It has taken more than eight years to bring the new Texas Integrated Eligibility Redesign System (TIERS) online in every region of the state. While its users ultimately may find it more efficient than its predecessor — the 1970s-era System of Application, Verification, Eligibility, Referral and Reporting (SAVERR) — it’s likely that the personnel involved in the transition are thankful the project’s finish line is now firmly in sight.
The switch to TIERS had an array of problems from the start. Although the project began in June 2003 as a pilot in both Travis and Hays counties, and the system was implemented in Williamson County in 2006, the process dragged on through the end of the decade.
Different systems integrators tried pushing the TIERS implementation through — Texas first went with Deloitte, then switched to Accenture only to return to Deloitte — but the Texas Health and Human Services Commission’s (HHSC) attempt to modernize its eligibility system seemed destined for a colossal failure.
According to Texas officials, the back-and-forth dance between Accenture and Deloitte led to some technical issues with the code embedded in TIERS. The application encountered networking issues that slowed processing and, at times, pages on which users were working would suddenly go blank.
Combined with workers being unfamiliar with TIERS and insufficiently trained, it’s no surprise that a November 2007 state audit called TIERS “cumbersome to use.”
The inevitable slowdown of work led to backlogged eligibility cases and snowballed into a stereotypical troubled government project.
These days, however, the outlook is brighter, thanks largely to help imported from Michigan. Stanley Stewart, who had guided the Wolverine State through a similar eligibility system implementation, was hired in early 2010 as a consultant by Tom Suehs, executive commissioner of the HHSC.
Stewart was made the HHSC’s deputy chief of staff for Eligibility Integration and put in charge of the entire TIERS rollout. Sixteen months later, TIERS was fully online and functioning in every region of Texas.
While it would be inaccurate to label Stewart the project’s sole savior, his appointment and direction of the TIERS rollout was something both Suehs and Stewart felt was critical in turning around the system implementation process.
Suehs said that Michigan faced problems similar to those in Texas, just on a smaller scale. So instead of reinventing the wheel, he handed Stewart control of the TIERS project.
The move may have been seen as risky to some, given that the two had never known or worked with each other. But Suehs was desperate for improvement, and he was impressed enough by Stewart’s project management approach to roll the dice. “It became obvious that he had the people skills,” Suehs explained, “and that’s part of what was missing here.”
When Suehs became HHSC commissioner in 2009, he immediately began fielding complaints from existing TIERS users, as well as from employees transitioning from the old SAVERR application.
After speaking with front-line workers, Suehs concluded that the TIERS technology was “probably OK,” but the relationship between users and IT personnel leading the migration needed serious improvement. Users were telling software designers what they needed, but their feedback didn’t seem to make a difference.
“Somehow the communication between the front-line worker and our technology staff had broken,” Suehs said. “It also became clear that we weren’t training the staff in a sufficient way to accept the technology transition. So I boiled down our issues to communication, training and listening.”
Stewart’s turnaround methods were less about the technology and more focused on the people operating the system.
His first step was to evaluate and ultimately improve TIERS training, which was being done in a lecture format by people who didn’t know the system well. Stewart had the trainers relearn the system from the ground up, and then work actual cases brought up by employees to give them “hands-on” experience in solving various problems.
Another important change, Stewart said, was not letting employees return to the old SAVERR system once they began TIERS training. “That made a big difference, and once people started being a little more successful, other people came along,” he said, adding that new hires took readily to TIERS, while those who were successful using SAVERR “struggled a little bit,” but are doing well.
The investment in training and better onsite support reduced worker frustration and improved productivity, Stewart said. Like their Michigan counterparts, HHSC employees working with TIERS tended to spend hours trying to resolve issues themselves.
“Now if it’s more than 10 minutes and you can’t get through it — you can put a little flag outside your office and somebody will come and help you,” Stewart said.
Along with training and teamwork improvements, Suehs re-emphasized accountability from his implementation team, including weekly meetings for senior management to confront project issues. Those meetings include representatives from various offices, from the data staff to public information officials. All issues are brought to the table and, according to Suehs, the meetings don’t move forward until management reports on each office’s performance on clearing the backlog of eligibility cases.
Suehs was adamant that everyone report on their progress and have all of their issues addressed.
“I knew everybody would be busting their backsides to make sure they did things from the previous week and that they only had Monday and Tuesday to polish it up,” Suehs said. “It means that I was forcing them to be focused on a week-by-week basis of addressing our issues and addressing the problem.”
Stewart also persuaded Suehs to bring TIERS online without waiting for upgrades and tweaks to the system. “Stanley convinced me to suspend doing any major improvements in the technology. He said, ‘Let’s bring the technology online, and ... tweak it after that, but quit messing with it right now.’
“That is a major policy decision I think Stanley generated very early on as a suggestion that probably had more impact in establishing the system than anything else,” Suehs said.
Despite the recent momentum, social service advocacy groups say TIERS isn’t completely out of the woods yet.
Celia Cole, a senior policy analyst at the Center for Public Policy Priorities, said the application process for benefits eligibility is better — but it’s still heavily paper-based and labor-intensive. “In some ways we’re trying to get a horse to pull a train,” Cole said. “They are out of sync. We have these outdated application processes, yet we have these great new electronic and automated tools for getting people onto the program.”
And Martha Orozco, managing attorney of Lone Star Legal Aid’s Public Benefits Unit, contends that TIERS still struggles to meet requirements for the Food Stamp Act. At first, denial letters issued by the system didn’t include the reasons why an individual failed to qualify for the food stamp program — which Orozco said is mandatory. Those letters now include the required explanation, but the reasons for denial often are “completely wrong and irrelevant,” she said.
Orozco added that application forms generated by the new system can be confusing, especially to non-English speaking applicants. This can result in these applicants failing to provide required information and being denied benefits.
Still, given their progress over the past 16 months, HHSC officials say they’ve achieved an important milestone. The basic rollout of TIERS was completed when the Dallas region came online in September, according to Stewart. As of that date, programs such as Medicaid, food stamps, and the Texas Works employment education and training program were all running through TIERS.
Further deployments to handle Medicaid for the elderly, disability and long-term care, and a three-year certification for the Texas Supplemental Nutrition Assistance Program (SNAP) for people who receive Supplemental Security Income were complete in mid-December.
Still, Suehs wants to keep Stewart around for at least another year — to help with various system changes and improvements, such as Web portal upgrades and early planning for TIERS to acquire a larger client load in January 2014 due to national health-care reform. Suehs also wants Stewart to transfer his skills to the HHSC’s regional directors and supervisors before departing.
Suehs added that while Stewart was brought on as a consultant, he treated him like his deputy chief of staff and gave him that authority. “I think that was critical to the success of the project,” Suehs said. “He wasn’t just an outside adviser; he was responsible, and I was going to hold him accountable.”
To make sure each region in Texas stays on top of things, Stewart gets daily reports from them that list any delinquent cases and follows up on them as necessary.
Stewart was quick to credit Suehs for the TIERS success, however, saying it was his trust in bringing in an outsider and giving Stewart full authority that helped the implementation turn the corner.
As for the future, Stewart said he’ll work with the HHSC to tie up loose ends. But he anticipates the remaining work to be completed quickly because staff members now have bought into TIERS and the new training system.
“I ruffled a few feathers here to get it done,” Stewart said, “but the lesson for other states is that when you bring in a consultant, they must transfer knowledge and involvement to those who are going to be left to run the program.”
