1 Eligibility Business Process Re-engineering & Conversion to a Task-Based Model (Lessons Learned - Successes Achieved) Presented by: Kim Forrester Health & Human Services Agency County of San Diego

2 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

3 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

4 BPR Project Goals Establish joint governance Document and implement consistent core processes Improve eligibility and clerical training Improve performance, productivity, and flexibility

5 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

6 How the new task based process works…

7 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

8 Changes Status Reports Renewals General Tasks Same Day Applications Pending Task Groups Organizational Model

9 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

10 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

11 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

12 ACCESS Calls by Program

13 Implementation Implementation of Same Day in all FRCs – completed in Nov 2009 Self-Service functionality in April 2010 for ACCESS “No Wrong Door” policy

14 Key Accomplishments Where we started…Where we are headed…Accomplished 200,000 Paper Case FoldersVirtual caseloadX Single-program specialty workersMulti-program knowledge workers X days wait for application interview appointment Same day application processing X Managing an individual caseloadManaging tasks as a team X FRC tailored operationsConsistent 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

15 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

16 Meeting Increasing Demand

17 Improving Timely Application Processing

18 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%

19 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 –Community Partners –Benefits CalWIN

20 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

21 Questions? Next Steps: