Archive for HIPAA

Oregon Treadmill Desks Gaining Traction

In April, Oregon state legislators were pursuing a bill that could someday bring treadmill desks to state offices. If passed, the bill would initiate a two-year pilot program to test the “walking workstations,” determine their cost and effectiveness, and define the parameters of a potential larger-scale deployment within state agencies.

The bill, introduced by Rep. Jim Thompson, is expected to pass, according Legislative Director Jim Williams — and the idea is already attracting attention out of state.

Oregon was one of the first states to opt for a quasi-governmental state-based health insurance exchange following President Obama’s Affordable Healthcare Act. This bill by Rep. Thompson, Williams said, should be a no-brainer given the state’s dedication to public health, and the sedentary nature of the typical office environment.

The bill is currently in committee waiting on funding, Williams said, adding that he feels the votes will come in. “That’s not really an issue,” he said, adding that it’s time to stop talking about improving delivery of medicine and delivering health. “Let’s go ahead and do something about it… If we have a goal of losing weight and obesity is one the leading causes of medical problems, why shouldn’t we do everything that we can to go ahead and reduce obesity?”

When passed, Williams said, this bill will create a more productive workforce and lower the cost of medical care in the state. “We’re going to lower the cost of medicine,” he said.

Employees would not be forced to walk on a treadmill all day like a hamster, Williams said, but allowing employees the option of having a desk where they can alternate between walking and sitting — or putting a few treadmill desks in common areas — could lead to a healthier, happier workforce.

At the non-profit Association of Washington Cities, CEO Mike McCarty has been using a treadmill desk for the past three months to help fight the degenerative effects of type 2 diabetes.

“It’s a way to stay in motion while you’re working,” he said. “I find that I can do emails for a couple hours walking at two and half miles per hour, and not really break a sweat. It’s quiet, and it allows you to stay in motion while you’re being productive work-wise — maybe even more productive than you probably would be sitting at a desk.”

Using the treadmill desk over the past few months, McCarty said he’s lost five pounds — and not sitting all day helps him manage his blood sugar, which can be a serious issue for diabetics.

“That’s really what my expectation was, that it affords me a better quality of life and the ability to control my blood sugar a little bit better — and hopefully I’ll live longer as well,” he said. “I am an advocate of these things.”

If money and space were no object, he said, he would at the very least start putting the machines in common areas so people who wanted to break up their day could walk while making phone calls or answering emails for a few minutes.

“I’m not sure we’re there culturally yet,” he said, noting that the price of some treadmill desks is comparable to the price of the stand-up desks offered to some employees in their offices.

If the bill in Oregon passes, the Washington state Department of Labor and Industries (DOLI) may try to piggyback on the pilot study, said Doug Spohn, wellness manager for the agency. “We have a pretty comprehensive employee wellness program, so we’re looking at ways to get people to overcome the sitting all day thing.”

The DOLI is like a state government insurance agency, Spohn explained. “The mission of our state agency is to keep Washington state employees safe and at work. Because the nature of our business is insurance claims and trying to prevent insurance claims, we tend to be very conservative as far as risk aversion.”

This climate has made some in his agency hesitant to get people standing up and moving while they work, for fear they could hurt themselves, Spohn said, but he’s confident these machines would be a natural progression to his agency’s Wellness 360° program.

Wellness 360° is the agency’s program intended to provide a holistic approach to employee health, from physical factors in the work environment down to stress-management and the impact of various management techniques.

“I’ve been working about a year on this particular larger-scale effort where we would use these treadmills, and I’ve gotten green lights all across the board so far,” he said. “But when the rubber meets the road, we’ll see what happens.”

Though there are no official plans in place to use treadmill desks in Washington, Spohn said that if Oregon passes their bill, he would love to be part of the effort.

Photo: Dr. James Levine keeps a 1-mph pace on his treadmill while checking his e-mail in Rochester, Minn. AP/Jim Mone

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Florida, LexisNexis Partner to Combat Public Assistance Fraud

Florida, the state with the highest per capita identity theft complaints, is experimenting with a new way to weed out potential fraudsters in its public assistance programs. If the federal government concludes that the program meets a civil rights review, then the model could spread to other states soon.

Florida is working with LexisNexis, a private company known for its digital archives of newspaper articles and legal documents, to pilot an automatic online identity authentication system for three types of public assistance: Medicaid, Temporary Assistance for Needy Families (TANF) and the Supplemental Nutrition Assistance Program (SNAP).

The Florida Department of Children and Families (DCF) currently receives 90 percent of public assistance applications online, which entails a manual review of applicants’ self-reported information across multiple databases and a follow-up phone call. The LexisNexis model functions more like online financial services in the private sector, where software verifies a person’s identity based on a few items of personal information.

LexisNexis, which won the three-year, $2.9 million contract from Florida, uses a database it’s compiled of 500 million unique American identities to vet applicants. The company cross references a range of biographical information, including social security numbers, residential addresses, incarceration records and death certificates. The screening is automatic and based on four multiple choice questions (randomly selected from a pool of 35 possible questions). If a person fails the test, he or she can apply again through the manual online process, by mail or in person.

“What we’re trying to determine is that the person does exist, that it’s not a made-up identity and that they’re who they say they are,” said Susan Vitale, deputy secretary for DCF.

Last year, Florida recorded 69,795 identity theft complaints, equal to 361.3 complaints per 100,000 state residents, according to a February report from the Federal Trade Commission. About 1.6 percent of nationwide identity theft complaints, the report said, involved government benefits applications.

So far, the Florida pilot program is on pace to save the state of Florida close to $80 million, which is $50 million more than originally projected. If successful, the pilot would mark an important turning point for the detection of waste, fraud and abuse within public assistance. Rather than recouping money from someone already exploiting the system, this would stop it “upfront, at the door and not [let] them in,” Vitale said. “That is a very big paradigm shift.”

The pilot started in seven counties in Central Florida in March, and will go statewide in June. Florida had to request a waiver from the U.S. Department of Agriculture (USDA) to use the automatic online software to screen for identity theft in federal food stamp applications. Federal evaluators are monitoring the pilot to make sure that protected groups under civil rights law, such as minorities, the disabled and people with limited English skills, are not intimidated or discouraged by the automatic online screening. Florida is required to report back to the USDA on the pilot’s impact on protected groups through customer surveys, the tracking of complaints, community feedback and changes to the total number of SNAP participation.

Identity fraud in public assistance is “certainly something that you would want to prevent [and] to the extent that you can make online applications more secure, it’s a good thing,” said Elizabeth Lower-Basch, a policy coordinator and senior analyst with the Center for Law and Social Policy. “You just need to make sure that it doesn’t create burdens for people.”

Because the LexisNexis identity screening technology is so new in the world of public assistance, policymakers aren’t sure how it will impact participation rates just yet. Many of the factors that determine whether someone participates in public assistance are related to state economic conditions and the profile of the applicant, such as a person’s age, gender, level of income and education.

But governments can also affect someone’s likelihood of seeking public assistance. Past studies of SNAP by Mathematica Policy Research have demonstrated that people enter SNAP at higher rates if state governments perform outreach, expand their eligibility definitions or ease income reporting requirements. Last year, Gov. Andrew Cuomo singled out fingerprinting in his State of the State address as a screening method that he believes discourages participation in New York City’s food stamps program. (Mayor Michael Bloomberg defended the program, arguing it’s the best way to cut down on fraud.) Whatever the reason, analysis from the Food Research and Action Center suggests that many families living in poverty in urban areas qualify for food stamps, but don’t take advantage of the benefits.

Vitale insists that Florida’s program won’t hamper people trying to access benefits. “The idea here is to detect the fraud upfront,” she said, “but it is not to prevent people from applying.” For her part, Vitale suggested the convenience of applying online and the prospect of shorter processing times might increase participation.

If Florida’s experiment appears to reduce fraud without turning away people who are actually eligible, then other states might copy the program. Vitale said she’s heard from state officials in Wisconsin, Michigan, Texas and Pennsylvania that are all interested getting the same waiver to try out identity authentication. “We’re happy to lead the way,” she said, “and hope that other states will follow.”

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Kyle Janek Receives Bob Bullock Public Service Award

Kyle Janek, executive commissioner of the Texas Health and Human Services Commission, was awarded the 16th annual Bob Bullock Award for Outstanding Public Stewardship at the GTC Southwest conference on Tuesday, June 4, in Austin, Texas.

The Bob Bullock Award is presented each year to a Texas state executive or elected official for outstanding leadership, innovation and a career that demonstrates dedication to serving Texas citizens. Bob Bullock was a former Texas politician who during his career served as the state’s comptroller, lieutenant governor and secretary of state.

“[Bob Bullock] is a legend in Texas politics and he had a profound impact on the way policy is created and carried out,” Janek said. “It’s an honor to be thought of this way and receive an award named for such an iconic Texan.”

Janek was appointed Texas health and human services executive commissioner last September by Gov. Rick Perry. As head of the Health and Human Services Commission, he oversees five health and human services agencies, with more than 56,000 employees total and annual budgets of $30 billion, all while serving more than 4 million Texans, according to the commission.

Roughly a decade prior to taking his position as executive commissioner, Health and Human Services programs were distributed among various agencies and essentially siloed from Medicaid. After a major cross-agency consolidation, the programs were brought together under a single enterprise made up of multiple agencies and departments. As executive commissioner, Janek is tasked with overseeing the enterprise.

A practicing anesthesiologist since 1986, Janek’s career in public service began when he was elected to the Texas House of Representatives, where he took office in 1995 and served for eight years. He was elected to the Texas Senate in 2003 where he served for more than five years. According to Janek, since he was the only physician in Texas’ part-time Legislature at the time, he absorbed many health-care related duties, and served on the committee for public health. Janek remains a board-certified anesthesiologist today.

Janek said his experience in the medical field has helped shape the way he carries out operations in state government. Since he was formerly a Medicaid provider, he sees training and work experience from a provider’s perspective and understands how doctors think.

But by entering into government, he began to look at challenges from other angles and consider budgetary factors not solely from a medical perspective.

So what has been Janek’s strategy for success in the public sector?

Janek said he first ran for public office because he wanted to contribute his own ideas to government rather than hearing about decisions made after the fact.

“I was driven by the job and the opportunity to do things that actually had an impact when I was dissatisfied with the way government was performing,” Janek said. “So whether it was in the public sector or private sector, I enjoyed having a job that made a difference.”

AP Photo/Harry Cabluck

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Health Insurance Marketplaces Delay Mobile Apps for Now

In October, state health insurance exchanges (HIX) will start enrolling Americans for coverage as required by the Affordable Care Act (ACA). That’s good news for people with computers and broadband connections, who should have an easy time accessing state exchange portals to compare offerings, determine eligibility, enroll in plans and pay premiums.

But many who rely on smartphones for Internet access will have to choose a different way to apply for coverage, at least this year.

“We did have an extensive discussion around mobility and mobile access to our exchange early on,” said Curtis Kwak, CIO of the Washington Health Benefit Exchange. “Because the timeline was engraved in concrete for Oct. 1, we didn’t get a chance to build that into our version one application. But it’s definitely queued up for version two, which is planned for an August 2014 launch.”

State leaders understand that smartphones play an important role as Internet access tools, but in the scramble to get their HIXes up and running by October, most states haven’t yet tackled the question of mobile access.  

But smartphone use for Internet access is particularly high among some of the groups most likely to look to HIXes for health coverage because they aren’t getting it through employers.

Of adults who use their cellphones to access the Internet, 45 percent of 18- to 29-year-olds, 51 percent of African Americans and 42 percent of Latinos do most of their online browsing that way, according to the Pew Research Center’s Internet & American Life Project. People in households that earn less than $50,000 a year and people who haven’t graduated from college also are likelier to rely on mobile phones to get online, Pew said.

“[States] are finding themselves behind the eight ball as far as being ready for the exchanges. So they’re not as focused on the newer technology,” said Jinnifer Wattum, director of eligibility and exchange solutions for Xerox Government Healthcare Solutions.

People who lack Internet access will be able to interact with HIXes in other ways like calling customer service centers or mailing paper forms. And smartphone users won’t be entirely out of luck either.

Citizens will be able to use their mobile phones to read material on state exchange portals and perhaps to conduct some transactions. But which functions they can use, and how easily, will vary by state.
Watch video (above): Massachusetts’ Health Insurance Exchange Focuses on Reusability

“The good news is that the health benefit exchange interface is not a very heavy interface,” said Manu Tandon, secretariat CIO at the Massachusetts Executive Office of Health and Human Services. “Our idea in general is to make the amount of information we ask of citizens, especially if we’re asking the second time around, as minimal as possible.”

The Massachusetts HIX interface will contain a minimal number of data fields, Tandon said. It could become even simpler as the state’s system starts to pull more data from a hub that the federal government is building to supply data to state exchanges in real time.

If citizens don’t need to enter a lot of information, they might be able to conduct transactions through the browsers on their smartphones, he said.  

Massachusetts comes to the ACA with a strong advantage: Most of its residents already have health insurance, thanks to legislation the state enacted in 2006. When its new ACA-compliant HIX opens for business, most residents will use it to renew or change their coverage, not to enroll for the first time, Tandon said. Massachusetts will need to collect less data than typical states, so more residents will be able to use their smartphones to complete the tasks.

But in most other states, residents seeking health coverage will need to complete a lengthy form. The “streamlined application” — a single form used to apply for Medicaid, the Children’s Health Insurance Program and health insurance plans offered on state exchanges — is complex, said Bruce Caswell, president and general manager of health services at Maximus, a Reston, Va.-based company that partners with local governments to provide health services for poor communities. “That might not make it suitable to be completed on a mobile device.”

So what will Americans be able to do on their smartphones when HIXes open in October?

Smartphones aren’t the only mobile devices citizens can use to access state health insurance exchanges. Nevada is working to accommodate tablet computer users to interact with its Silver State Health Insurance Exchange.

“Tablets have a screen size that will allow for the comparison of plans side by side, and all the things that go along with the plan,” said C.J. Bawden, communications officer of the Silver State Health Insurance Exchange. The much smaller screens on smartphones don’t easily allow for that kind of activity.

Nevada is designing its exchange’s interface to display well on standard computers and tablets, Bawden said. ”We are going to move forward into development of an app or development of a mobile site, in future years, to make it easier for a person with a tablet to walk through all of the steps.”

In the exchange’s early years, Nevada will analyze how long it takes to navigate the site and where users encounter problems to improve the site across various devices.

Tablets could also become an important tool for navigators, or people who, under provisions of the Affordable Care Act, will educate individuals and small employers about health plans and help qualified individuals enroll. In Nevada, many of the navigators who guide citizens through the exchanges carry tablets, Bawden said.

Bruce Caswell, president and general manager of health services at Maximus in Reston, Va., said that navigators might become the real force driving adoption of mobile technology for health insurance exchanges.

“”I think that an iPad or tablet-based, downloadable app that individuals in the field can use in a comfortable setting to educate, communicate and then help navigate the process is going to be critical,” he said.

In states like Nevada, where vast areas of sparsely populated territory lack broadband and wireless service, navigators who visit residents during open enrollment periods might need other mobile technologies as well, said Bawden. ”We’re looking at putting together a truly mobile system, possibly with a vehicle with a satellite uplink to drive out to these remote locations.”

If consumers are using an iPhone or Android phone with a larger screen, they’ll be able to navigate the exchange Web page, said C.J. Bawden, communications officer of Nevada’s Silver State Health Insurance Exchange.

In some states, including Nevada, users of both smartphones and feature phones will be able to get text messages reminding them about premium due dates, open enrollment windows and other important deadlines.

“You’re going to have the ability through the Web portal to choose your preferred method of contact, whether that’s by SMS [short message service], email, a telephone call or regular mail,” Bawden said.

Xerox is developing Nevada’s exchange and Web portal, and the company created a function that reminds consumers when a payment is due.

“As long as the client has given their authorization and mobile number, we can put it on their account that 10 days before their premium is due, a text message will go out,” said Wattum. “They would have to go into the website to pay their premium, but it does give them a reminder via text that they need to do that.”

Rather than make smartphone users fend for themselves on their full-blown HIX portals, some states will most likely build mobile-optimized versions of those sites with simplified interfaces, said Caswell. Smartphone users probably won’t be able to complete entire applications on those mobile sites, but they’ll be able to go through the preliminary eligibility screenings.

“You might even see a relatively straightforward way to do health plan comparisons, at least at a basic level of comparing product costs and features,” he said. “But with the expectation that for a lot more detail, you’d have to go to a bigger browser version.”

While Massachusetts won’t create a separate mobile site in the first incarnation of its new portal, the state is taking mobile browsers into account, along with popular big-screen browsers, as it designs the interface.

“You always have this problem that you want to have the same content be presentable using different presentation media,” Tandon said. “This is no different.”

States could make more specific accommodations for smartphones starting in the next year or two. “I think what you’ll see in the first quarter of next year are mobile applications for paying a premium and making simple changes,” Wattum said.

Based on her conversations with officials in various states, Wattum said it seems that most users won’t be able to shop or apply for plans entirely from their smartphones until late 2014 or 2015.

Massachusetts is still confirming plans to add mobile functionality, said Tandon. “Our current thinking is to develop a mobile Web application for the state-based exchange using Oracle’s ADF Mobile product, which would support the iOS and Android OS using the same code base.”

That application probably would work best for functions like calculating insurance subsidies, managing a user account and paying premiums, Tandon said.

“Other functions, such as applying for health insurance, would be a lengthy process and may not be a good fit for mobile apps,” he said.

In Washington, Kwak envisions someday offering a mobile app that users could download for free from the Washington Health Plan Finder website or a commercial app store. But it’s not yet clear whether downloadable apps are an effective way to reach the state exchange’s target market, he said.

State officials also must remember that mobile apps carry a cost, Kwak said.  “I think there’s some perception out there that mobile applications are a dime a dozen,” he said.

That might be true for users who download the software, but it’s not the case for the organization that has to develop, test and market the app. “I want to be sensitive to the fact that there is major work in developing even the simplest mobile application and making it available to the public,” he said.  

Smartphone interfaces for health and human services already exist outside the realm of HIXes. For example, Maximus has developed a downloadable app for people receiving Temporary Assistance for Needy Families benefits in Wisconsin to demonstrate that they are seeking employment.

“You can use this mobile app to submit time sheets, to document your job search activity — literally taking pictures of the business cards from in-person interviews you’ve had,” Caswell said.

On the health-care side, this year Maximus will pilot the use of a mobile-optimized Web browser in some of the states where it provides services for the Children’s Health Insurance Program and Medicaid programs. Beneficiaries with smartphones will be able to use this browser to perform some basic activities, such as looking up health-care providers, Caswell said.

However, mobility, in general, has been making its way into the health benefit market at a glacial pace, Caswell said. HIXes provide a chance for catch-up.

While states are busy just getting their HIXes and portals up and running, they also realize that many of the citizens they’re trying to bring onto the exchanges are people under 30 who rely heavily on their smartphones, Caswell said.

“You need to have those folks in the exchanges, because from an actuarial perspective they’re critical to ensuring that the exchanges are sustainable,” he said.

It’s certainly time for a greater emphasis on mobility, agreed Wattum. In the past, organizations providing services to low-income and uninsured populations assumed that those clients lacked access to computers or weren’t technically savvy.

“That’s just not the case,” said Wattum. “And especially in the last three years, mobile devices have become the norm for every population.”

States need to figure out how to provide services through mobile devices, she said.

Like Tandon in Massachusetts, Wattum looks to the federal health-care data hub to pave the way for better smartphone access in the future.

When an applicant enters basic information, such as a name, Social Security number and current address, the federal hub will use that to verify citizenship, pull income figures from the IRS and otherwise retrieve data needed to apply for insurance and government subsidies, she explained. If the hub supplies that data, states won’t need complex on-screen forms to capture the information from applicants.

At least, that’s the theory. “States are hesitant about whether or not that’s truly going to be real time and whether it will be ready for this fall,” Wattum said. “Once that automation is proven out, I think the states and the federal government will be more open to investing in technology such as a mobile app.”

Photo of Manu Tandon by David Kidd

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Dirty Jobs in Government: Pest Mitigation

On the hot and humid Florida Keys, aerial spraying plays a vital role in controlling the mosquito population. The Florida Keys Mosquito Control District uses advanced computer modeling and sophisticated technology to attack breeding grounds for these airborne pests.

District activities are divided into two functions: spraying for existing mosquitoes, and spotting and eliminating larva sites in the water.

Both tasks rely on helicopter flights and a sophisticated spray management system that guides the pilot to the right areas and records the concentration of pesticide being released.

Flight and spray patterns are determined at the district office and saved onto a memory card, which is uploaded to the helicopter’s onboard system. For larva sites, inspectors note locations by hand, and that data is placed on digital maps.

While in flight, an automated system consisting of two GPS antennae and a wind measurement probe records data and monitors the wind speed and aircraft direction. Spraying goes on and off automatically to ensure the cloud drifts over the appropriate area.

“The pilot just has to go to the spray area, activate the unit, and it’ll set up the first line,” said Stephen Bradshaw, the district’s aerial operations supervisor. “It’ll show the pilot where to go so the product will drift across the spray area and be more effective.”

The district also plans to upgrade its land-based technology. Instead of having inspectors report larva site findings manually, the agency is seeking a tablet or smartphone system to enter the information digitally. This way, data is directly entered on the map pilots will use to direct their spraying.  

Photo courtesy of Shutterstock. Read more about dirty jobs in government.

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