Presented by:

Vicki C. Grant, PhD, MSWVice President

Eligibility Process Improvement:

Change at the Operational Level

Enrollment and Renewal Processes

Interaction of:

• Process

• People

• Automated Eligibility Systems

The Process

Churning is Rework

Data and Case Reviews:• 30% of closures reopened within 30 days

– this becomes next month’s work.

• 95% of closures reopened in a 6 month period– this is rework.

• 45% of closures statewide re-enroll within 12 months.

Ineffective Communication• Problem: System Generated Communication

24,000 clients received at least 1 official notice in the last 6 months

Average number of notices per client was 4.1 per day Range of notices was 1 to 48 in a day

• Solution: Change the Computer System 172,660 fewer pieces of paper 43,165 fewer envelopes Save 2 hours/day per worker by reducing inquiries about

notices Save 30 minutes/day per worker in researching notice and

explaining

Incorrect Addresses

Local office counted returned mail over three days:

– Received 473 pieces of mail

– 228 pieces (48%) were returned by post office

Language Match

In a large county, the Spanish caseload retention rate increased by 34% when the annual redetermination form was changed to multi-lingual.

Streamlining Work

.

BEFORE AFTER

Processing Time 28 days 3 days

Wait Time 87.5% 14%

Eligibility Determination Time 40 min per app 18 min per app

Touches 72 16

Overtime Cost $27,000 monthly $0 monthly

Model for Improvement

What are we trying toaccomplish?

How will we know that achange is an improvement?

What change can we make thatwill result in improvement?

Act Plan

Study Do

Aim

Measurement

Cycle for

Learning &

Improvement

Prediction

Pre-WorkPre-Work

The Seven Transactional Wastes1. Waste of Overproduction – Preparing unneeded

reports, reports not read or acted on,multiplecopies in storage

2. Waste of Time (Idle) – Batch processing,i.e., monthly closings, weekly billing, monthlycollection reports

3. Waste in Transportation – Unneeded steps,document/data travel distance

4. Waste of Processing (Too Fast) – Excessive sign-offs

5. Waste of Stock on Hand (Inventory) – Transactions waiting to be processed

6. Waste of Movement (Worker) – Unneeded data entry, extra steps

7. Waste of Making Defective Products – Incorrect data entry

Example: Oregon Health Plan

They went from this:

Sorts Applications

UnknownSelf Employment

Team 1 Team 2 Team 3 Team 6Team 5Team 4

START

START

FaxedApplications

Barcode Worker

Sorts

SPDMAA/MAF/BCCP

RedirectedFaxes

Applications Worker Mail

Research forDuplicates

Sorted to WorkerMail Boxes

Sorted to UnitMail Boxes

Prints Informationfrom DB2

Given to LeadWorker toResearch

Enters on LogSheet

Stapled

Date Stamped

Duplicate Non-Duplicate

db2File File

Color-FlaggedTeam Applications

UnbornDV/GCMother's

CareEmergency

OHP Application / Mail Room Process

OHP Application / Bar Code Process

Team 1 Team 2 Team 3 Team 6Team 5Team 4

SortedApplications

Barcode WorkerBarcode WorkerBarcode Worker

Sorts Teams 3 & 5Sorts Teams 2 & 6Sorts Teams 1 & 4

Sorted byLanguage

English OtherRussian VietnameseSpanish

Sorted byCategory

Scan ReadyReapplications

UnbornApplications

New Applicationsto be Scanned

Scan Ready NewApplications

Domestic ViolenceApplications

Bar Code Created

Applications areDispositioned

ApplicationsDelivered to Case

Set Up

UnknownSelf Employment

FaxedApplications

Barcode Worker

Sorts

Research forDuplicates

RedirectedFaxes

Applications Worker Mail

Sorted to WorkerMail Boxes

Sorted to UnitMail Boxes

Prints Informationfrom DB2

Given to LeadWorker toResearch

Enters on LogSheet

Stapled

Date Stamped

Color-Flagged

Mother'sCare

EmergencyUnbornDV/GC

Duplicate Non-Duplicate

Team Applications

Identifies Unknown

Barcode Worker

Self Employment

OHP Application / Case Set Up ProcessApplications Delivered from Bar Coding

Applications Pre-Sorted by Team/Language/Category

NewApplications

Add Persons

UpdateDescriptors

Assign Applications

Application AssignmentsProvided by Lead Worker

Assignment by Amount Requestedand order of Processing Priority

ApplicationsDispositioned by

Worker

Priority

Reapplications

NewApplications

ApplicationsDelivered to Team

Lead Worker ReturnsApplications for Absent

Workers

Pending orChange Status

Update Address &Phone

Complete CaseInfo at Top of App

Filed in Cabinet bydate and Team order

Contact Client toComplete 7211

Reapplications Priority Applications

DV/GC Applications

Mother's Care

Unborn Applications

17 & Under

Emergency

Adult Child

Assigned toLead

Filed by NextDay Priority

Filed inBuckets bydate and

Team order

ImagedApplications

Flicked

Delivered toOFDM

Next Day, Pickup 1st Page of

Application

Non-CitizenApplications

INS Number &/or INS Card

Call INS

SAVE form

Attach toapplication

WEBM FINDfor Case

Information

Open CMCase

Closed CMCase

No CMCase

Case MembershipList

Select Persons

CM Case Set Up

VP, CP, NACases

Mark CaseStatus on

Application

Non-5503Labled5503

UCMS Transferfor P2 Cases

Line thru branch#, put 5503

START

LeadTakes to

Mail Room

UPS HNAApplication

Mail Roomand BarCode

Process

Lead takesto CaseSet Up

EmergencyMother's

CareNews Reapps DV/GCUB MAA

Assignedto Lead

Assignedto HSS1

Assignedto HSS2

START

Lead bringsApplications from

Case Set UP

EligibilityBegins

May bePended

Mother'sCare

Faxed

TRACSNarrative

ClientNotified

ClientNotified

EligibilityDecision

ApplicationDisposition

ImageBucket

Lead takesto Imaging END

Team 1 Application Workflow

Referred to otherteam/program/

process

SLFReferral

SPDReferral

MAAReferral

CoverSheet

Put in SLFBucket

Lead takesto SLFteam

Put inMAA

Bucket

Put in SPDBucket

Lead takesto Case Set

Up

BCCPEnd StageRenal

Deliveredto Point

MedicalTrans.

CoordinatorNotified

CompleteAFS443

HIPPayment

HSS4Reviews

CopyAFS443

Copy toCoordinator

Copy withApplication

Expectation: A new flowchart

Proposed OHP Application Process

Unlabeledapplications will

have labels made

Labeledapplications are

scanned andsorted bylanguage

START

Application is runthrough mail

opener

Worker opens,assembles and

date stampsapplications

Labels

Applications areassigned to

workers

END

• “It was interesting for me to follow the application process and imagine it was a person. First, we date-stamp your forehead, put a name tag on you and then throw you in a drawer for 20 days…” - Team Member

• “No longer is it an application, it is “Mrs. Brown and her children who are waiting on the decision for benefits.” - Team Member