Transcript

I'm Sumith Avital, I'm a product manager here at Nava working on OSCA. So where are we? Are these just plans? No. We're about to show you a demo so that you can see exactly where we are, and others may show you Polish prototypes, but we're showing running code with a path to production. Our repository is public and you can deploy it yourself, and I can show that to you a little later. Again, these aren't just plans, we're showing you a working application. Even though there remain many unknowns in CMS is not required to deliver their final rules until June. We've made a ton of progress. We have already built the primary end to end experience and we're layering in more detailed features daily. At Nava, we believe the only way to avoid delivery risk is to deliver, and the only way to deliver is to deliver. Deliver as quickly and as iteratively as possible. So let's jump back into this journey map for a second. When a certification is needed, either during application or based on a look back window, Osco receives client and ex parte data from the existing state system. The agency would ping exparte data sources and send a certification request to Oscar. That can be through API or a batch process, and then we attempt to automatically certify compliance. So this is a critical step here. It's been a constant theme from all the policy experts we've met with, and we're working to automate community engagement verification and exemptions upstream here. And this is one of our metrics we're measuring to ensure we we maximize the number of people who do not need to take action to remain compliant. So this is the single biggest Levitt to prevention. Our app checks the ex parte data for any automatic exemptions, something like having a child under 13 and when applicable returns that determination to the state system. So if the member doesn't have to log hours or income, we've successfully. On that and we never and that member never enters the Oscar app. So if they do need to certify, then Oscar notifies the members and gives them a link to Oscar and from here we'll jump into the Oscar app. All right, I'll demonstrate that automated certification request by showing a manual certification request in our app. So we've modeled out three requests scenarios, generic certification, new application, and recertification. So in new application and recertification, the look back periods here have been fixed to simulate state configured periods we may get back from them. For example if a state wants to look back monthly, they can do so. For the demo, I'll create a generic certification. And. I'll add in name. Medicaid case number. And leave the look back periods here umm the same and request certification. So now let's look at, umm, the member landing page. Oscar uses US WDS for its interface, but we can adjust the design to match the state's look and feel. So the certification request that we just created is linked to the members account. From here the member can do two things for this specific request. They can report activities where they enter their community engagement activities or request an exemption if they meet a qualifying condition. The member can review any previously submitted certifications as well. And just a couple notes from our initial research and feedback, we do understand that many members are exempt and don't even realize it. So we're planning to add plain language guide that asked simple questions to help them discover and confirm their exemptions or take them to report their community engagement activities. The goal there is to take the burden off the member to have to know any details about the policy, like we're thinking about how to guide them through that so there are no missed opportunities. Again, building iteratively, so that's coming. We'll start with request an exemption. We have it before you start page that orients the member to what they'll need and how much time it may take them. Well, we also have a progress bar at the top so member can get a sense of how far along they are. We'll click start. And we're showing 2 exemption types today and we plan to support all applicable exemption types. I'll pick a short term hardship. But continue. Upload evidence. Upload that, continue and the member can review it and submit. Before I do, I'll jump back to the dashboard and you just see here that the the exemption application is in progress, so if I need to collect more documents and jump back in later, I can do so. I'll go back and review and submit. Alright, looks good and I'll see here that my application is being reviewed. So based on policy, we set it up so a member can only submit an activity report or an exemption for a specific certification request. So we'll create a new certification request, and I have one already prefilled here. Have my actual name. And I'll request the certification and we'll jump back into the dashboard so we can go through the report activities flow. Umm. So here I'll choose report activities and we have a before you start that notifies the member like on time, it takes documents they'll need and then we'll save progress as well. And as a member, I'm going to create a new activity report for a specific reporting period. These reporting periods would be sent from the state so the member does not have to report on unnecessary periods. Next I'll add an activity and you'll see here we notify the member that there are a couple different ways that they can meet the requirement. So they can report 80 hours of qualifying activities, show 500 dollars, $580 of earnings, which is federal minimum wage times 80 or a combination of the two. I just want to note that we just have hours as part of our like V1 steel cable version, but we are working on income verification as well and how the combination of the two can be used. So we have a very basic form. Where I'll add in. Details about my employee name, reporting period, and hours. I'll enter 70 hours. I can attach evidence here of my. My pay stub or anything else continue. And we can see the one reported activity there. So members can add multiple activities that total the 80 hour requirement. I just showed a single work report for 70 hours. And so you can see the calculation happening. And here it shows that we're that we are calculating to the requirements. The member even needs 10 more hours or $72.50 of income to fulfill that requirement for the month. I'm just going to continue to review and submit that report. And then if I go back to the dashboard again, I can see that my activity report has been submitted and is being reviewed. So that's the member side currently. There's lots more to come. I'm going to jump into this staff side. So here we have the staff side and again we use, we use USW DS for the interface, but we can adjust the design to match the states look and feel and we're planning on connecting to the state so IDC or SSO so it's a more seamless experience. This landing page has a list of the tasks currently assigned to the casework of who's logged in, and as a caseworker. There's a couple of things in this top navigation bar. They can search for a member, view all cases, or view all tasks. In Search, a caseworker can search for a member by e-mail. We'll also add the ability to search by name and case. In the Certification Cases queue view, the caseworker can see all open and closed cases and just a high level information on on the case. So here you can see the case that I submitted and we'll click into that one that with the activity report. And I'm taken to the case details screen, so the case worker can see different case certification details. So name, member name, e-mail status, the reporting period, they can see the tasks associated with that case, any requests for information which will show in a little bit exparte data, we don't have anything there and the reporting, the activity report. Umm, so let's click into the Review Activity Report task. That takes us to the task view. As a caseworker, I can assign this to myself. And I can start working it. I can see this is um for work program. I can see the organization named the reporting month hours income would be there when, if, if that was added and any supporting documentation. And then I can make a decision on on this documentation if the activity report is valid or more information is needed or it's not acceptable. So for this I'll show the request For more information flow. So I'll select no additional information is needed. And I'll be taken to this where I can say document. Is for the wrong reporting period. And I'll click submit. And as a caseworker, I can see that the request for information was sent. I'll also see it here in the case details. If if a different case worker would have come in, they'll see that it's on. We're waiting for the member. And let's actually to like continue this RFI flow. Let's jump back into the member dashboard. And see what it looks like on the member side. So here we're seeing for a member, they'll they'll see that they need to add additional information and they can click on that button. And they'll have some instructions and then the message from the caseworker document is for the wrong reporting period and so I can upload some. Additional documentation. Make any notes. And hit Submit Additional information. And that's it for the RFI. So the case will be updated and the caseworker can work that task. So let's. I'm back in the the staff view here and just kind of closing out the the one final feature with the top with the staff portal and this is the task queue view. So here caseworker can see a list of all open tasks, completed tasks and they can just pick up the next task. Umm, make a decision on it. Review the documentation. Yes, that's acceptable. Submit and. They can move on. So that's where we are right now in our current progress. As I said, we're moving fast and adding functionality daily. A repo is open source. You can find it in our GitHub and we'll send the link in the chat too. We have instructions on how to get this set up and started. Umm, So yeah, we're deploying daily and multiple times a day. This is. This just means that our system is safe, it's stable and built for continuous improvement and iteration. So we've been meeting with policy strategists. At States and others in our network to get feedback and incorporating that into our road map. So here our priority is usability for States and partners where designing for easy adoption. Our current development focus is on the initial automated exemptions and compliance pieces, which are critical to reducing the burden on, on, on. Our members will also be focusing on accepting income and verification. We'll make the member status determinations more clear. We want to pilot with partners to validate. We'll we'll do some basic role based access controls, get reporting basics and work on the AI automated review of evidence to reduce the caseworker administration burden. We're prioritizing the road map to solve the biggest eligibility bottlenecks with the least integration pane, so as we learn more about the policy implementation and work directly with states, we'll update the road map as needed. All right, so just wrapping some things up here. So we want to help you get started. We we have the experience, we have running code in production. We've been getting feedback and we'd love to set up a 15 minute call with you and states that are interested in getting started or just learning more. You can fill out the form at the Nava PBC Medicaid site and will reach out to you. If you're a nonprofit and think this would be valuable to one of your partners, please share that link. Let them know to fill out the form and encourage them to set up a call with us. If you're interested in jumping into the code, join the repo, get in there, and finally join us for the next demo on November 12th. You will get to see the next progress that we're making like that we're making. The registration link is there and will be sent in the chat as well. Umm, and that's about.