AVS Projects Robust Return on Investment Saves a State Millions

Solara Cochran

In August 2013, AutoGov began processing Asset Verification Service (AVS) requests for one of our very innovative and aggressive state government clients. After a successful implementation, the entire team was eager to hit the ground running. We were excited and astonished by the swift return on investment: within the first two hours of operation, the uncovered assets found by our solution paid for the entire program in cost savings.

To gain a greater insight into the meaning of this discovery, we must first understand the costs associated with leaving these assets unfound. Using the net present value of $76,000 as the annual cost of a normal long term care (LTC) Medicaid case, use of the AutoGov AVS solution found a great deal more than previous manual verification programs. In fact, the AVS requests produced over one million dollars in previously unknown depository assets, and the solution took, on average, less than 6 days to uncover well over one hundred submitted cases that exceeded the allowable state threshold for Medicaid.

Congress passed Section 1940 of the Social Security Act. This amendment requires states to implement an electronic Asset Verification System (AVS) for the aged, blind and disabled Medicaid population. AutoGov is on the forefront of innovation for integrated eligibility and program integrity, and our AVS project is one of only two fully implemented solutions in the country.

Until now, Medicaid applicants were only required to volunteer their banking information. As an individual, they could simply choose not to disclose a checking, savings, or certificate of deposit account. Medicaid case workers had no way to verify that applicants were fully disclosing all assets. It's a new day, and that is no longer true. With the help of AutoGov and our data partners, Medicaid caseworkers can be sure they are approving the right individuals.

AutoGov continues to uncover waste, fraud, and abuse for state and federal entitlement programs. For a quick and easy AVS implementation with very little upfront cost, contact Solara Cochran at (512) 439-2900 or email solara.cochran@autogov.com.

Where does Medicaid expansion stand today?

Solara Cochran

What are the states going to do?

 The Affordable Care Act will significantly expand both eligibility for and federal funding of Medicaid beginning on January 1, 2014. Under the law as written, all U.S. citizens and legal residents with income up to 133% of the poverty line would qualify for coverage. However, the United States Supreme Court ruled that states do not have to agree to this expansion in order to continue to receive existing levels of Medicaid funding.  Many states have chosen to continue with their current funding levels and Medicaid eligibility standards. 

 Some states such as New Mexico are taking a more progressive approach, asking their Medicaid recipients to pay co-pays for some treatments.  Co-pays will be required for services such as ER visits for routine medical care or using a brand-name drug over a generic.  One of the main goals of the revamped program is to better coordinate the care provided to recipients to improve their health or keep medical conditions from worsening and becoming more costly to treat.  Empowering people to take responsibility for some of their own healthcare costs will likely save millions of dollars for New Mexico.

 The State of Missouri has opted out of the Affordable Care Act Medicaid expansion.  Missouri still plans on reforming Medicaid.  There are now three legislative committees set up to study Medicaid reform.  Missouri law makers want to try and solve some of the problems the Medicaid program faces.  “In my old, country way of looking at things, I’d like to fix the bucket,” said Missouri Senator Jay Wasson. “I’d like to stop the leak before I put more water in it. I wouldn’t put more water in a bucket that already leaks.”  Missouri's leaders seem to want Medicaid recipients to have some skin in the game.  Ideas like incentives for preventative care and co-pays are being seriously considered. 

 Today, Medicaid provides more questions than answers.  Regardless of the outcome, change is on the horizon.  One silver lining in all of the upheaval is technology continues to play an even larger role in finding solutions.  Now organizations like AutoGov can help states, healthcare providers, and the public make decisions based on real-time information.  "Big Data" is alive and well in healthcare.  It is impacting all of us each and every day.

Changes in Healthcare Means Limiting Freedom

Gregg Phillips

Healthcare providers have limited freedom to run their businesses due to rate cuts, price fixing and needless regulations.

AutoGov is a typical small software company. Our customers are healthcare providers such as nursing homes, hospitals and home health companies. We are entangled in the never ending struggle balance scarce resources against the needs of our customers to ensure high service levels are maintained while offering a disruptive product.

We are free to charge whatever we choose is the optimum price for CaseVue. We spend weeks analyzing our costs against feedback we receive from our customers. If we are right, the market rewards our decisions. If we are wrong, we are punished. But, they are always our decision.

Troubling trends have emerged for our customers, however. They are increasingly hamstrung by government sponsored price fixing - eliminating a key freedom that business leaders require to be successful. For many of these providers (aka businesses) the inability to set prices as they see fit requires doors to close, further limiting capacity in this $3 trillion industry.

We watch as politicians, faceless bureaucrats and and the well meaning healthcare advocates make decisions that ultimately stifle their ability to survive. The basic laws of supply and demand are ignored.

Price fixing and monopolies are always bad in free market economies.

Businesses, including healthcare businesses will fail. Hospitals and nursing homes will close. Home health providers will struggle to recruit quality care givers. Drug companies will discontinue key research.

Our customers are watching helplessly as decisions are made and rates are set, or rather fixed, that ensure their rights and freedoms to run their businesses are reduced or eliminated.

Fair warning to all involved, this will not end well.

We all deserve the opportunity to succeed.

AutoGov Releases Updated Risk Management Software for Medicaid and Healthcare Reform

Taylor Phillips

Leveraging analytics driven by more than 30 million cases, CaseVue allows healthcare providers, states and insurance companies with a comprehensive solution to managing risk in eligibility, enrollment and insurance exchanges.

CaseVue v5.0

Quote startCaseVue combines advanced analytics with world class data to ensure fast, accurate eligibility, enrollment and exchange decisions.Quote end

Austin, Texas (PRWEB) January 14, 2013

AutoGov Director of Technology and Analytics, Taylor Phillips; announced today a major release of his company’s flagship healthcare risk management software, CaseVue 5.0. This important version introduces improvements and tools designed to ensure that information necessary for Medicaid eligibility and enrollment is available in real time on a caseworker’s desktop.

Business office managers and caseworkers are often saddled with making decisions without the benefit of data necessary to prevent mistakes or errors. In these times of rate pressure and uncertainty in the healthcare reimbursement structure, mistakes and errors often mean money – significant write-offs and even fines. Phillips says, “CaseVue combines advanced analytics with world class data to ensure fast, accurate eligibility and enrollment decisions.” CaseVue gathers case data and fuses information from third party data providers to feed an algorithm designed facilitate decisions. A remarkably fast turnaround…this process takes less than one second.

Thanks to AutoGov’s new financial partner, Ontario, Canada based Fusebill (fusebill.com); CaseVue can now be priced to suit our client’s needs – by the score, in packages or on a monthly basis! AutoGov’s specialists can create a custom pricing structure to support any healthcare business.

The software also features new self-service sign-up, administration, training and reporting designed by Phillips and an amazing development team at Rochester, NY based Netsmartz (netsmartz.net).

CaseVue is part of a comprehensive platform used by healthcare providers and government agencies to provide decision support solutions with a base in predictive analytics. CaseVue provides users with fast, accurate decision support tools that improve both the timeliness and quality of eligibility, enrollment and exchange related decisions.

AutoGov’s CaseVue software has provided scores to healthcare providers and government organizations since its launch in 2005. AutoGov’s algorithms are informed by data mining and statistical analysis of more than 30 million Medicaid, Food Stamp and TANF cases. The company’s firm belief is that solutions for its clients must be affordable, practical, and harness technology to support day-to-day operations without major disruption or unnecessary expense.

Contact one of AutoGov’s CaseVue specialists for a demonstration at 512-439-2900 or sign your company up today at http://www.casevue.com.

AutoGov at the University of Alabama's Business Analytics Symposium

Taylor Phillips

AutoGov founder Gregg Phillips had the distinct pleasure of speaking at the 2012 Business Analytics Symposium hosted by the IBA, Institute of Business Analytics, at the University of Alabama. 

Official "about" from the Symposium website:

The Business Analytics Symposium is a two day event exploring the diverse landscape of analytics in business.  World-renowned experts in the fields of statistics, data mining, analytics, and business attend. 

In addition to many excellent presentations and discussions, guests have the opportunity to interview and get to know University of Alabama students pursuing graduate degrees in Statistics, Business Analytics, and Economics. 

In addition to meeting the up and coming talent, guests have the opportunity to network with seasoned colleagues.  Many of our partners will take part in an exhibition  following day one of the event where you will have the opportunity to learn about how they use analytics .

Past speakers include Bill Kahn of Traveler's insurance, Lan Guan of Accenture, Kevin Busby of Capital One, Sundar Dorai-Raj of Google, Gene Grabowski of Ford, Collen McCue of Geoeye Analytics, and Tom Bohannon of SAS.

Lean more here:

Here are a few of our twitter highlights during Gregg's speech:

AutoGov Socially

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