The Washington State Department of Health (DOH) administers the state’s Ryan White HIV/AIDS Program (RWHAP) Part B funding. Before 2020, the system that Washington DOH used to manage HIV service data made it difficult to verify eligibility in a simple or user-friendly way. Within this system, determining a clients’ current eligibility could be time-consuming. Case managers had to confirm clients’ RWHAP eligibility by looking for clients’ information in multiple places—their Washington RWHAP database and the AIDS Drug Assistance Program (ADAP) application system—and had to use those different profiles from separate systems to make eligibility determinations. It also meant that case managers spent more time entering and finding data that they would have spent on other tasks. In addition, the previous system required “superusers” at the DOH to create user accounts for any agency that needed it—which was an administrative burden and often created a significant delay in adding people to the system. Another challenge was that clients often had to fill out multiple applications if they needed services from different RWHAP Parts.
Reaching a key decision point
Washington’s DOH wanted to streamline client eligibility determination and reduce barriers for clients. To achieve this, the team decided to transition to Provide Enterprise, a care management platform for agencies to manage their RWHAP-funded programs.
While ADAP already used this system, other RWHAP Parts and agencies across the state did not—and several features in Provide Enterprise led to their decision to switch:
- Widespread ability to register users in the system. In Provide Enterprise, a much wider array of users were able to create new user accounts—which removed the administrative burden of the previous system.
- Consolidated client application for services. This reduced barriers for clients because it meant they only had to fill out one application, instead of completing an application for every RWHAP service they needed.
- Automatic eligibility checks built into the system. This meant that the system would flag whether a client was eligible or not for any given service, as opposed to the user having to manually check this. Because of this, users could more quickly and efficiently determine whether a client was eligible for a certain service.
- More customizable workflows. This meant that workflows could adapt to the needs of different RWHAP agencies across the state and allowed for recipients, subrecipients, and those outside of RWHAP (e.g., Housing Opportunities for Persons with AIDS [HOPWA]) to have an at-a-glance workflow. These features also provided other benefits for the DOH team, including better ability to meet RWHAP compliance, such as payor of last resort, and allowing them to spend their quality assurance time more efficiently instead of doing manual eligibility checks.
Syncing up different data systems
Provide Enterprise allows agencies to manage their RWHAP programs, including eligibility, enrollment, and care delivery. Before selecting and setting up a platform in Washington, the DOH team needed to:
- Create and publish a request for proposals from outside vendors.
- Ensure secure data sharing by procuring a virtual private network (VPN) for all stakeholders and offering a VPN to all health clinics (so they could safely connect with Provide Enterprise).
- Set up data sharing agreements (DSAs) to formalize how partners exchange data outside of RWHAP (e.g., HOPWA and/or Medicaid) and Business Associate Agreements (BAAs) for RWHAP across Parts.
Setting up DSAs was particularly important because other state agencies in Washington use a software system called WaTech to host their data systems. The DOH, which administers Part B and ADAP, signed a DSA with the agencies administering RWHAP Parts A and C, as well as Medicaid.
Having conversations upfront
The Washington team emphasized the importance of having conversations with other stakeholders up front when transitioning to Provide Enterprise.
These conversations allowed the Washington DOH team to build relationships with other agencies (including the agencies administering RWHAP Parts A, C, and D and HOPWA) and have conversations that helped remove barriers—in their own work and for their clients seeking HIV services. Talking with other agencies and stakeholders provided opportunities to crosswalk case management experiences with case managers and administrators from different RWHAP Parts and agencies—and to better understand what’s important in the eligibility process.
For example, Seattle-King County Public Health is the RWHAP Part A recipient in Washington, and they also receive Ending the HIV Epidemic in the U.S. (EHE) initiative funds, which only uses confirmation or preliminary confirmation positive HIV status as a criterion for eligibility. Stakeholders from Seattle-King County did not initially join the DOH’s eligibility efforts when it came to their EHE information system—but once Seattle-King County stakeholders joined the conversation, they worked with DOH to navigate integrating an EHE component to allow EHE-funded services and clients to document and validate HIV status from the same Washington system. Ultimately, this process brought the teams closer and paved the way for future eligibility innovation.
Learning from what worked—and what didn’t
The Washington DOH team emphasizes that there will be trial and error when it comes to streamlining eligibility processes and aligning requirements. For example, the team encountered challenges with training users on Provide Enterprise. Their vendor provided a curriculum that wasn’t detailed enough for the DOH’s purposes which meant they needed to customize and build it out. Given the initial training curriculum, DOH trained “superusers” from various programs who could then train their own teams but found that this wasn’t effective. Ultimately, the DOH created their own training and manuals and have also used a platform to develop training videos. This provided a true “train the trainer" model using DOH’s own curriculum and allowed staff to become proficient in the data system and train others appropriately.
Making eligibility easier, one step at a time
The full transition to Provide Enterprise took two and a half years. As a result, RWHAP client eligibility processes have been centralized within Provide Enterprise—and eligibility criteria are aligned. One client profile that tracks eligibility across all Parts can be shared across all relevant agencies, and RWHAP clients can go to any agency and receive referrals. Washington’s experience demonstrates that RWHAP Parts A and B are a good place to start when it comes to streamlining client eligibility, but they’re just the beginning. RWHAP Parts C and D as well as EHE agencies need to be at the table too. As the DOH team learned, building relationships within jurisdictions involves flexibility and problem solving to create innovative solutions with collective buy-in.