Latest News Tech for the People: How One-e-App Pioneered Digital Healthcare Access
May 30, 2023
Tech for the People: How One-e-App Pioneered Digital Healthcare Access

The year was 2005, and two nonprofit foundations, the California HealthCare Foundation and The California Endowment, were poised to change the way individuals accessed health and social services in California. They established the Center to Promote HealthCare Access, an institution dedicated to the development and implementation of technology aimed at providing efficient access to vital services.

Their breakthrough product was the One-e-App (OeA), an innovative web-based system enabling families to connect with an array of publicly funded health and human service programs. It was the first of its kind, trailblazing a path for a future where health coverage, food and nutrition benefits, utility and cash assistance were just a few clicks away. The story of One-e-App is the story of the organization that became Solution Interest Solutions and, today, lives on as One Degree.

Before 2005, most people still went to insurance agents to fill out dozens of pages of applications for their health coverage needs. However, with the birth of the OeA system, a significant shift began that improved resource access for low-income communities. Healthcare administrators within clinics and community-based organizations started to enroll their clients online, changing the landscape of how health insurance screening and eligibility were administered. During this era, legacy systems across industries were being replaced with innovative online platforms, including the shift from paper applications to the online Common App for college admissions and the surge of web-based document storage and sharing solutions such as Dropbox. It was the OeA team that stood at the forefront of this transformation in social services.

The organization’s longest employee and lead engineer, Naresh Ravuri, shared his experience of launching OeA nearly twenty years ago. “Reflecting on my journey with this technology, I feel truly blessed. I joined the team in 2007, although the project started in 2005. From that moment, it was a whirlwind of rapid, intense work striving to scale up OeA to meet the needs of our partners and their communities. Knowing that we were developing something that could potentially help millions of people gave us the drive to keep pushing forward.”

A crucial aspect of the OeA development team’s approach was forging deep, authentic relationships with clients—including San Mateo County, the County of Alameda, Los Angeles Department of Health Services, and Maryland’s Department of Health. This allowed them to more fully comprehend the unique needs of service providers and the communities they served. The team gained particular insight into a significant gap in safety net healthcare programs: the enrollment of individuals who, due to immigration status or other reasons, didn’t qualify for comprehensive Medi-Cal coverage. Partnering closely with their clients, the team quickly developed OeA to help enroll the highest need and poorest community members into much-needed healthcare services. While initially embraced primarily by community-based organizations, OeA usage evolved to encompass county and state health departments. This expansion led to the screening of over 9 million people across four states—California, Arizona, Indiana, and Maryland—and processing upwards of 12 million benefit program applications. 

Beyond facilitating enrollment in safety net programs, OeA served to reduce duplicative administrative procedures. In the past, healthcare administrators who worked directly with communities faced the burdensome task of filling out screening and eligibility paperwork for multiple systems. OeA, however, simplified the process. Functioning as a one-stop system to determine whether individuals qualified for Medi-Cal/Medicaid or other safety net programs, OeA saved providers considerable time and resources.

Ravuri reflected on how OeA enhanced accessibility, stating, “Our application was a breath of fresh air—straightforward and intuitive. With the aid of a helper, individuals could easily fill out the application, which put all the required information at their fingertips. Unlike paper forms that often didn’t capture enough information, our application provided all the necessary details, enabling us to do accurate eligibility calculations and promptly provide the results to our clients. We also introduced kiosks to access the platform in certain areas. The kiosk proved invaluable, especially for those who didn’t have online access at home. They could simply go to a county office and apply using our web-based application, a far cry from the lengthy and daunting paper forms of the past.”

In the early days of OeA, no other nonprofits or commercial vendors were involved in similar work. The team truly pioneered the use of technology to improve access to services and benefits. Aiming to deliver on its mission to promote healthcare access, the team recognized that Web 2.0 technology created an unprecedented opportunity to provide people with faster and easier access to healthcare resources and opportunities. Over the next decade, OeA became a tailored solution, adapting to respond to changing benefits policies and serving different agencies at the local, county, and state levels. Simultaneously, OeA became a blueprint and case study that other companies used to scale up similar technology solutions for benefits access. Today, every state in the country uses a system that, at its core, was modeled off the very first online application for benefits—OeA.

In the last 10 years, few industries have been left untouched by the Web 2.0 revolution, and the benefits and social services field has been no different. Many governmental agencies now have advanced even further to deploy robust, federally and/or state funded enrollment systems, like Covered California, that have reduced the need for OeA, a powerful technology for its time. However, One Degree knows that much more can be done.

Steve Spiker, Chief of Programs and Technology, shared, “Even though electronic applications have now become commonplace, there are still significant barriers to low-income people being able to easily access healthcare benefits and social programs. Despite the digital revolution, the enrollment process can often seem like a black box, where people can be rejected for unknown reasons and spend months or years in appeals or reapplications. The system pressures many people to give up. We are excited that some things have improved over time—for instance, renewals are now just a text message away—but the struggle to access and maintain benefits is still all too real for many. Developing technology and reforming administrative systems that offer universal access, transparency, and referrals to multiple service providers is where we currently see the greatest need.”

Recent changes in California state policy and the Governor’s budget have expanded and strengthened benefits eligibility for low-income families and undocumented individuals. As a result, many original programs that used OeA are being phased out, with families being transferred to MediCal. One Degree applauds this transition, seeing it as a positive step towards ensuring high quality healthcare and reducing administrative burdens. Consequently, One Degree is gradually sunsetting OeA and channeling resources towards what it perceives is the next evolution in social services—integrated eligibility and enrollment for benefits and services through an open resource and referral platform.

One Degree CEO Rey Faustino expressed, “We are immensely grateful to the original team of visionaries who conceived, developed, and launched OeA, as well as the unwavering support of our state, county, and CBO partners throughout the years. OeA has not only facilitated the enrollment of individuals into vital benefits, but it has also had a profound and far-reaching impact on countless lives, creating a ripple effect of positive change. Today, we are redirecting our focus towards addressing the evolving needs of the communities we serve. We are committed to finding innovative, equity-centered solutions and working with community partners to achieve our goals.”

“With One Degree, our priority lies in the next frontier of social service and benefits access,” he continued, “Ensuring that the technology infrastructure actually improves people’s lives. Equally significant is the robust foundation our past work has built, which has allowed us to foster invaluable relationships with key partners and clients, spanning from Los Angeles and San Francisco to the wider reaches of California. Even as we begin to phase-out OeA, the legacy of this pioneering technology system continues to inspire and guide our work.” 

The sunsetting process for OeA begins this month and is projected to run until spring 2024. In reflecting on his experience with OeA, Ravuri shared, “It’s sad to close an application that has served millions of people and fulfilled their needs for so long, but it’s comforting to know that people today can access the benefits they need through many alternatives like Covered California. I’m proud of our work at One Degree and with OeA,” he continued, “where we prioritize people and their needs and build solutions from there. Our impact has been wide. And as we move forward, we continue to leverage our history, our experiences, and our legacy to deliver the technology that people truly need.”