State: MA Type: Model Practice Year: 2004

Through the initiative sponsored by the Boston Public Health Commission and Community Catalyst in collaboration with Boston community health centers we have been able to develop and sponsor RealBenefits. RealBenefits, a web-based information service and tool set, was developed to provide human service, and other private and public sector organizations, with the capacity to perform sophisticated benefit eligibility screening, counseling and advocacy for eligible low income families, easily and at low cost. In the first five months following the availability of the final version of RealBenefits approximately 1,800 households were screened for eligibility and 3,500 applications for various public programs were generated. For a myriad of reasons, the internet has been slow to reach providers of human and social services, but the development of tools such as RealBenefits increases the capacities of service providers to take advantage of the ways in which the internet can defy time and space. Specifically, RealBenefits allows users to 1) maximize benefits designed to promote self-sufficiency and stability for low-income families and their communities; 2) create capacity in public and private health and human service agencies that increases services offered to low-income families and maximizes revenues; and 3) promote change in public benefit application systems.
In the midst of world-renowned health care institutions, approximately 10 -15% of all Boston residents lack health insurance coverage. It is well established that the uninsured delay seeking needed care, get sicker and have on the whole worse health outcomes than their insured counterparts. While Massachusetts has, by national standards, a vast array of health access programs, it is complex and difficult to navigate. These programs have varying eligibility criteria and application processes that are subject to frequent change. While welfare reform expanded eligibility for a host of public benefits, including cash assistance, Medicaid and food stamps, it also resulted in the decentralization of applying for these benefits. Each benefit has a different authorizing agency, eligibility guidelines and application process. Moreover, the newly instituted time limits meant low-income families faced employment demands that in turn conflicted with the office hours of these agencies. These policy measures did not create an environment useful to low-income working families to access needed services. Applying for public benefits currently required families to apply separately for multiple programs. The challenge facing health care organizations are: complex eligibility rules, lack of knowledge and a fragmented government system makes it difficult to enroll people in needed health care programs. The complex job of assessing people ¡s eligibility and helping them complete applications for programs fall to already overburdened health and human service organizations. These organizations are faced with a myriad of programs with different applications, verification, and eligibility rules can be confusing. Moreover, recent budget cuts and program changes make it difficult to stay current. Ultimately, the challenge was to meet patient needs, maximize revenue, and improve fiscal responsibility and efficiency. RealBenefits helps health and human service organizations ensure that they are informing their clients about all the programs they may be eligible for. RealBenefits simplifies the system by helping workers determine which program a client is eligible for and by using the automated system to complete applications. Subscribers (front line health and human service workers) conduct a standardized interview with a client (family), inputting basic information into the system. RealBenefits analyzes the client's information and calculates eligibility for multiple public benefit programs. RealBenefits offers convenient, "one-stop shopping" for obtaining needed benefits and services. RealBenefits builds on an existing network of health care providers with vast experience and expertise serving vulnerable populations, particularly low-income communities of color. RealBenefits provides a gateway for health and human service agencies to provide services in a more efficient and productive manner. RealBenefits bridges the divide of knowledge and access of low-income Bostonians and providers with needed public services and benefits. In Massachusetts, RealBenefits can screen for the following programs, all eight MassHealth (Massachusetts Medicaid program); MassHealth for Seniors; Children's Medical Security Plan, Free Care/Uncompensated Care Pool; CenterCare, Healthy Start; Women's Health Network, Prescription Advantage; Indigent Drug Program; Food Stamps Program; and Earned Income Tax Credit.
Agency Community RolesThe mission of the Boston Public Health Commission (BPHC) is to protect, preserve, and promote the health and well being of Boston residents, particularly those who are most vulnerable. The BPHC, the oldest existing health department in the country, serves the City of Boston by providing emergency medical services; collecting and publishing data on the health of Boston; identifying and preventing threats to the public health through policies, education and services; and filling the gaps in services to target underserved populations on health needs. BPHC programs, services and staff are dedicated to the core priorities of expanding prevention strategies, increasing access to health care for all Bostonians, and reducing and eliminating racial disparities in the measures of good health. In early 2001, BPHC contracted with Community Catalyst to underwrite a significant portion of the development costs to build a Massachusetts version of a software program entitled Medical Application Processing Systems (MAPS). Community Catalyst is a national nonprofit advocacy organization based in Boston, which builds consumer and community participation in the U.S health system to secure quality, affordable health care for all. Community Catalyst brought decades of technology expertise and extensive knowledge of eligibility for public programs. BPHC assumed responsibility for three areas, 1) investment of capital; 2) coordination of field operations and communication during the pilot phase including recruitment of sites; and 3) convene regular stakeholder meetings. The BPHC has an extensive history on working with community health centers on various public health initiatives from infant mortality to lead poisoning, to cancer prevention to immunizations. Building on this well-established relationship, we extended a formal invitation to all 26 centers to participate in the project. Costs and ExpendituresThe BPHC invested $269,000 to support the development and implementation of RealBenefits in Boston. An additional $25,000 of staff time was provided as an in-kind contribution.As the proprietor of RealBenefits, Community Catalyst assumed responsibility for creating a business plan and broadening statewide and national collaborators. ImplementationThe three year contract with Community Catalyst covered three stages, development; implementation; and maintenance. The initial development stage lasted almost six-months. In July 2001Phase I of the implementation stage began with recruitment for a pilot estimated to run 18 months. The BPHC extended an invitation to all 26 Boston community health centers to join, four accepted. The final pilot sites included four community health centers, a hospital-based pediatric clinic and a BPHC program, the Mayor's Health Line. BPHC and Community Catalyst engaged in a series of planning sessions with all stakeholders, the first version of MAPS was available in late 2001 for field testing. Initially, MAPS was a software program requiring installation and periodic updates at all field sites. Training was provided to all participating sites. Technical assistance was available as needed by telephone 24 hours a day. In December 2003, it was announced that MAPS would be modified from a software program to a web-based tool called RealBenefits. As part of this offer, BPHC agreed to underwrite the cost of user licenses for a two-year period. The final version of RealBenefits became available in July 2004. The BPHC again offered all the Boston community health centers to take advantage of the availability of RealBenefits. Another six community health centers and two human service agencies, and three new BPHC program accepted the invitation. Community Catalyst and BPHC then conducted another series of demonstrations of the new product. Several other health centers expressed interest, but due to internal technology limitations were unable to utilize RealBenefits at their site. Throughout the remainder of 2004, BPHC staff in conjunction with Community Catalyst conducted trainings for new sites and users. In January 2005, BPHC was able to extend the two year licensing agreement to three years free of charge.  
Participating agencies grew almost threefold after the pilot phase, going from six sites to 17. Our ability to offset a majority of the cost to struggling health centers and community agencies allowed them to take advantage of this opportunity. BPHC played a critical role in developing a local version of RealBenefits that benefited Boston and Massachusetts. The BPHC served an important function both monetary and logistically. We meet our contractual agreements and have ultimately met the goals of the project.
The reality is that internet-based applications are here to stay. RealBenefits is an important step for bridging the digital divide. The Commonwealth of Massachusetts has unveiled its initial version of an online benefit tool called the Virtual Gateway. The model already available through RealBenefits is helping to inform that process.