Aquilent’s comprehensive work on the Enrollment System Redesign enables the VA to expand the enrollment of health care to veterans for the first time since 2003.

• the objective_

• The Enrollment System Redesign (ESR) provides a centralized enrollment system for evaluating veteran eligibility and enrollment for health care benefits provided by the Department of Veterans Affairs (VA). The VA required changes to business rules to comply with new legislation requiring the VA to relax the thresholds currently restricting access to health care for veterans.

  Veterans are currently assigned to Priority Groups based on characteristics of their military service and their income, expenses, and net worth. The Priority Group 8 (PG8) enhancement increases the number of veterans receiving health care benefits by increasing the income threshold by 10%.

  The Income Verification function validates the veterans’ self-reported income to ensure their health care benefits are appropriately assigned. At times, co-payments are required from veterans who are not disabled by law. This allows the VA to recoup costs. The self-reported income of veterans is validated through requests to the Internal Revenue Service (IRS) and the Social Security Administration (SSA) through the Income Verification Matching (IVM 2.9) program as the system that interfaces with ESR.

• the solution_

• Aquilent provided comprehensive services to achieve the VA’s goals and objectives, including project management, requirement analysis, application design and development, as well as system and integration testing.

  ESR integrates with VA components in the Veterans Health Information Systems and Technology Architecture (VistA) and HealtheVet common services such as the Master Patient Index (MPI) and Person Services Identity Management (PSIM) to provide enrollment information to sites of interest. ESR is a Java/J2EE application using BEA WebLogic, open-source frameworks such as Spring and Hibernate, and COTS such as ILOG JRules. ESR complex business rules are designed in an easy-to-use graphical style and executed in the ILOG Rules Engine.

  The PG8 enhancement revised the ILOG rules that determine the enrollment priority groups to take into account the 10% increase in the VA thresholds. In addition, a number of reports were provided that allow the Health Eligibility Center to monitor the results of this initiative.

  Aquilent also maintains the IVM 2.9 software, which was built on the .NET architecture and interfaces with the ESR system as well as VistA through HL7 messaging.

• the payoff_

• Aquilent’s leadership provided the VA with the expertise to quickly and efficiently modify the centralized enrollment system for the change in health care policy. The entire project was accomplished in less than 7 months from start to deployment in production. As a result of the PG8 enhancements, more than 200,000 additional veterans are expected to be approved for health care benefits. In addition, the income verification program leads to recovery of health care costs from those veterans who by law must make co-payments.

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