In February 2007, Georgia’s Division of Family and Children Services (DFCS) embarked on a journey to introduce lean methodology into its organizational culture. The effort, which was initiated by Gov. Sonny Perdue’s Commission for a New Georgia, aims to make Georgia the best-managed state in America through the Office of Customer Service, tasked with making access to state services faster, friendlier and easier.
“People in DFCS work hard and have huge workloads, so asking them to take a week away from work to participate in the improvement process was a challenge,” recalled Gwen Bailey, Rapid Process Improvement (RPI) champion for field operations.
Mona Castile, the Spalding County supervisor for Aged, Blind and Disabled (ABD) Medicaid, was one worker short and had gotten transferred back onto a caseload with a three-month backlog when the RPI initiative began. RPI, also known as lean management, is a set of tools that helps to identify and steadily eliminate waste from an organization’s operations.
“By the end of the week of training, we were full supporters of RPI,” she said. “When you start hearing talk about improving customer service, a lot of times you may be concerned that improving services for external customers could come at the expense of internal customers (staff). This has been a win-win for external as well as internal customers.”
With technical assistance from lean specialists at Georgia Tech’s Enterprise Innovation Institute, DFCS began to identify areas for improvement within Medicaid, the program area designated by Commissioner B.J. Walker for lean implementation. In February 2007, the DFCS leadership team began meeting with Bill Ritsch of Georgia Tech and representatives from the Governor’s Office of Customer Service to discuss and develop plans for working with DFCS staff.
“We conducted RPI events on Medicaid determination of eligibility processes in June, July and August in Clayton County, Henry County and Spalding County. Weekly reporting mechanisms were developed to enable us to monitor post-implementation progress,” noted Bailey. “The big picture was to embed lean methodology in DFCS operations.”
At the Family Medicaid Intake event, the goal was to reduce processing time for new applications while increasing accuracy. Prior to the implementation, people seeking to establish Medicaid eligibility would wait an average of nine to 49 days.
With a target goal of 12 days or fewer, the county office dedicated two case managers to processing Family Medicaid Intake applications. The RPI team also developed metrics to track performance and created written practice standards. Now, customers who walk in with all of the necessary information to process an application will likely receive same-day determinations.
“There’s been no policy change – policy still allows varying standards for timely completion of applications – 10 or 45 days. But now we’ve got a targeted goal of 12 days and it’s a goal that’s being measured on a weekly basis,” Bailey said. “As you know, what gets measured gets done, and we want to make that goal.”
Once clients are determined eligible for Medicaid, they must be reviewed every six months. This area – Family Medicaid Ongoing – was the focus of the team’s second RPI event. The goal was to improve the quality of information submitted for re-determination and to encourage earlier response from customers.
“No face-to-face interaction is required to establish or continue Medicaid eligibility. Our review form – which is mailed out to determine continued eligibility – was reduced from four to two pages,” noted Carlene Burgess, DFCS RPI champion. “We also gave customers a shorter response time and simplified written communications mailed out in an effort to reduce the need for checklists and follow-up phone calls.”
In a three-month measurement before the RPI implementation, DFCS staff had to send follow-up checklists to between 69 to 92 percent of its customers; post-RPI, that number decreased to 34 to 60 percent. Before the implementation, between 49 to 56 percent of customers sent in their information within the allotted four-week time; afterwards, that number rose to 61 to 67 percent.
The third RPI event focused on ABD Medicaid Intake. As with Family Medicaid Intake, the team wanted to reduce the processing time for new applications while increasing accuracy. According to Castile, before the RPI it took 25 days to process qualified Medicare beneficiary applications. It now takes two days on average.
“We implemented same-day face-to-face consultation for all ABD walk-ins, established a ‘duty worker’ who was scheduled specifically to see ABD customers and updated the self-service application station,” Castile said. “This has really made a big difference, because it means people will get that all-important medical assistance and they’ll have access to it much faster. By paying the Medicare premium for our clients, it increases the amount they receive from Social Security.”
Ritsch acknowledged the project had its challenges, but says that the end results speak for themselves.
“The only thing consistent in this world is change, and even though RPI isn’t rocket science, it’s still really hard to change the culture of any organization,” he said. “DFCS has really begun to follow the PDCA principle – plan, do, check, act – and they will have continued success as a result.”
In May 2008 with Georgia Tech’s assistance, DFCS began a four-module series of training for an additional 40 employees to become RPI champions. By the end of August, new RPI processes will be developed for presentation to DFCS leadership.
“We think RPI can transform how we do business. DFCS is a large agency that touches a lot of lives,” Bailey noted. “Services to Georgia residents can’t help but get better as a result of us streamlining our operations and it will help with getting services out to the customer faster, friendlier and easier.”
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Writer: Nancy Fullbright