Motivation for cloud migration and modernization

Many of the legacy IES make it challenging for the agencies to be agile and flexible in dealing with eligibility and enrollment processes. There are three main personas that are relevant for IES:

• The end-user or beneficiary

• Agency workforce and case workers

• Program leadership and benefits administrators

The following sections focus on these personas and outline the challenges and motivation for administrators to migrate and modernize IES.

Improve customer and beneficiary experience

Timely and accurate application processing is critical in helping the customers that need immediate assistance with healthcare, cash, or nutrition benefits. Legacy systems often provide a poor consumer experience as they cannot scale to meet the surge during an open enrollment or an unexpected situation (such as COVID-19). These systems also lack the capabilities required to provide a digital experience to customers, such as self-service, mobile application submission, text communications on case status, and online scheduling for interviews.

Enhance workforce productivity

Agency workforces have to deal with large volumes of applications and manual processes that result in increasing application backlogs and delayed benefits to consumers. Benefits application documents can include federal tax forms, pay stubs, social security cards, and other documents. These documents are in multiple formats, including PDFs and images, and are submitted from various sources, including mobile devices, the web, mail-in, and contact centers.

The workforce spends a significant amount of time processing, and validating these documents. Often, this process is manual, which is error prone and requires specific domain expertise. Additionally, manual processes take time away from case workers which can otherwise be spent in high value activities such as ensuring that a constituent is getting the best available support.

Improve insights into program operations

Having access to data-driven insights allows agencies to build programs and advocate for innovative policy changes to better serve constituents. These insights include visibility into enrollment models, backlogs, budget forecasting, fraud, waste, and abuse. Often, benefits program leadership lacks the level of visibility needed to optimize the program operations and costs.

Handle data at scale and improve security

There are millions of customers applying for benefits every year, resulting in tens of millions of documents and hundreds of terabytes of data. For example, Healthcare.gov alone handled data for approximately 12 million consumers during the 2021 open enrollment period. (Source: https://www.cms.gov/files/document/health-insurance-exchanges-2021-open-enrollment-report-final.pdf)

This data not only comes in from the applicants, but is also exchanged with federal, state, and local agencies, as they communicate with each other to validate the application. Hosting a storage solution at scale is a major challenge for many agencies. Data security and privacy are also of primary concern, as agencies have a responsibility to protect sensitive customer data.

Handle large call volumes

Handling large call volumes is a major challenge for various agencies as the follow up for each application results in multiple calls to the agency on activities related to pending applications.

Better digital experiences and customer collaboration can eliminate the need for repeated calls about basic questions (the most common one being “where are my benefits?”) so that agents can spend more time on interviews, appeals, or more complex benefits related questions. Another challenge is to ramp up call center operations during disasters, such as COVID-19, which impacted the US workforce and resulted in unemployment insurance-related calls and applications.

Reduce costs and minimize TCO

Legacy systems and software for IES require a significant maintenance investment, with increasing annual costs. These systems require multi-year enterprise licensing agreements for proprietary hardware or software and the underlying infrastructure becomes harder and more expensive to maintain as it ages. If they are built on obsolete technologies, legacy system support requires a specific (and sometimes hard to find) set of skills and expertise. As the developers who built the software retire or switch to other technologies, it becomes increasingly harder to find and retain the right talent. Cloud migration will help address some of these challenges and minimize total cost of ownership (TCO).

Modernization focus areas for IES benefits administrators

Based on the challenges described earlier, the following figure summarizes how you can utilize cloud capabilities to modernize an IES and outlines major focus areas for benefits administrators.

Focus areas for IES and benefits administrators – including a better beneficiary experience