The Problem
The county-funded program for indigent patients at John Peter Smith Health Network (JPS) was plagued by inconsistent and disconnected eligibility determination processes. JPS, a large regional trauma center and ambulatory network serving the safety net population in the Dallas/Fort Worth metropolitan area, had struggled for several years to reduce the confusion and eligibility disruptions experienced by vulnerable county residents applying for enrollment in its JPS Connection Program.
The Solution
After success working together to implement the State of Texas’ 1115 Medicaid Waiver, JPS asked COPE Health Solutions for assistance with improving the efficiency of its Eligibility Center. COPE Health Solutions’ performance improvement specialists applied a methodological approach to define the problem, measure process performance and analyze for root causes, and then select the highest benefit alternative solutions using sophisticated cost-benefit analysis and risk assessment techniques. COPE worked closely with JPS to ensure the recommended solutions set would have practical value for JPS eligibility center staff.
Highlights of our approach:
- Systematic assessment of the client’s multiple eligibility determination center and staff processes to identify all process variations and analytic gaps
- Structured interviews with all eligibility center “customers” (patients, patient relations and frontline clinic staff, finance and appeals, etc.)
- Complete inventory of process inefficiencies and inconsistencies
- Cost-benefit prioritization and risk assessment of all solutions
Results
- New eligibility triage process to ensure resolution of most complex eligibility cases (e.g. property owners and third party insurance) without slowing down eligibility determination for other applicants.
- New streamlined eligibility process dramatically reduced turnaround time of application and disposition
- Improved average initialized case lag time from 5-30 days to same day.
- Improved disposition time from average of 20 days (and up to 115 days) to same day disposition for 43% of cases.
- New control processes to monitor the center’s future process performance.
- A 50% decrease in application paperwork for staff and applicants, including:
- 95% reduction in proof of residency documents.
- 51% reduction in proof of income documents.
- 30% reduction in proof of assets documents.