| Health and Human Services |
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Extending Health and Human Services (HHS) Agencies Beyond Traditional Boundaries
Health and Human Services agencies use ILOG’s business rule management system (BRMS) to administer a wide range of services, including:
- Family and child support
- Public healthcare insurance
- Public pensions and retirement pensions
- Unemployment insurance
- Welfare programs
ILOG BRMS provides an agile solution to automate and support effective decision making for entitlement, error-free benefits calculations, funds management and delivery, real-time fraud detection, and case management. ILOG BRMS empowers HHS agencies to modernize legacy systems, shorten service delivery, consolidate services, and curb fraud and prevent errors, while keeping their systems current with constant legislative and regulatory changes.
HHS agencies benefit from ILOG BRMS in four key areas:
1. Accelerate and streamline regulation implementation and maintenance
Traditionally, implementing and maintaining regulations has been one of the heaviest burdens on HHS IT organizations. Entitlement programs rely on complex and constantly changing regulations. In some cases, the complexity is compounded by multiple levels of federal, state and local regulations. Legacy systems make the maintenance of business logic and the implementation of changing regulations prone to errors, resource-intensive and time-consuming. Moreover, the skills required to maintain those systems are rapidly fading.
HHS customers that implement ILOG BRMS save significant time and make large-scale improvements in their business rule management processes. Business rules’ update can be handled in a matter of days rather than months. Moreover, business rules templates and clear representation streamline the business rules update process and facilitate the reuse of business rules. ILOG BRMS also provides a complete audit trail of business rules’ edits, thus satisfying public sector’s stringent requirements for accountability.
2. Improved accuracy, streamline processing and respond in real time
Erroneous and improper payments are a drain on HHS agency budgets. Over-payments are rarely recouped, while protests for under-payments generate unnecessary and costly appeals and reviews. Long processing times and severe backlogs negatively impact customer satisfaction and call for political scrutiny. Fund management and fund delivery are complex issues for many social workers.
HHS agencies that automate complex routine decisions with ILOG BRMS significantly improve the accuracy of those decisions. ILOG BRMS customers report a 99-percent accuracy rate. Moreover, ILOG BRMS-based decisions can be computed in real time, thus significantly enhancing customer delivery and reducing backlog. ILOG BRMS also supports complex HHS decisions, such as implementing budgetary or policy priorities, by enabling case workers to perform what-if analyses. Moreover, ILOG BRMS provides a complete audit trail of business rule execution, allowing case workers to explain decisions to clients and effectively support appeals processes.
3. Consolidate, share and expand services
HHS agencies consolidate their services with ILOG BRMS, simplifying access to HHS programs and generating cost savings while significantly improving client satisfaction in the process. One-stop portals provide convenient and centralized access to all HHS programs available in one jurisdiction.
Cost savings abound, through guiding people to the right programs, improved information sharing across programs—especially for programs tied to income limits—and a reduction of redundant tasks. HHS portals can be especially useful to non-profits and healthcare organizations since those organizations are in constant contact with people in need. Direct benefits include improving program enrollment and claims accuracy on HHS healthcare
4. Fight fraud
Fraud is a burden on many HHS budgets, and audit teams have limited manpower to deal with increasing volumes of claims.
ILOG BRMS supports HHS agencies’ objectives to fight fraud in several ways, including:
- Improved quality, timeliness, and security of customer data
- A platform to proactively manage fraud risks and to detect fraudulent patterns as claims are processed—in real-time—throughout HHS agency processes
- Automated and supported audit and fraud investigation processes
ILOG BRMS customers
ILOG BRMS supports HHS agencies’ critical modernization initiatives at all levels of government. ILOG HHS customers include:
- The Department of Veterans Affairs—Federal government
- The State of Minnesota—State government
- The District of Columbia—State government
- The National Health Service—United Kingdom
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