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Ventura County’s Health Insurance Eligibility App is a Win-Win-Win

Ventura County’s Health Insurance Eligibility App is a Win-Win-Win

How do you improve responsiveness after seeing a significant reduction in your work force? For the Ventura County Health Care Plan leadership, the first step was a call to their IT department. The end result of this collaborative effort was the development of a desktop application that saves time and improves service for customers.

“We experienced an unprecedented number of high-cost claims that put us in a financial challenge,” explained Dee Pupa, Health Care Agency Deputy Director. “As part of our mitigation plan, we had to reduce staff by 20 percent. After reassignments, we were left with the question, how do we close the gap … while maintaining the same level of customer service?”

The health system was receiving hundreds of calls and faxes from their clinics every day to verify eligibility. With the reduction in staff, there was significant concern on how those calls would be handled in a timely fashion. “You can imagine the strain on staff,” Pupa said.

“We knew we were going to get the same type of call volume, but we had to find ways to continue to meet our members’ needs with a reduction in workforce,” said Staff Service Manager Christina Turner.

And so the customer service and IT staffs began meeting to find a solution.  For Health Plan IT Manager Tom Shirk, the goal was simple: create an application that would allow eligibility checks to be quicker than a phone call. “We wanted to make it simple, easy to use and run 24/7.”

The eligibility application allows for instant insurance verification. Clinic staff just needs to sign into the app, plug in the correct member information and they will immediately see in real-time if there is verification. No longer do they need to call or fax in the request and wait for an answer. This means savings of time for clinic staff as well. The real-time check has also decreased eligibility errors that were a result of a delay in actual verification. 

It only took Shirk and his team about a week to be ready to start testing the app. And the only cost involved was labor. “Our main goal was to make it quicker than a phone call,” Shirk said.

The Health System, which serves 15,500 county members, has not only been able to maintain the same level of customer service with fewer employees, but has actually improved response time.

“Our customer service folks love the app. It has cut down tremendously the number of phone calls and faxes, which has really helped accommodate the reduction in staff,” Pupa said. Health Plan staff is now freed up to focus on the variety of other types of calls that come in.

The application is also popular among the clinic staff; it has now been integrated into 31 Ventura County Medical Center clinics, as well as two hospitals. As of March of this year, the app had received more than 86,000 hits. So when a health-plan member is at the registration desk, staff can quickly access the application rather than putting in a call and waiting for verification. And because the application is available 24/7, clinic staff can check verification at any time.

“When you think of the average eligibility call being about 2 minutes, you can see the time savings,” Turner said.

“The eligibility app is a win for the clinic employees, it’s a win for the health care plan employees and it’s a win for our members,” Pupa explained.

Beyond the savings of time, there has been a savings of money. The healthcare industry average is about $8.40 per eligibility/benefit call, compared to 49 cents done electronically.

“The application is an example of the county family coming together,” Pupa said.  “The fact this app was seamless and collaborative, it just made me grateful to be part of it. It really brought the health care plan team, the clinic team and the IT team together.”

This Ventura County program is a recipient of a 2017 CSAC Challenge Award, which spotlights the most innovative programs in county government. The Call for Entries for the 2018 awards is now open.

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