Enabling Smarter Government with Analytics to Streamline Social Services

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:

򐂰 Cost reduction

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

case backlogs.

– 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.

򐂰 Revenue enhancement

In this category we included activities for reducing costs as complementary to

enhancing revenue:

– 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

budget pressures.

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

be avoided.

– 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.

򐂰 Cost avoidance

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

identified also:

– Better able to focus limited resources on those who need it most

– Improving the WPR, which leads to more recipients becoming

self-sufficient