem, removing data silos and providing all agencies with trans-formative information and knowledge.
• Integrate silos of data across disparate LTSS systems/programs for complete client-pro-gram visibility and a 360° view of consumers
• Advanced analytics-driven dashboards, intelligence charts, and heat-maps enable management to gauge the success of new policies and measure performance of agencies/staff against business-focused metrics
• Executive social network analysis to increase understanding of LTSS population
Quick Take
Program Eligibility
• States that spend less than 50% of total Medicaid medical assistance expenditures on non-institutional-based LTSS are eligible to receive BIP funding.
• States must agree to implement the following structural changes:
> No Wrong Door / Single Entry Point
> Core Standardized Assessment Instrument
> Conflict Free Case Management
• States must also implement data collection and reporting of service, quality and outcome measures. The data collected is not to be reported to CMS, however states are required to provide services and financial reporting to CMS on a quarterly basis.
• States are encouraged to create Electronic Information Exchange (EIE) to enable efficient and more integrated No Wrong Door / Single Entry Point systems. An Enterprise/Medicaid data warehouse can be implemented at the core of EIE to enable a common repository of functional and financial data. Analytics based on the EIE can provide valuable learning to drive continuous improvements in program quality.
States need to formally apply for funding and submit a work plan describing a list of activities to implement structural changes to accomplish BIP goals. The following high level activities are required:
Taking Advantage of BIP Funding
BIP Work Plan Requirements
States with approved BIP applications: NH, MD, IA, MS, GA, TX, IN, CT, AR, NY, NJ, LA, OH, ME, IL
STAGE 1: • Establish NWD/SEP Single Entry Points and Initial ScreeningSTAGE 2: • Implement Streamlined Eligibility and Enrollment Process
No Wrong Door/Single Entry Point
UNIFORM PROCESS• Establish Core Data Sets (CDS)• Implement Core Standardized Functional Assessment Instrument For All Populationsand Geographic AreasMULTIPLE PURPOSES• Determine Eligibility, Identify Support Needs and Inform Service Planning
CONFLICT FREE CASE MANAGEMENT• Separate Non-Functional Eligibility from Service Provision• Collect Metrics, Ensure Quality Monitoring and Reporting• Capture “voice of consumer”; Establish Clear Mechanisms to Accept and Resolve Grievances
DATA COLLECTION AND REPORTING• Community Services Received by Individual• Quality Data Including Clinical Measures • Outcome Measures By Population
Data Collection and
Reporting
Conflict Free Case
Management
Core Standardized Assessment Instrument
3government healthcare solution overview
About CognizantCognizant (NASDAQ: CTSH) is a leading provider of information technology, consulting, and business process out-sourcing services, dedicated to helping the world’s leading companies build stronger businesses. Headquartered in Teaneck, New Jersey (U.S.), Cognizant combines a passion for client satisfaction, technology innovation, deep industry and business process expertise, and a global, collaborative workforce that embodies the future of work. With over 50 delivery centers worldwide and approximately 164,300 employees as of June 30, 2013, Cognizant is a member of the NASDAQ-100, the S&P 500, the Forbes Global 2000, and the Fortune 500 and is ranked among the top performing and fastest growing companies in the world. Visit us online at www.cognizant.com or follow us on Twitter: Cognizant.
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© Copyright 2012, Cognizant. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the express written permission from Cognizant. The information contained herein is subject to change without notice. All other trademarks mentioned herein are the property of their respective owners.
Ensure Your Successful BIP Participation Today With our Healthcare Government Practice expe-rience, Cognizant has the proven expertise and technology to help you turn your unique challeng-
es into opportunities for transforming delivery of care while succeeding at cost containment. For more information about how Cognizant will help you succeed with BIP, contact us at [email protected] or visit www.cognizant.com.
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