Integrated eligibility’s time has finally arrived
Why it’s time to rethink your approach to integrated eligibility systems modernization
A little over a decade ago, many US states began making a big push to modernize and integrate their benefits eligibility systems. These system are used to determine eligibility for Medicaid and other social services programs such as the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families among many others.
While many states have made impressive strides, the results have not been entirely positive, with efforts often plagued by high cost and implementation challenges. But we’re now at the dawn of a new era. Fresh approaches, technology advances and new entrants into the field have come together to offer states an alternative solution to the challenge. With the convergence of technological advances, growing public expectations and operational imperatives, integrated eligibility’s time has finally arrived. It goes beyond being a mere technical priority; it’s a strategic imperative that can help states address immediate challenges, improve service delivery, enable innovation and enhance constituent outcomes, while positioning them for sustainable long-term success.
Seize this pivotal moment by downloading our issue brief - arm yourself with the insights you need to leverage the power of integrated eligibility.
What’s wrong with the previous approach?
Armed with the benefit of hindsight, we can see that the largest contributor to first-generation difficulties may simply have been bad timing. Although the cloud was far from new in 2011, it had not yet matured to the point we see it today, and most government chief information officers (CIOs) would have had little experience implementing solutions utilizing it. Taking a cloud-native approach or integrating multiple software as a service (SaaS) applications to form a complete solution would have seemed foreign and risky to many at the time. They would therefore naturally address challenges like this with a “build a custom application” approach, the same tried-and-true methodology that had been used for the previous twenty years.
The effect of this decision, however, is that it locked agencies out of the incredible advancements cloud companies would make over the next dozen or so years. As a result, these “modern” IESs were never quite modern from the outset.
Why new approaches can now revolutionize IES modernization.
The advancements in cloud technologies and delivery models over the last dozen years, and developments in other technologies that have built on those advances, have proven to be game changers in application design.
Cloud service models, for example, have matured. Platform as a service (PaaS) and infrastructure as a service (IaaS) have joined SaaS, providing software developers and their customers with more flexible and powerful options. Containerization and microservices architectures are enabling software development teams to work at an unprecedented speed and scale by simplifying or eliminating many of the complexities associated with a traditional server environment. Low-code solutions are enabling people to create or change rules, processes or integrations with a simple drag-and-drop user interface instead of arcane software languages and development tools.
Over the same time span, many SaaS providers have introduced features or released versions specific to the needs of government agencies. Salesforce, for example, the leader in cloud-based customer relationship management, now offers a version specifically designed for public sector benefit management.
Because of these and many similar advancements, any state contemplating or struggling with an IES project would surely benefit from a modular cloud-native approach. The advantages are compelling:
- Faster development and lower costs
- "Future-proofing" of your investments
- The ability to leverage the investments and economies of scale of major software providers
- An improved customer experience with human-centered design
- Improved employee satisfaction and agency performance
The cost of doing nothing
This all sounds great, but has the ship already sailed? An agency’s current IES may not be ideal and different choices may have been made if the ACA had been passed today, but if it ain’t broke, don’t fix it, right? Even if it is “broke,” how does an agency sell a modernization project to government leaders when they’ve only recently “modernized” this very system?
The good news is that the speed and flexibility of the cloud model can enable agencies to incrementally implement the new functionality, rather than a wholesale rip and replace. Legacy systems can be integrated like any other modular component. Investments you’ve already made are protected.
The cost of doing nothing and simply staying the course will inevitably become unsustainable if it hasn’t already. It’s not just a monetary cost; it’s also a cost paid by constituents and workers with frustration and poor outcomes.
As most states continue the effort to modernize and integrate benefits systems, now is the time to break the cycle and reassess the approach.
"Why KPMG"
KPMG has worked with governments for more than 100 years. Our teams work closely with agencies to modernize outdated technology and business processes, creating positive change that benefits government workers, constituents and communities. Leveraging our experience spanning many large and complex integrated eligibility and other HHS modernization initiatives, we offer an approach backed by industry-leading methodologies and technology frameworks to incrementally modernize and “future-proof” your IES investment.
The KPMG Resource Integration Suite (KRIS) is a modern, flexible, and configurable solution designed to help states overcome years of frustration with their existing IES solution—without the pain of rip and replace.
It encompasses the KRIS Connected System Integration Platform (SIP) and KRIS Benefits Management “app” powered by Salesforce Public Sector Solutions. The modular SaaS solution is built on industry-leading third-party products pre-configured with KPMG intellectual property to meet agencies’ public benefits management and integration needs.
Rooted in KPMG's extensive transformation experience and guided by the KPMG Enterprise Reference Architecture (KERA) for Health and Human Services (HHS), which provides a blueprint for what a best-in-class HHS enterprise looks like, it is unlocking possibilities for states, enabling them to deliver, monitor, and manage their programs more efficiently than ever before.
Combining pre-configured enterprise architecture asset accelerators, low-code tools, integrated case management, advanced analytics, AI, and an omni channel client experience, it empowers states to adjust readily to changing laws and regulations, easily incorporate business processes changes and adapt seamlessly to technological advancements such as GenAI.
KRIS Benefits Management is powering the future of integrated eligibility.
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Integrated eligibility's time has finally arrived
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