Center Projects

Collaboratives

Medi-Cal Eligibility Process Improvement Collaborative (November 2006 – February 2008)
The California HealthCare Foundation awarded a grant to the SICF Process Improvement Center to conduct a collaborative to improve access to and retention of public health coverage for eligible families by improving the effectiveness of Medi-Cal enrollment practices in 13 California counties. The county teams focused primarily on improving work flow and customer service. By using Plan-Do-Study-Act (PDSA) cycles on a small scale, teams tested and implemented strategies. Examples of results are:

• Humboldt County estimated the impact of improvement could potentially bring $10,708,517.82 in additional state and federal revenues to county medical providers within the first year the goal is met.
• San Diego County projected that with a 27.43% reduction in discontinuances, 18,321 fewer applications will be discontinued county-wide in 2008.

The long term benefits of collaborative participation were expressed by one participant as:
“Great improvement in process. Culture change for staff to embrace change and engage in strategic planning stages. Buy in/ ownership in PDSA process alleviated fear of change. If it worked, implement it. If it didn't, tweak it or stop. Enhanced community partner communication/collaboration. Worked as one solid team. Resulted in team effort focusing on decreasing failure to provide denials/discontinuances in the Medi-Cal program. Ensuring improved outreach enrollment, retention and utilization.”

Additional information on the results of the Medi-Cal Process Improvement Collaborative can be found the following document Slowing Medi-Cal Churn: Counties Collaborate to Improve Efficiency.

Louisiana Eligibility Process Improvement Collaborative (February 2006 – January 2007)
The Louisiana Department of Health and Hospitals engaged the SICF Process Improvement Center to improve the efficiency and effectiveness of Medicaid eligibility operations in Louisiana. This collaborative included 22 state and local teams and focused specifically on reducing application processing time. Below is a table showing processing time achieved in Louisiana:

These reductions increased organizational capacity by eliminating non value added steps in the process and improved employee morale. The Louisiana Eligibility Process Improvement Collaborative ended in January 2007. Their efforts to improve continue through WorkSmart, which is their continuous eligibility process improvement initiative. The results of the Louisiana Eligibility Process Improvement Collaborative and the transformation of the eligibility process will be documented in an upcoming report to be published by the IBM Center for the Business of Government in the summer of 2009.  

Children’s Hospitals Eligibility Process Improvement Collaborative (June 2005 – July 2006)
The Robert Wood Johnson Foundation (RWJF) awarded a grant to the SICF Process Improvement Center to lead a collaborative of children’s hospitals committed to improving Medicaid/SCHIP enrollment. The collaborative included the following six hospitals from five states: Connecticut Children’s Medical Center in Hartford, Connecticut; Alfred I DuPont Hospital for Children in Wilmington, Delaware; Columbus Regional Medical Center in Columbus, Georgia; Medical College of Georgia Children’s Hospital in Augusta, Georgia; Riley Hospital for Children in Indianapolis, Indiana; and Virginia Commonwealth University Health System in Richmond, Virginia.

The original goals of the Children’s Hospitals Collaborative were to:

• Increase children’s access to health coverage when presenting for care at children’s hospitals with on-site Medicaid/SCHIP eligibility units;
• Increase the conversion of children’s status as self-pay to public insurance, thereby reducing hospital bad debt;
• Increase the eligibility processing speed and efficiency, thereby improving customer service; and
• Increase the accuracy of the eligibility process.

As a result of collaborative participation, teams achieved the following:

• Increase in patient inquiries about assistance
• Increase in the number of Medicaid applications submitted
• Increase the use of data to identify issues to address
• Increase penetration rate (Medicaid applications as a percentage of self-pay)
• Increase and improved data sharing across health system departments
• Increase communications between financial counseling and the billing unit
• Develop effective written communication with patient families about the availability of financial assistance

Team members learned that small scale testing can be used to quickly learn the potential impact of a change and to discover what is happening in a process. Following is feedback on the aspects of the learning session that were most beneficial.

“Understanding that all PDSAs do not have to be "big” things, that "fact finding missions” are as valid as a trial run of a document.”

Covering Kids & Families Process Improvement Collaborative I and II  
(October 2003 – November 2005)
The Robert Wood Johnson Foundation funded the SICF Process Improvement Center to lead two collaboratives of teams composed of Covering Kids & Families grantees along with state and local eligibility offices. The goal was to maximize the efficiency and effectiveness of the enrollment and retention processes in Medicaid and SCHIP eligibility systems. These two collaboratives included 28 teams from 21 states. The second collaborative included seven teams that participated in the first CKF Collaborative and seven state teams with no collaborative experience.

The teams’ small scale testing during CKF PIC II resulted in improvements such as:

• Utilization of language indicators to match non-English speaking customers with staff who speaks their language.
• Reduction in closures due to failure to comply with procedural requirements
• Reduction in the application processing time for a hospital by nearly 50%.
• Implementation of a strategy of verification of client’s addresses at each contact
• Reduction in the percentage of returned mail by one third by using the postal service's website validation process.

Results from CKF PIC I include the following improvements:

• Implementation of the strategy of allowing clients to re-enroll by phone.
• Implementation of a standardized Medicaid application within health departments for presumptive eligibility.
• Eligibility workers complete an online application for SCHIP using Medicaid application details for applicants determined ineligible for Medicaid due to excess income rather than simply referring the family to SCHIP to make an application.
• Developed a CHIP TIPS document to obtain consistency between outreach workers regarding eligibility requirements.
• Implementation of an automated referral system between Medicaid and SCHIP that included an automated email reminder to workers to complete the referral process.
• Implementation of a simplified renewal process when a patient comes into the community health center with a need or request, the worker at the health center gets the information and calls the eligibility worker who can then renew the client over the phone.

One participant wrote about the aspects of the learning session that was most helpful:

“The environment itself is helpful. It is extremely beneficial to be reminded of and mindful of our mission/commitment to serve our beneficiaries –this is all about our customers, not us. The decisions we make about what we do, we ultimately do to our clients and workers. This so nicely frames what we are to do. I think this type of collaborative forces you to be visionary, to think about what really could be and should be better, easier, simpler, not so much about how everything has been done for years or even perhaps the havoc change will create.”

Teams found using PDSA cycles were a significant method for improving. As one participant said to be the most helpful aspect of the first learning session.

 “The detailed PDSA cycles have been really helpful in hitting the ground running. In addition, we like the narrow scope of each cycle. It makes us see progress quicker and see the value in planning ahead.”

The Covering Kids and Families Process Improvement Collaboratives generated significant improvements in application and renewal processes. For further review of the impact of the collaboratives, please see: Improving Processes and Increasing Efficiency: The Case for States Participating in a Process Improvement Collaborative.

Additional retention strategies, including proven process improvement strategies, can be found in the report Covering Kids and Families: Promising practices from the nation’s single largest to insure eligible children and adults through public health coverage.

Supporting Families After Welfare Reform Breakthrough Series Collaborative
(August 2002 – February 2004)
The Robert Wood Johnson Foundation funded the SICF Process Improvement Center’s first learning collaborative as a part of the Supporting Families After Welfare Reform Initiative. Eleven county and state teams from 10 states worked to improve the efficiency and effectiveness of the Medicaid, SCHIP and Food Stamps eligibility processes. The results of this collaborative are highlighted in The Supporting Families Story: A Movement Toward Quality Improvement.

Consulting Engagements on Process Improvement

Louisiana Department of Health and Hospitals (February 2007 – Present)

Maryland Department of Health and Mental Hygiene (February – September 2008)

The Lucas Group (2007 and 2008)

Select Health of South Carolina (January – May 2006)

Other Projects

January 2008 – Present
With funding from The Duke Endowment, the South Carolina Department of Social Services engaged the Southern Institute on Children and Families to implement a Child Abuse & Neglect Services Quality Improvement Project. The project focuses on DSS internal process improvement and building and strengthening community coalitions in two counties.

July 2004 – June 2006
The United States Department of Agriculture awarded a participation grant to the Southern Institute on Children and Families to increase food stamp participation in three South Carolina Department of Social Services county offices through faith-based community partnerships. The Process Improvement Center worked with the county offices to improve the eligibility process to increase capacity to accommodate a larger demand.