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Eligibility Business Process Re-engineering & Conversion to a Task-Based Model

(Lessons Learned - Successes Achieved)

Presented by: Kim ForresterHealth & Human Services Agency

County of San Diego

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Background• The County’s eligibility determination

performance and productivity trends indicated:– Areas of excellence: Food Stamp Accuracy– Areas for system-wide improvement:

• Timely processing of applications within State mandated timeframes - inconsistent

• Low Medi-Cal productivity ratio • Low Food Stamps participation

• Public assistance eligibility determination processes and operations needed to be refreshed and aligned with CalWIN system

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Vision for the Future

• A regionalized eligibility determination system that:– Delivers benefits efficiently and accurately

to eligible clients• Strengthens the region’s healthcare safety net

• Promotes good nutrition and self-sufficiency among low-income San Diego County residents

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BPR Project Goals• Establish joint governance• Document and implement consistent core

processes• Improve eligibility and clerical training• Improve performance, productivity, and

flexibility

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BPR Participation and Partners• More than 200 staff

– Front-line eligibility & clerical staff and supervisors– Managers

• Union representatives participated• UCSD Center for Management Science and

Health evaluated progress and measure the impact of changes brought about by the BPR

• Community partners and advocates were engaged and regularly updated during

the BPR process

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How the new task based process works…

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Implement a task based eligibility determination process…

• In a task based FRC, all HSS:– Work in Task Groups– Perform specific tasks – No assigned caseloads– Emphasize team approach– Process same-day applications

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Changes

Status Reports Renewals

General Tasks

Same Day Applications

Pending

Task Groups Organizational Model

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Prior to transitioning to task based and same day intakes…

• Family Resource Centers (FRC) must:– Complete case imaging – Train 100% of their eligibility staff in multi-

program– Establish a Call Center to support

operations

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Implementation

• Phased-in implementation of task based to all FRCs to evaluate Best Practices and Lessons Learned – April 2009: Pilot office– July 2009: 5 FRCs– Oct 2009: 3 largest offices

• Supported by ACCESS Customer Service Center

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What is ACCESS

• Centralized contact center

• Extension of HHSA’s Family Resource Centers

• Serves customers and providers (CW, MC, FS, GR, CAPI)

• ACCESS staff have same qualifications as FRC staff and take case actions

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ACCESS Calls by Program

Total Calls (ACD+Aban) by Skill

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

3/09 4/09 5/09 6/09 7/09 8/09 9/09 10/0911/0912/09 1/10 2/10 3/10 4/10 5/10

CalWORKs CAPI Food StampsGeneral Information Medi-Cal Miscellaneous

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Implementation

• Implementation of Same Day in all FRCs – completed in Nov 2009

• Self-Service functionality in April 2010 for ACCESS

• “No Wrong Door” policy

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Key AccomplishmentsWhere we started… Where we are headed… Accomplished

200,000 Paper Case Folders Virtual caseload X

Single-program specialty workers Multi-program knowledge workers

X

15-18 days wait for application interview appointment

Same day application processing

X

Managing an individual caseload Managing tasks as a team X

FRC tailored operations Consistent uniform operations across FRCs

Implemented, being perfected

(Missed) Communication via voice mail and message desk

Response through centralized ACCESS Customer Service Center

Implemented, additional

enhancements in progress

Customers assigned to a specific FRC

“No Wrong Door” access Policy issued, implementation in

process

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Key Accomplishments

• Met increasing demand for public assistance without increasing staff

• Reduced wait times for an intake interview

• Reduced variation in service

• Increased productivity and efficiency

• Improved customer service training for eligibility staff

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Meeting Increasing Demand

Trend in Food Stamp/SNAP RecipientsJune 2006 - May 2010

80,000

90,000

100,000

110,000

120,000

130,000

140,000

150,000

160,000

170,000

180,000

190,000

6/06 9/06 12/06 3/07 6/07 9/07 12/07 3/08 6/08 9/08 12/08 3/09 6/09 9/09 12/09 3/10

Recipients Trend

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Improving Timely Application Processing

Food Stamps ApplicationsPercent Processed Timely & Number of Applications

52%54%57%57%57%52%

47%48%47%41%43%

48%49%55%53%

60%59%59%

69%66%63%66%

70%75%75%77%

51%

4,7005,094

7,807

9,1339,496

8,5808,255

5,643

9,930

8,644

7,330

7,0586,793

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Mar-08

Apr-08

May-08

Jun-08

Jul-08

Aug-08

Sep-08

Oct-08

Nov-08

Dec-08

Jan-09

Feb-09

Mar-09

Apr-09

May-09

Jun-09

Jul-09

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-10

Feb-10

Mar-10

Apr-10

May-10

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

11,000

% FS w/in 30 days FS applications

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Outcomes: Productivity & Satisfaction

• According to UCSD’s Final Evaluation Report, the BPR project:– Improved productivity by 39% (original

goal was 20-25%)– Improved client satisfaction by 22%

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Outcomes: Partnerships

– Full implementation of the Face to Face Waiver allowed working with partners in new ways:

• Open pathways to apply

– By Phone through San Diego 2-1-1– Community Partners– Benefits CalWIN

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Lessons Learned

The BPR development/implementation process included plans for frequent communication, balancing staffing, and technology enhancements as well as avenues to engage community partners. Looking back additional suggestions:

• Communication• Additional Community Involvement• Technology and Staffing

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Questions?

Next Steps: