Extraordinary Results
Implementing a Health Benefit System Processing $10B+ Annually
About CalPERS Health Program
The California Public Employees’ Retirement System (CalPERS) is the largest purchaser of public employee health benefits in California and the second largest public purchaser in the nation after the federal government. In 2021, CalPERS spent over $10.2 billion to purchase health benefits for active and retired members and their families on behalf of the state of California (including the California State University) and nearly 1,200 public agencies and schools.
CalPERS has a vested interest in the health of their members, not only during their time as employees, but also throughout retirement. This long-term relationship drives the high-quality comprehensive health benefits that they provide, which help their members maintain their quality of life no matter their age.
myCalPERS System Enhances Health Service
For over a decade, the myCalPERS system has supported CalPERS health and pension benefit management. The system undergoes continual enhancement to optimize depth, breadth, quality, and cost of California medical care. The benefits of the system include:
- Convenience: The implementation of myCalPERS for health benefits streamlines the enrollment and management of health plans. Members conveniently access and update their health benefit information online, reducing the need for manual paperwork and phone calls.
- Self-Service: Members use myCalPERS to make changes to their health plan selections, review coverage options, and even compare different health plans. This self-service functionality empowers members to make informed decisions about their health benefits.
- Real-time Access: myCalPERS provides real-time access to health benefit information, reducing delays and the potential for errors that can occur with paper-based processes.
- Increased Efficiency: Automating health benefit management through myCalPERS significantly reduces administrative burden on CalPERS staff, allowing them to focus on more complex issues and improving overall efficiency.
- Data Accuracy: myCalPERS has built-in checks to ensure data accuracy, reducing the likelihood of errors associated with manual data entry.
- Cost Savings: By reducing the need for paper forms, mailings, and manual data entry, CalPERS achieved cost savings associated with the administration of health benefits.
- Member Communication: myCalPERS serves as a communication hub for important updates, notifications, and reminders related to health benefits, ensuring that members stay informed.
Capio Delivering High-Value System Enhancements
Capio Group is CalPERS’ trusted partner in both the implementation and continued enhancement of the myCalPERS system. For over a decade, Capio Group and CalPERS have improved the system for the benefit of members, business partners, and staff.
Recent Problem
Judges could not pre-pay premiums online. With no pre-pay functionality in the myCalPERS system, each payment was a separate customer case manually created, processed, and tracked. Invoices were also created manually in the system as cases. CalPERS technical staff were required to close out the cases once they were manually processed by staff. This manual process led to delays in several steps of the process, data inaccuracies, and late premium payments that led to Judge health coverage being dropped. The new functionality needed to identify new members, invoice them, accept payments, keep the account accurate and correspond with members when action is needed.
Project Approach
CalPERS requested a full end-to-end process evaluation for Judge prepaid accounts and how it can be incorporated into the recently refactored Complementary Annuitant Premium Program (CAPP) process (a similar prepaid process for CalPERS members). Capio collaborated with stakeholders to map as-is processes to identify key functional and technical requirements. The process would need a number of new flows to account for Judge specific rules, variables, and timing. This greatly increased the complexity of the project.
This greatly increased the complexity of the project. Our team used a hybrid-agile approach, breaking the project into smaller iterations, each focusing on delivering a specific set of functionality, but also diligently planned and scheduled based on CalPERS needs. Together, we built a minimum viable product to discover system, data, and timing impacts on the process before moving on to the next iteration of improvements. A detailed data roadmap was created to ensure successful conversion of existing prepaid accounts into the new data model. The team’s work discovered and fixed existing defects in the CAPP functionality and ultimately improved that process as well. Our team continued to work closely with business subject matter experts throughout development, constantly improving through regular feedback loops.
Project Success – A More Efficient Process for Staff and Members
Developing and improving the Judge prepaid account functionality eliminated all manual work, saving a great deal of time and money. The process went from taking 15-20 staff resources to just one. Since the enhancement was released, the growth in these accounts has grown 457%, but still just one staff person monitors and maintains all of these accounts.
New accounts and transactions are processed daily providing excellent service levels and the data is much more accurate. Member calls to the help desk were greatly reduced.
The project was implemented within the timeframe estimated during the JAD session without any major issues and the functionality was enhanced in later releases by adding delinquency and auto-cancel processes. In the end, the client was very satisfied with the project outcome.
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