How Rhode Island consolidated its health infrastructure

Rhode Island has taken quite a few punches for the delays and cost overruns it encountered while overhauling the computer system that handles public health, but you don’t launch the biggest IT project in state history without learning a few things along the way.

The United Health Infrastructure Project (UHIP), a single system for all the state’s health and human services agencies and programs that replaces a decades-old segmented solution, went live on Sept 13, but it has stumbled getting off the ground. For example, some employees had trouble logging into the new system, and some customers continue to report problems completing the application and enrollment process or reporting changes.

However, “the system is working for a vast majority of the people we serve,” Brenna McCabe, public information officer at the state’s Department of Administration, wrote in an email response to questions from GCN.

More than 1,400 new applications were processed between Oct. 14 and 19 alone, and since the launch, $191.5 million in Medicaid benefits for about 284,500 enrollees have been processed.

UHIP, also called RIBridges, replaces InRhodes, the state’s former health and human services eligibility and enrollment system. The 30-plus-year-old InRhodes prevented the state from complying with the Affordable Care Act. It relied heavily on paper and programs that were frequently siloed, McCabe said.

“The new system is a single repository for client information across 48 programs and several agencies,” she said. “In the past, changes reported by someone receiving benefits across multiple programs were immediately known only to the worker to whom the changes were reported. Now, client changes are reflected across all relevant programs at the time the changes are reported. This enables the state to perform more accurate eligibility determinations and benefit calculations.”

Residents can apply for Medicaid or HealthSource RI, the state-run Obamacare program, through RIBridges, which enables benefits and health coverage for about 318,000 state residents. Other benefits, McCabe added, include electronic documentation management and greater automation both of eligibility determinations and incorrect payments. It also supports better verification of customer-entered identity, financial and citizenship information against 10 federal and state data sources such as the Internal Revenue Service, Social Security Administration and Rhode Island Works, the state’s welfare program.

To make the transition to RIBridges, the state combined almost 100 interfaces -- including converting about 400 million data fields -- McCabe said. Ultimately, the state took InRhodes off-line and switched to RIBridges. The state-based health exchange, which was already online, was integrated that into the new system, connecting residents with health and social services programs through one application.

Rhode Island tapped Deloitte to build RIBridges. It’s hosted in the state’s secure data center on a redundant platform, McCabe said. “We have software and hardware in place to monitor and log all user transactions as well as prevent unauthorized access,” she added. “We also have near real-time replication in place to ensure complete and safe storage of data.”

Troubles have plagued RIBridges throughout its four-year build-out. For instance, the contract with Deloitte was amended 31 times since the company was hired for the job in 2013, according to a Sept. 8 news report. What’s more, UHIP was initially slated to launch by April 2015, the report states.

Costs almost tripled to $364 million from original budget estimates of about $135 million. Despite the cost overruns, McCabe said Rhode Island expects a significant return on investment: about $15 million in state general revenue funds in fiscal 2017 and a return to the full state investment within a few years.

To address the problems, state officials have been working weekly for more than a year with the federal agencies involved in UHIP, particularly the Centers for Medicare and Medicaid Services. “We extended the project’s testing and training timeline by two months and conducted a hybrid pilot of the system in response to recommendations made by [the Agriculture Department’s] Food and Nutrition Service,” McCabe said. “That pilot consisted of thousands of test cases processed in a simulated version of the new system.”

The success of that pilot led to the Sept. 13 launch of RIBridges, she said. But even the launch itself is under fire from state lawmakers who say officials ignored warnings from federal agencies that the system wouldn’t be ready in the middle of September.

In time, state officials hope that the benefits the new system brings outweigh the troubles.

RIBridges “helps to ensure that we are delivering the right services to the right people at the right time through stronger eligibility checks and will improve customer service by making it easier and more convenient for Rhode Islanders to apply for and track their benefits,” McCabe said. “Overall, it will make government work better for Rhode Islanders by providing a single application and seamless coordination across multiple health and human service programs.”