A driving force for health equity

The Development of the Epic Eligibility Assistance Tool for UDS 2018 Reporting

By: William Pinnock, Aleksandra Sumic, Arielle Goranson, Joan Nelson & Emily Youngers

In May of 2018, OCHIN unveiled the Epic Eligibility Assistance Tool—a tool designed to help clinics report annual insurance assists to HRSA as part of Uniform Data System (UDS) requirements. The development of the tool offers an exciting example of the power and strength of the OCHIN collaborative. What follows is a story of collaboration, demonstrating that often, the lessons learned in the development phase of OCHIN tools are just as important as the tools themselves.

Despite federal initiatives to increase coverage, millions of Americans remain uninsured or have frequent coverage gaps. To help improve coverage rates, the Affordable Care Act included a provision for Outreach & Enrollment Specialists in clinics. These are individuals whose role is to assist patients with either gaining or maintaining Medicaid coverage.  In response, OCHIN Research teamed up with the Department of Family Medicine at Oregon Health & Science University to support this effort via the Community-Based HIT Tools for Cancer Screening and Health Insurance Promotion project—or more simply, CATCH-UP.

CATCH-UP is a five-year, National Cancer Institute-funded study that seeks to improve continuity of health insurance coverage and receipt of needed preventive care among CHC patients, by developing new health insurance support tools within the EHR.  In developing the CATCH-UP Enroll Tool, the project team collaborated with various OCHIN teams including Practice Coaches, ePET, PMO, Business Objects, Reporting Workbench, and Web Development. In addition, knowing that this tool was going to be given to and used by members, the team collaborated with seven OCHIN member organizations who helped provide key inputs for tool design and testing. These discussions led to the inclusion of the HRSA Outreach & Enrollment (O&E) fields in the CATCH-UP Enroll tool to be used for quarterly O&E reporting within the clinics. As a result, the tool was better aligned with the operational needs of the participating OCHIN member organizations.

The CATCH-UP Enroll tool was officially rolled out to study clinics for the 18-month implementation trial on September 16, 2016. Less than a year later, HRSA reporting shifted and clinics were no longer required to produce quarterly O&E reports. Instead clinics moved to annual reporting of “Total Assists” to HRSA as part of the UDS. This prompted OCHIN to think of ways to leverage the existing CATCH-UP tool, and lessons learned from this study, to support this updated requirement. 

The CATCH-UP team provided OPEX with key learnings from the study, including: workflow feedback from members in the study, lessons learned from members piloting the CATCH-UP Enroll Tool, and lines of code that could be integrated into a new tool. With this knowledge OPEX, ePET, PMO, Practice Coaches, Business Intelligence, and Research joined forces to repurpose the CATCH-UP tool, now officially titled “Eligibility Assistance Tool.” The tool tracks eligibility assistance work for two purposes:

1. To support annual UDS reporting

2. To support clinic operations around providing eligibility assistance.

Following a testing period, the Eligibility Assistance tool was rolled out in the May 2018 Enhancement Pack, and was greeted with enthusiasm and excitement from clinic O&E staff. The following month, having completed its implementation trial, the CATCH-UP tool was sunsetted.

The lessons learned from the recounting of the development phase of the Epic Eligibility Assistance Tool are ones we can all learn from. The CATCH-UP project highlights the opportunity for members to bring their voices to developing relevant tools that can support their work through research participation. The careful coordination of teams across OCHIN and the involvement of members demonstrate the power in leveraging varied expertise to develop multi-purpose tool sets. Most importantly, this story emphasizes the OCHIN spirit of collaboration and its importance in developing sustainable solutions that benefit everyone.

If you have any questions about the Epic Eligibility Tool, please contact Aleksandra Sumic , Arielle Goranson, & Joan Nelson.