Thursday, 28 October 2004 Process Improvement Collaborative Present: Stephany Vaioleti, Barbara Luksch, and Alan Takahashi Next meeting: 22 November 2004 at 1:30 PM 1. BESSD Participation in Process Improvement Lillian Koller requested that Benefits, Employment, and Support Services field staff attend our community training workshops. There were representatives at recent workshops in Waipahu, Kamuela, and Honolulu. 2. Random Sample Follow-Up for Passive Renewals Alan explained that approximately 60% of renewals are adult-only cases and 40% are cases with children. For the latter, a major problem with random sample follow-up is people who do not respond to Med-QUEST’s telephone and/or mail requests to review their cases. We discussed how to approach improve this situation: * Meet with Med-QUEST’s enrollment call center supervisor to solicit their help with customer address and telephone number changes. * Get Med-QUEST eligibility workers to check addresses and telephone numbers whenever they talk to a customer. * Change Med-QUEST voicemail messages to ask for a current address. * Send a one-page form to QUEST and Medicaid providers with the headline “Help Us Help You Get Paid.” Most health care providers verify a patient’s address and telephone number during each visit and they could fax changes to the local Med-QUEST office. * Create a change form with questions they will review with the customer, write changes, and make sure it gets to the local Med-QUEST office. Note: this suggestion is from a community organization that conducts home visits. 3. Kahuku Local Project’s Reminder Postcards: August Data 10 renewal postcards were mailed (6 cases with children and 4 adult-only cases) on 08/16/04: * 7 received the postcards * 3 others: 1 customer had a new post office box so the postcard was resent, 1 postcard was returned and the outreach worker was unable to contact the customer, and 1 homeless customer completed his renewal in the Kahuku Hospital emergency room on 09/29/04. Responses to the survey: * 1 customer said she did not receive her Med-QUEST renewal form because mail was stolen from her mailbox. She was excited to receive the postcard so she could contact her Med-QUEST eligibility worker. * 2 found the renewal form easy to complete and were happy they extra paper work was not required. * 1 called the outreach worker to make sure pay stubs were not required. 4. Electronic Application The Kahuku Local Project outreach and inreach workers requested whenever Med-QUEST staff downloads an application that an automated email response be sent to the person who uploaded it. Barbara will ask DevTurtle to add this feature. 5. Application Denials “Categorical Eligibility-Other” and “MA now FA” are not denials but changes made in the HAWI system. We decided to eliminate these data from our monthly totals because they incorrectly increased the number of denials. Barbara will revise the numbers, update “Table 3: Denials by Reason,” and email the corrected data to Covering Kids & Families. 6. Faxed Applications One Med-QUEST office asks organizations to also mail the original application. However, this is unnecessary and contradicts information presented at community training workshops. We agreed an original copy should not be requested unless there are problems reading the faxed application. 7. Outstationed Eligibility Workers Barbara and Alan keep the list up-to-date with help from Kathy Suzuki-Kitagawa (Outreach and Assistance Project) and Med-QUEST supervisors. Barbara will email her current list to Alan for comparison with Med-QUEST’s records. 8. Storyboard Our presentation for Learning Session 3 will highlight progress on three aim statements: * Decrease from 57% to <5% Med-QUEST cases closed with children during the renewal process due to not providing information in O‘ahu Ongoing Unit III by 1 June 2004. * Decrease from 50% to <5% Med-QUEST cases closed in the Hawai‘i Covering Kids Kahuku Local Project area during the renewal process due to not providing information by 1 December 2004. * Decrease from 30% to <5% Med-QUEST applications denied due to not completing procedures by 1 February 2005. Monday, 22 November 2004 and Wednesday, 22 December 2004 Process Improvement Collaborative Present: Stephany Vaioleti, Barbara Luksch, and Alan Takahashi Next meeting: 19 January 2005 at 11:00 AM 1. We reviewed information from our 11/15/04 meeting with Michelle Kidani, Customer Service Branch Administrator, Lori-Lei Aponte, Enrollment Call Center Supervisor, and Lillian Koller, DHS director. * The call center received about 6,100 calls in November. * The provider hotline will merge with the enrollment call center. * Lori-Lei will update the enrollment call center handout distributed by Hawaii Covering Kids at community training workshops. They will also refer callers who need Med-QUEST applications to 211 and www.coveringkids.com. * Beginning January 2005, call center staff will ask each caller to confirm his/her mailing address and telephone number to help keep Med-QUEST’s records up-to-date. Alan will research access to HAWI’s address screen (ADDR) using their personal logon profiles so changes can be efficiently entered directly into the computer.. We also discussed Med-QUEST Eligibility Branch’s request for access to the Interview Data Screen (INDA) and Application Maintenance Screen (APMA). The former is to input the date Med-QUEST received a pregnant woman’s application from BESSD and the latter is to add the medical program to a case. This will allow quicker registration when there is an existing BESSD case. 2. Effective 1 December 2004 the verification checklists will be used by all Med-QUEST eligibility workers. The voicemail activity will be implemented in January 2005. 3. Maine sent a survey on income self-declaration that Alan will complete. 4. The Kahuku Local Project will initiate research on applications that were denied during the past year because required information was not provided. This will help them better understand the missing information and how to improve their customer service. 5. A change form for community organizations was reviewed and a PDF copy was posted on the web site (Workshop Questions and Answers). It was also mailed to all community training workshop participants. 6. We designed flowcharts to display paths for Med-QUEST applications that are faxed, mailed, and electronically downloaded at the Honolulu office. Tuesday, 14 December 2004 Conference Planning Committee Present: Dee Helber, Linda Colburn, Ruth Ota, Alan Takahashi, Barbara Luksch, and Sue Uyehara Next meeting: December 2005 1. Great Job! Barbara shared several compliments she recently received from previous Malama i na Keiki participants--they found the events professionally stimulating and appreciated the positive and fun networking environment. 2. Guest Speakers Our invited speakers are Donna Cohen Ross from the Center on Budget and Policy Priorities and Kim Gennaula from KGMB-TV. 3. Date, Location, and Theme We chose Friday, 18 March 2005 at the Best Western Plaza near the Honolulu airport and the focus will be customer service. Ruth and Dee will lead an opening exercise defining a typical customer, support systems will be developed, and Linda will organize an activity that integrates a customer service mission with action. 4. Participants The limit will be 100 and our list includes: Conference Planning Committee members, Sanuk Sistahs, one Med-QUEST eligibility worker per unit, four Oahu Med-QUEST supervisors (workshop trainers), outstationed eligibility workers, and outreach workers (frontline staff who interact directly with families full-time). 5. Travel Aloha Airlines coupons purchased with DHS funds will be given to Neighbor Island eligibility workers. Partial travel scholarships--approximately $100--will be offered to others who stay the entire day. We will remind people to book their flights early. Wednesday, 15 December 2004 Process Simplification Task Force Present: Havinne Anderson, Liane Hiramoto, Rebecca Delafield, Ruth Ota, Linda Colburn, Alan Takahashi, Brian Higgins, Barbara Luksch, and Lillian Koller Next meeting: TBA 1. Positive Reactions We shared feedback about the simplified application and renewal processes from customers and outreach workers. It shows Hawaii’s forward progress to help people who need our services. 2. Electronic Application Update Barbara distributed a handout explaining the phases. The Hawaii Covering Kids Kahuku Local Project is currently implementing Phase 1 and Phase 2 programming is almost completed. The major barrier is antiquated computer equipment at the Med-QUEST eligibility offices. They have NT4 workstations that were retired by Microsoft in 1998 and dot matrix printers. The computers have maintenance and upgrade problems along with a dearth of antivirus software manufacturers and Microsoft’s 2004 conclusion of patch production. Med-QUEST currently has no plan to replace the computers and printers, except when other divisions upgrade and transfer used equipment. Furthermore, eligibility workers and clerical staff do not have internet access to download the electronic applications. 3. Hotline Service (211) Havinne explained services offered by Aloha United Way 211. They currently have a contract with Hawaii Covering Kids to answer calls about children’s health insurance and a sample data report was distributed. It was decided to delete the category “Unknown” from their database options because it has made some reports futile. We discussed Havinne’s experience with Tele-Interpreter, which is a mainland company providing immediate access to 150 languages 24/7. They are used nationally by 211 services and AUW pays by the minute. The company has a confidentiality clause, screens and hires the interpreters, and conducts quality checks. The Hawaii State Department of Health is exploring this service for its bioterrorism program. It was suggested that the Hawaii State Department of Human Services research using this company or a similar one, Language Line, to provide competent and easily available interpreter capabilities. It was noted Tele-Interpreters and Language Line could eventually contract with local interpreters for languages not currently on their lists. Sprint PCS and Verizon Wireless have not cooperated to provide 211 service. Havinne is requesting help from the Aloha United Way board and Hawaii State Civil Defense. 4. Process Improvement Collaborative Update The percent of applications denied because a customer did not provide required information has decreased from 27.3% (11/02-06/04) to 14.2% (07/04 to 11/04). It is attributed to Med-QUEST eligibility workers using new verification checklists and community training workshops sponsored by Hawaii Covering Kids. The Centers for Medicare and Medicaid Services (CMS) allows states to use new addresses supplied by the United States Post Office. Med-QUEST is revising its policy so when a letter is returned the computer information will be updated and the notice will be resent to the new address. The task force members were informed on Kahuku Local Project reminder postcards, Change Report Form (1179) for outstationed eligibility workers, and change form for community organizations. 5. “Enrolling Children and Youth in QUEST and Medicaid” Feedback Hawai‘i Covering Kids and Med-QUEST sponsored 21 community training workshops for 194 participants from 67 organizations on four islands during the past thirteen months (November 2003 through December 2004). Locations included Hana (2), Hilo, Honolulu (4), Kahuku, Kaimuki, Kalihi, Kamuela, Kaunakakai (2), Kahului (2), Kohala, Kona, Mililani, Papakolea, and Waipahu (2). Linda Colburn and Barbara Luksch facilitated brainstorming sessions to solicit answers to three questions: * What are barriers to enrolling and retaining eligible children and youth? * What rules get in the way? * What are possible solutions to outreach, enrollment, and retention barriers? They reported on these major themes in response to the questions: * Simplification accomplishments since the community training workshops began such as children and pregnant women application, new renewal processes, reminder postcards, and verification checklists, * Barriers to enrolling and retaining eligible children and youth, including these top three: customer service, language (complicated forms, inconsistency in using interpreters, English-only communication to homes, etc.), and rural communities (Med-QUEST offices too far away, general delivery mail problems, etc.). * Recommendations to eliminate the barriers such as comprehensive customer service training, customer surveys, extending office hours, simplifying forms, field testing all forms before publishing them, contracting with interpreter services such as Tele-Interpreters or Language Line, writing current simplified procedures in the Hawai‘i Administrative Rules, and reducing workloads for Med-QUEST eligibility staff. It was noted that flextime originated to eliminate traffic congestion for employees. However, since staff is at the Med-QUEST offices in the early morning and early evening hours, they can interact with customers during these hours. This would be especially convenient for customers who work. Lillian requested that Linda and Barbara present complete details at a Med-QUEST staff meeting. Alan will schedule the meeting so information can be shared with appropriate personnel and action plans developed to eliminate the barriers as soon as possible.