PIC OklahomaPIC Oklahoma

Learning Session 2 Learning Session 2 Chattanooga, Tennessee Chattanooga, Tennessee March 30 – April 1, 2004 March 30 – April 1, 2004

Educate Process

Remind

Increase number of Increase number of successfully renewed successfully renewed medical cases by medical cases by decreasing automatic decreasing automatic case closures by 80% case closures by 80% by March 1, 2004by March 1, 2004

Oklahoma’s StructureOklahoma’s StructureNo face-to-face interview requirement

Self-declaration of income and resources

Six months’ continuous eligibility for children

Synchronized eligibility

Determine eligibility for all categories prior to denial/closure

Maintain eligibility when families move from county to county

Reinstated automatic closures process 07/02

Current Events Current Events Concurrent Managed Care TransitionConcurrent Managed Care Transition

Board voted 11/7/03 to eliminate Managed Care Organization program

Transition of nearly 200,000 clients from Managed Care to Fee-for-Service to Primary Care/Case Manager program in 4 months

Aggressive member outreach campaign

Provider contracting to extend network statewide

Expanded care management & program supports

RemindersReminders

Alternative Alternative

ProcessProcess

AnalysisAnalysis

Action Period 1Action Period 1

Letter reminders include information

on calling for phone renewal

Phone reminders made

early evening

1st Class letter

reminders include

Return Receipt

Requested

RemindersReminders

PDSA#1PDSA#1 - Calling clients who had not returned their Benefit Review Form

PDSA#2PDSA#2 - Reminder letter sent to clients who had not returned Benefit Review Form

PDSA#3PDSA#3 - letter reminders sent with ‘Return Receipt Requested”

Phone

reminders

PDSA#4PDSA#4 - Phone reminders made early evening

PDSA#10PDSA#10 - reminder letter sent with information on renewals conducted over the phone

Letter

reminders

Phone renewal

by dedicated

caseworkerFocus group

survey of

caseworkers on

phone renewals

Analyze case

history after

closure

Analysis of form

readability and

content

Analysis of

renewal form

AnalysisAnalysis

Analysis of return

rates medical vs.

comprehensive

casesPDSA#5PDSA#5 - Return rates of medical only and comprehensive cases

PDSA#6PDSA#6 - Survey on Benefit Review Form

PDSA#9PDSA#9 - Survey on Benefit Review Form at

non-DHS site

PDSA#11PDSA#11 - Review case history of original PDSA cycles

PDSA#12PDSA#12 - Focus Group with caseworkers

PDSA#14PDSA#14 - Review reopened cases for impact on managed care enrollment

Alternative ProcessAlternative Process

Phone renewals

Phone renewal

by dedicated

caseworker

Phone renewals on

medical only cases

PDSA#7PDSA#7 - Conduct phone renewals during business hours

PDSA#8PDSA#8 - Conduct phone renewals on medical only cases during business hours

PDSA#13PDSA#13 - Phone renewals conducted by a designated caseworker

ResultsResults

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Baseline Caseload

Caseload A

Caseload B

Designated Worker

Baseline Caseload 43% 33% 54% 44%

Caseload A 56% 48% 74% 63%

Caseload B 69% 61% 52% 65%

Designated Worker 84%

January February March April

Aim Statement Goal

Percentage of Medical Only Cases Percentage of Medical Only Cases Completed Before DeadlineCompleted Before Deadline

***Caseload A and B (April data sets) contain some cases completed by designated worker

Results for Action Period 1Results for Action Period 1

Implemented a process change to better the work

flow by designating a worker to complete

medical only reviews, including phone

renewals.

RemindersReminders AnalysisAnalysis

Alternative Alternative

ProcessProcess

Summary & Next StepsSummary & Next Steps

Implementing alternative processImplementing alternative process

Testing impact on work flow Testing impact on work flow

Education and TrainingEducation and Training