102 Enabling Smarter Government with Analytics to Streamline Social Services
4.1.2 Business Value Assessment results
As a consequence of the Business Value Assessment, approximately $20 million
dollars in annual savings were identified. The savings realized were a result of
cost reductions, revenue enhancement, and cost avoidance:
Over 80% of the savings were derived from reducing costs. Cost reductions
came from a number of areas, including improving eligibility determination,
reducing fraudulent activities, and reducing appeals.
– Improve eligibility determination.
One of the key conclusions of the study was that in many cases
information was not available to ensure that those receiving the
benefits were eligible for that benefit. With SSIRS the case workers
were able to determine whether the client qualified for the benefit much
earlier in the process. This reduced the number of months that benefits
were paid erroneously.
By having the correct information at the case worker’s fingertips and
helping prioritize case work, SSIRS helps reduce the gap of action
required versus action taken by case workers during the eligibility and
case management process. This resulted in 5.5 million dollars of
savings to the county, drove improvements in WPR, and reduced the
– Fraudulent activity reduction
SSIRS is an effective tool to enforce program integrity. SSIRS is enabling
the Program Integrity Division (PID) to more efficiently manage the
investigation process, giving them tools to prioritize cases and investigate
common fraud and abuse issues. For example, with identity and
relationship resolution capabilities they can identify clients that are sharing
addresses or using fraudulent addresses.
SSIRS supports not only fighting fraud abuse and errors through
traditional methods, but also provides the capabilities to avoid making
improper payments up front in the eligibility process. This focus on
prevention is critical to avoiding the “pay and chase” approach that is
expensive to administer, and the level of dollars recouped is about x%.
The study identified approximately 9 million dollars in potential cost
savings related to fraud prevention and by PID to more effectively
investigate fraud, abuse, and errors.
Chapter 4. Business outcomes 103
– Appeals reduction
The number of appeals is a growing issue for SSA. At the time of the
study, SSA was handling approximately 1000 appeals per year at a cost of
roughly ten thousand dollars per appeal. By better understanding the type
of issues filed for appeal and their dispositions, SSA gains insight to
improve processes and training.
The study identified approximately $2 million in cost savings by reducing
the number of appeals through improved business processes.
In this category we included activities for reducing costs as complementary to
– Reducing general assistance (GA) costs (revenue enhancement)
In addition to providing the information to make better decisions about
eligibility, SSIRS is able to provide insight to make sure that clients were
taking advantage of the correct federal, state, and local programs. This not
only supports the client, but also ensures that dollars from the county's
General Assistance fund are optimized and not used when other programs
should be providing the service. This is critical given the continuing
For example, indigent adult health care costs funded from Direct County
funds can be reduced by identifying individuals who are qualified at the
point of care for the federal Medicaid program. This was an unnecessary
burden on the GA fund and with the correct information from SSIRS can
– Optimizing use of Medicaid
A few more examples are the reduction of costs through identifying where
multiple individuals are using the same Medicaid card at clinics or
hospitals, or claiming to be homeless and receiving payments while
associated with a household.
SSIRS is helping SSA improve the management of welfare to work cases by
giving case workers the information that they need to better manage the case
backlog and identify clients who are not completing mandatory work activities.
This helps the county avoid non-compliance sanctions by the federal government.
In addition to the quantified benefits, a number of qualitative benefits were
– Better able to focus limited resources on those who need it most
– Improving the WPR, which leads to more recipients becoming