piramid pre-review presentation
TRANSCRIPT
PIRAMID Pre-review:
Better than „Pay & Chase‟ Case Reviews
presented by
Vesta Kimble
Deputy Executive Director
Family Investment Administration
Maryland Department of Human Resources
September 10, 2012
NAPIPM
Maryland‟s SNAP Payment Error Rate
* As of March 2012
Most Recent FNS Table
of Most Improved States for
Reducing SNAP Payment Error Rates
In 6 years, our SNAP
caseload has more than
doubled
In 6 years, our staffing levels have decreased 12%
Maryland‟s CARES Eligibility System
Multiple Strategies During FFY 2011 and FFY 2012
to Reduce the SNAP Error Rate
Rushmore Consulting
for Quality Control
Gold Fork Competitive Awards
On-line Training and Refresher Quiz (Mandatory for Case Managers)
Side-by-side Comparison of Maryland’s
Supervisory Review System v. PIRAMID Pre-review
PAY & CHASE PRE-REVIEW
Staff to perform
reviews
FEW: Supervisors (and
sometimes lead workers)
Peers, well-trained clerks,
supervisors, lead workers, teams
Volume of
reviews
LOW: Tied to a quota of
reviews per case manager
Expectation linked to # of
applications approved and
redets/interim changes processed
Method of
review
ASSUMED: Reviewer
knows the elements to
review and HOW
Specifies the questions to ask
and specific contributing causes
as well as error types
Useful of data LITTLE: Maryland‟s
system was primarily
used for personnel
evaluations of case
managers
Immediate and drilled down by
error type, error cause, pre-review
questions and further specific
identifiers (e.g. telephone, face-to-
face interview, mail-in)
Flexibility NONE: Tied to the legacy
system; difficult to
program changes
Programmed in Excel; changes in
review questions, format, error
causes, etc. OVERNIGHT
Accuracy Re-review reveals errors
not coded; errors not
corrected or untimely
Re-reviews show compliance; no
review can finalize without errors
being corrected
Need to cleanse caseload of OLD errors from years of rushing, short-cuts,
turnover/neglect
Two pairs of eyes
Promised FNS quick action to reduce the error rate
One Local Office SNAP caseload
= 1,200 households
(as of 10/1/11)
Each month:
100 cases come out for redetermination
10 cases are scheduled to close
12 new applications are approved
122 cases out of 1,200 can be “fixed” per
month maximum.
How to Fix the Buried and Hidden Errors
Within one year, all cases could be reviewed.
Designing our Pre-review System
• Recruited a Pre-Review Workgroup to use errors from SNAP,
TANF & Medicaid Quality Control reviews, SNAP Management
Evaluation reviews and Audits to design Pre-review questions.
• Pre-review Workgroup included representatives from:
• State Health Department, Office of Inspector General
• DHR Policy, Training, Quality Control and Program Evaluation
• Local Department front-line staff
• Began meeting in February 2011, designed review questions
from March through June 2011
• 194 specific questions were developed for SNAP, TANF,
Medicaid, General Public Assistance and MCHP
• Only 19 questions are mandatory for SNAP; however, local
offices can opt to select additional questions based on their
needs. Often offices add questions for corrective action plans.
Jump
Designing our Pre-review System
• July 2011 strategy was reviewed by Local Office leadership,
DHR leadership, IT staff at DHR (marketing the concept in
advance to all stakeholders)
• Family Investment automation staff began the design in
ACCESS, but the plan was halted by DHR IT, who feared a
system based on ACCESS would not be secure
• Needed to begin pre-review no later than October 2011; we
promised FNS the strategy would be underway by October.
• Turned instead to an Excel front-end design and SQL back
end; data are stored in a SQL server; local IT control access
• Used the Active Directory shared drive in each local office as
the delivery method for the files…we call this “the PIRAMID
portal”…6 staff at DHR Central have access to the folders
PIRAMID Pre-Review File Structure
(Active Directory Shared Drives) The Path of a PIRAMID Pre-Review
8_27_12_337_1046721_ Bernard_Karen_REM332.xls
Blank_Pre-review_Form1.xls The blank file auto-saves
With the Date, District office,
Client ID number, Pre-reviewer’ s
name, Case manager’s Logon ID
EFinal_8_27_12_337_1046721_ Bernard_Karen_REM332.xls
The file name changes to “Final”
or “EFinal” (if errors) when done
Data elements auto-load into an
SQL server for analysis
Implementing Our Pre-review System
• Rolled out to the Local Departments in September 2011 with
in-person training for all pre-reviewers, supervisors and
managers.
• Telephone-based training sessions for PIRAMID Liaisons,
who are Super Users in the local offices and trouble-shoot
issues that Pre-reviewers and Case Managers encounter.
• The in-person training for Pre-reviewers was one-half day. It
included what we will now watch…a “video” of sorts to
introduce them to the concept before hands-on practice…
(NOTE: If you are viewing this PowerPoint online, just
click once to advance to the next slide. Then don’t click
again until the music stops.)
Introducing...
P I R A M I D
CORRECT PAYMENT ERRORS
INCREASE EFFICIENCY
ANALYZE DATA
WIN $$
For three years,
Our SNAP error rates have been too high...
Our rate is now the WORST in the nation…
We have been fined more than $2 million…
Our goal is to reduce our error rate to
less than 6 percent before October 2012.
PIRAMID Pre-Review will help us review more cases
than the existing Supervisory Review System.
We will review cases BEFORE the benefits are
issued.
PIRAMID Pre-Review is in YOUR office now.
So let’s take a look... from your desktop PC.
Pick a program and status.
For example, FSP Pending.
You can select samples of cases to review
in your District Office’s “GENERATOR V” file.
Pick a sample size.
Click on the gray button to create
the sample list.
Your sample list will be created and saved
to the PIRAMID Samples folder.
You can then pick a case to review
and click the “Create Pre-Review Form” button.
Your Pre-review form will open
and auto-fill the case information
(from the CARES eligibility system).
After you select your name as the Reviewer…
Click on the “Begin Review” button.
The review questions will load,
and then you can begin your review.
Examine your case record and CARES screens
and answer all questions that appear.
When you are done, click on the gray
“Ready to create report” button.
Then your report will appear,
with the errors listed at the top.
You can E-MAIL the review automatically to the
case manager for correction.
Your e-mail will be sent automatically through
GroupWise. This is what the e-mail looks like.
E:\PIRAMID\PRE-REVIEW\09_10_11_030_3XXXX222_Sherelli Lewis_RAA03E.xls
Sherelli Lewis
The “Subject”
line alerts the case
manager to the
errors
The Review file
is attached.
Your review will auto-save to the
“AWAITING CORRECTION” folder.
When the errors have been corrected, open the
file from the “AWAITING CORRECTION” folder.
For each error, click to choose “Corrected.”
Select the name of the staff person who corrected
the review.
Enter the date the correction(s) was made.
The “electronic smiley face” will let you know you are done.
To finalize the review, click the gray button named
“Finalize & save to the COMPLETED sub-folder.”
And the file will auto-save to
the “COMPLETED” folder.
Headquarters (DHR) will analyze all reviews in
this folder.
DHR will return reports to your “REPORTS” folder
Pre-review reports analyze productivity…
As well as the specific errors identified – by
contributing cause…
And the Top 10 most common types of errors.
From your PC…to your local server…to DHR...
Your PC
Your local
office network
server
DHR’s
SQL
server
We can then qualify for BONUS $$$$$
FLORIDA………………………..$ 6,083,577
MARYLAND?......………………$ ?,???,???
TEXAS……………………………$6,243,012
MISSISSIPPI……………………$1,182,562
“And you ask me what I want this year
And I try to make this kind and clear
Just the chance that maybe we'll find BETTER DAYS
Cause I don't need boxes wrapped in strings
And designer love and empty things
P I R A M I D T h a n k s t o :
PIRAMID Pre-review is
here for you and
your “better
days"
Complete as many reviews as possible
before an application is finalized or
immediately after a redet or interim change is processed
but before it takes effect.
Completing a large volume of reviews
and correcting the mistakes found
will improve our accuracy!
Use Pre-review results to measure and inform training and
local office business practices.
Measure efficacy of Pre-review in QC reviews, ME reviews,
OIG audits, and appeals.
Our Expectation Was Clear:
USES OF PRE-REVIEW DATA
• SNAP Challenge questions
• Long Term Care Challenge
questions
• Policy Training and Transmittals
to clarify
• Field Operations technical
assistance for business practices
• Personnel evaluations
Pre-review questions were and are
designed to identify mistakes in
process, not just payment errors
When possible, questions cut
across program boundaries
SOURCES OF DATA
• QC errors
• Management Evaluation findings
• Audits findings
• PERM findings
DESIRED OUTCOMES
• Lower QC error rates
• Fewer SNAP ME adverse findings
• Fewer repeat audit findings
• Lower PERM error rates
Lapsed Time for Performing
PIRAMID Pre-reviews*
Statewide for February 2012
Average Time = 5 minutes
Changes in the Number of SNAP Errors and Ranks of Top 10 Errors
Tracking the Errors by Review Question, Monthly
Future enhancements for PIRAMID Pre-Review
• Real time Review Log (now in testing) with auto-
calculating counts and flags for reviews awaiting
correction
• Hyperlinks to specific SNAP, TANF, Medicaid
Policy Manual sections for each pre-review
question, for case managers to click on when
examining mistakes
• Eventually, our new CARES 2.0 system will
incorporate Pre-review into the business process…
• And then, PIRAMID Pre-review will end.
