1. Wyoming Process Improvement Collaborative Aim Statement The Wyoming Team will identify the number of incorrect closures in the Laramie Field Office and significantly reduce or eliminate them by May 1 st.

2. Process Improvement Collaborative Challenges with gathering data for Core Measures: Lack of computer tech support to gather data No distinction between denials and closures Inconsistency with denial reasons used by workers Incorrect denial/closure reasons used by workers Lack of data to show number of cases due for renewal In Wyoming, we have long suspected that while enrollment is high, many eligible children lose coverage at renewal. Gathering data to show how this occurs was difficult.

3. Process Improvement Collaborative What has the team done so far? Developed a method for gathering and evaluating renewals and closures for the Laramie Field Office. Recorded and monitored information on denials, closures, renewals and denial reasons. Developed and implemented several intervention strategies. Tracked whether or not referrals were made to Kid Care CHIP for families who are denied for Medicaid at initial application or renewal due to income.

4. Process Improvement Collaborative Improvement Strategies/Interventions Surveyed clients, workers and Coalition Members about possible interventions. Created data collection sheets to be used in the Laramie Field Office to collect renewal, closure, and new application data, as well as referral data. Used Rubberstamp on renewal envelopes saying “Important! Insurance Renewal Information” to identify the mailing as a renewal for health care coverage which requires attention.

5. Renewal Form Survey Asked whether the renewal form charts were easy to fill out Asked if it was easy to find out what to do with the renewal form after you finish it Offered several choices of ways to make the renewal envelope stand out including bright colored envelopes and several variations on wording for a rubber stamp to be used on renewal envelopes. Asked for additional comments or ideas on how to improve the renewal form.

6. Results of Renewal Form Survey Respondents felt the renewal form was easy to fill out Respondents said they knew what to do with the survey after they filled it out. The majority of respondents chose a message rubber stamped on the envelope explaining the important nature of the contents or chose the option of having the renewal form sent in a bright colored envelope so it would stand out from other mail.

7. Laramie Field Office -The only reasons that can be chosen for denial and closure by workers on the new data collection sheets include: Excess Earned Income Excess Un-earned income Application withdrawn Client Request Other Health Coverage (SCHIP) Failure to provide info/ verification – (incomplete application, no signature, etc.) Failure to complete review No eligible person in household Participating in another household Not US Citizen Moved out of State

8. Data collection improves In February 04 the Laramie Field Office reported: 724 cases at the beginning of the month 68 cases due for renewal 29 cases closed at renewal 16 cases closed for failure to complete review 1 case closed before 12 months 11 new applications received 11 new new applications approved This is data which was previously very difficult to extrapolate from existing reports!

9. Results of Rubber Stamp and Bright Stickers Pending… Out of eight workers, two used the rubber stamp on the renewals they sent out. One worker used the rubber stamp by itself. One of these workers stamped the message on a bright yellow sticker to help it stand out. The results of this test will be compared on a “by worker” basis at the end of the following month.

10. Wyoming Process Improvement Collaborative Creating a way to collect the proper data from the field was essential and also more difficult than was expected. The data collection method evolved over three months. Asking workers to track client data on the new forms may lead to fewer wrongful denials in and of it self. Anecdotal information indicates that the sticker and rubber stamp may be motivating parents to deal promptly with the renewal form. Conclusions What conclusions can be made from this team’s work to date to guide future planning?