Get documents about "Applying for Medi-Cal On-Line
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Document Sample
California Statewide Automated
Welfare Systems (SAWS)
Consortia Modernization and
Innovation
ISM 2011
Michael J. Sylvester II
Assistant Director
Bureau of Contract and Technical Services
County of Los Angeles
Department of Public Social Services
1
Overview of Presentation
Background
SAWS Consortia Modernization Initiatives
On-Line Application Customer Portals
Interactive Voice Response (IVR)
Outbound Dialing
Contact/Call Centers
Document Imaging/Electronic Case Records
Kiosks
Lessons learned
Future Enhancements
Questions
2
BACKGROUND
3
County Social Services
58 county social service departments
Serving clients
In over 1,000 offices
In conjunction with community organizations
Over the phone
Online
Through the mail
In multiple languages
Using automated systems
LEADER/GEARS/GROW – Los Angeles County
CalWIN – 18 counties
C-IV – 39 counties
Interacting with state & federal systems for information 4
verification
Assistance Programs Supported
Medicaid – Medical coverage (Medi-Cal)
SNAP – Food Assistance Program (CalFresh)
TANF – Cash & Employment Services (CalWORKs)
Refugee Cash Assistance
Cash Assistance Program for Immigrants (CAPI)
General Assistance/General Relief (GR/GA)
Foster Care, KinGAP & Adoption Assistance
5
Clients Assisted
400,000 Applications Monthly
(8 Million Recipients)
1.5 million CalWORKs recipients
4.7 million Medi-Cal recipients
3.9 million CalFresh recipients
6
Application Process
Seek services
Complete application
Communicate with Eligibility Worker as needed
Submit any needed documentation
Receive notice of eligibility decision
Receive ID card, EBT card, benefits
7
CONTINUING CLIENT EXPERIENCE
Annual eligibility renewal
Requirement in federal law
Clients receive packets in advance
Provide information to eligibility worker
Eligibility recalculated
Periodic reporting requirements
Quarterly for CalWORKs & Food Stamps
Semi-Annual for most Medi-Cal parents
Changes most often reported
Employment
Income
Address
New family member
8
CONTINUING CLIENT EXPERIENCE
Reported changes often affect eligibility
If moved to a new county
If gained/lost job or gone from full to part time
If family member moved into/out of household
Eligibility worker processes these changes
Gathers any necessary verifications
Enters changes into automation system
System recalculates eligibility for all programs
Notifies clients if eligibility or benefits change
9
Automated Verification &
Information Exchange
MEDS
Statewide client index
Benefit Identification Card Issuance
Support Child Support collection & accounting
Electronic Benefits Transfer
EBT card issuance
Cash & CalFresh benefit allotment
Child Support
Provide client information and referral
Social Security (via MEDS)
Citizenship verification
Other State & Federal Systems
Income & employment verification
10
…PROBLEM:
LOTS OF PAPER AND VERY
LONG LINES
11
SOLUTION:
SAWS CONSORTIA
MODERNIZATION
INITIATIVES…
12
Modernization Initiatives
On-Line Applications / Customer Portals
13
On-Line Applications/Customer
Portals – What are they in CA?
California Customers can submit an application for
multiple programs (i.e. Medi-Cal, CalFresh, CalWORKs, and
County Medical Services Program (CMSP))
CA Statewide Benefits Portal –
www.benefitscal.org
This portal connects three On-line SAWS websites
for application processing for all 58 CA Counties
YourBenefitsNow! www.dpssbenefits.lacounty.gov
BenefitsCalWIN www.benefitscalwin.org
C4Yourself® www.c4yourself.com
All were live by February 2011
Multiple languages supported
14
On-line Applications/Customer Portals –
CA Statewide Benefits Portal
www.benefitscal.org
15
YourBenefitsNow BenefitsCalWin C4Yourself®
On-Line Applications/Customer Portals –
Benefits and Services Offered
Anonymous pre-screening
Apply for benefits in CalWORKS, CalFresh, Medi-Cal, etc.
Submit periodic reporting requirements through on-line forms
(i.e. QR-7 Submissions)
Annual Redeterminations
Uploading required supporting documentation
Check case status and benefit amounts (past, current and
future)
Obtain worker information, office hours and location, GIS
maps, directions, etc.
Provide messages: system and worker initiated
eSignature capabilities & latest security features, i.e.
„Captcha‟ 16
On-line Applications/Customer Portals –
Statistics (as of June 2011)
The number of hits to ‘BenefitsCal.org’ has increased over time
and is approaching 100,000 hits since going live in February 2011
The number of applications processed through the On-line SAWS
websites is approximately 250,000 total thus far (with approx.
27,000 new on-line apps per month Statewide):
• YourBenefitsNow (approx. 11,000 since February 2011); currently
averaging approx. 4000 per month
• BenefitsCalWIN (approx. 71,000 since November 2010); currently
averaging approx. 9,000 per month
• C-4-Yourself (approx. 164,000 since Oct 2007); currently
averaging approx. 14,000 per month
On-line applications comprise (%’s change constantly):
• CalFresh 45-60% (approx.)
• Med-Cal 25-35% (approx.)
10-15% (approx.)
17
• CalWORKs
On-line Applications/Customer Portals –
Best Practices & Lessons Learned
Include the users of the application in the design, development and
testing up-front and perform usability studies prior to completion of
design to avoid rework
Ensure executive level management are engaged in project through out
the project life-cycle
Ensure all levels of management are made aware of potential direct
and indirect business impacts on their operations
Ensure all appropriate staff receives training prior to implementation of
the project for processing of the incoming applications
Develop an on-line survey for users or other mechanisms to see where
customers are abandoning the application process or having difficulties
Include a “Report a Problem” link in the application so customers can
report issues as they experience them
Survey the public prior to implementation of the project for valuable
feedback
Ensure all appropriate application/server monitoring software is tested
prior to implementation of the project
Ensure your product works successfully with all browser types 18
Modernization Initiatives
Interactive Voice Response (IVR)
19
Interactive Voice Response (IVR) –
Benefits (Information over the Phone)
Used by many CA Counties for incoming self-service
primarily for the CalWORKs, CalFresh, and Medi-Cal
programs
Case Specific Information
• Check address
• Check grant amount or CalFresh allotment
• Check Medi-Cal Share of Cost
General Information
• Office hours
• Contact information
20
Interactive Voice Response (IVR) –
Specifics
Reduces lobby traffic by 30% or more
Linked to real-time data in SAWS systems
Available on a 24X7X365 basis with a Customer ID and PIN
Provides Clients the Ability to:
• Obtain automated case and benefit status information
• Check benefit amounts
• Check QR-7 and redetermination packet receipt
• Request replacement EBT/BIC cards
• Leave a message for a worker
• Check offices hours and verify address
• Obtain worker information
• Change/reset PIN for log-in (self-help)
Receiving over 400,000 calls (for self-service alone) per month
in CA Counties Statewide and climbing
Interactive Voice Response (IVR) –
Best Practices & Lessons Learned
Real Time Benefit information look-ups can have performance challenges, check
business requirements to determine if prior day information will work
Ability to request forms to be sent without staff intervention is very beneficial to
customer and staff
Adding IVR phone number to outgoing voicemail messages dramatically increases
usage
Ensure self-help features are enabled to reset PINs automatically without staff
intervention
Be sure that reporting mechanism captures all calls and selections regardless of
whether the customer listened to the entire message
Ensure enough time for JAD Sessions, finalizing the scripts, translations, recordings,
getting the wave files, scripting, testing and mailing of notices. Any potential slippage
in these tasks could impact the Project Implementation.
Look for data anomalies in back-end SAWS systems, as they will present to users
through this new media, i.e. blank worker names, or numbers
Ensure test data is consistent with what is expected in production. Using „Dummy
data‟ leaves you vulnerable to errors
Initially, the IVR offloads are not that high but ramp up over time. Marketing and
communication strategies play a very important role in adoption
Once IVR is implemented, customer involvement and feedback in very important
22
Modernization Initiatives
Outbound Dialing
23
Outbound Dialing – Benefits
(Communication via Phone Messages)
Implemented for CalWORKs, CalFresh, Medi-Cal, General
Assistance/Relief and IHSS programs
Option to Receive Various Information via the Phone,
including, but not limited to the following:
Reporting requirements reminders
Eligibility renewal due date reminders
Up coming appointments reminders
General information
Emergency messages
24
Outbound Dialing – Specifics
Automatically calls customers about missing documents needed
for continued eligibility (i.e. missing QR-7/Income reporting…)
Calls to remind customers of appointments, particularly effective
for Welfare to Work (WtW) requirements
Reminder calls to IHSS Providers to turn in time sheets
Messages sent in multiple languages
For sensitive messages, add‟nl security invoked by msg type for
individual ID prior to msg delivery. (ie: consent or requiring PIN or
personal info {i.e. birth date} entered prior to playing message)
Detailed reporting statistics captured for call dispositions, (i.e.
answered , reached V-mail, ring/no answer, busy signal, answered
hung-up, etc.)
Capacity: Some systems capable of making up to 40,000
outgoing calls per day
25
Outbound Dialing – Best Practices &
Lessons Learned
Need to consider whether consent is needed and what type of messages to
send as appropriate
Example: If customer provides a cell phone number, should he/she have to enter their
case number and PIN to get the message? If a customer is on a bus, driving a car,
pushing a stroller, or out job hunting, will they be able to or want to take the time to
enter the information?
Example: If the customer provides a home phone and lives with others, then should
they have to authenticate, provide case number and PIN prior to message being
provided?
Need to consider the timeframes for making call (i.e. too late or too early)
Automate call disposition status being updated in the backend SAWS system.
For appointment reminders, allow customers to respond to whether they will
attend or not, then automatically update the customer appointment in the system
so workers know immediately
When reporting, make sure a successful call is not defined by the customer
listening to the entire message
Perform full and thorough testing for campaigns to make sure that the messages
are clear and consistently played on phones, voicemails. Also, keep the
messages short and precise to be effective and save costs related to telephone
charges
Ensure business owners are assigned to each campaign to continually evaluate
their effectiveness 26
Modernization Initiatives
Contact/Call Centers
27
Contact/Call Centers – Benefits (Quick
access to County Eligibility Staff)
Apply for benefits
Check on case status
Report changes
Get information
28
Contact/Call Centers – Example of
Call Flow
Route to Agent with
IVR Correct Skills (Program
and Language)
Providing
Self-Service Check for
(existing) Agent
and Collecting Availability
Caller
Internet Information
VoIP or Ticketing
ACD Call System
Mgmt
Cell phone System
Telephone
Agents
Customer/
Participant
SAWS
System
Document
Imaging
System 29
Contact/Call Centers – Specifics
customer information (including exit point in IVR) provided
in „Soft Phone‟ client
Screen-Pop between Contact Center and SAWS with
case information
Calls and screens recorded for QA
Workforce management capabilities provided for staff
loading and planning
Supervisor management capabilities, (ie. queue
monitoring, call hold times, call wrap-up times, etc.)
Multiple languages supported
End-to-End reporting
Receiving nearly 700,000 calls (for full-service Contact
Center agents) per month in CA Counties Statewide and
climbing 30
Contact/Call Centers– Best Practices
& Lessons Learned
Include various partners in designing, planning and expanding services such as
Program, Line Ops, HR, IT and also, Community Agencies and Advocacy
Groups, PSS Commissions, Employee Unions and Bargaining Groups
Establish service delivery standards up-front ( i.e. acceptable hold times, call
back times, call wrap-up times, trouble ticket closure times, etc.) & actively
MEASURE performance & QC Error Rates
Do a ‟lot of research‟ and plan your staffing and infrastructure investments on
solid business measurements (i.e. caseloads, call volumes, tracking ticket data,
# of available agents, available square footage, geography, budget, etc.)
Continually research and implement best practices from other successful Public
& Private contact centers
Perform full Ergonomic workspace assessment and provide adequate and
efficient spacing and furniture (provide incentives…)
Have professional training and certificate programs for Customer Service Agents
available on an ongoing basis
Have an independent consultant do a thorough evaluation of the current
operation and provide recommendations on future expansion at a business,
technical and operational level
Adjust business processes to take full advantage of Contact Center services
Survey Customers to get information and feedback via surveys and interviews
31
Modernization Initiatives
Document Imaging / Electronic Case
Records
32
Document Imaging – Benefits
Applicants only need to provide information once
Information is made readily available for authorized use in eligibility and
benefits issuance process
Information is accessible from various locations (in-person, phone, etc.)
Reduces substantially the time it takes Intake and eligibility workers to
locate case records
Improves efficiency and effectiveness of the clerical support
Reduces errors and negative hearing outcomes
Improves communications between County workers and customers
Improved records retention, integrity and backup capabilities
Provides the potential for clients to submit documents and forms
electronically
33
Document Imaging – Example of
Process (Integrated with SAWS)
Image Scanning Image Retrieval
1. A worker opens a 1. A worker opens a
case file in the case file in the
SAWS system. SAWS system.
2. The worker triggers 2. The worker
scanning by clicking requests to see
the Scan button on images relevant to
the page. the current SAWS
system page by
3. System scans the clicking the Images
image and button on the page.
automatically pulls
the metadata for the 3. System requests
case from SAWS appropriate images
system. and displays them
to the worker.
* Note: Barcodes are also directly
scanned. 34
34
Document Imaging – Best Practices &
Lessons Learned
Find the „right‟ scanning process for your business environment, distributed or
centralized scanning
Build-in Quality control check-points and processes & create a official record of the
process followed for each document/case ingested (eJounral)
Regularly monitor workflow queues to index/file documents in a timely and
consistent manner and develop corresponding performance standards
Visit other counties to see other solutions before deciding on technology platform
and corresponding processes/approach
Training, Training and more Training - very important for adoption of the system
Forms Ownership - Identify forms and assign owners early in project (Develop an
Enterprise Forms Taxonomy)
Develop internal champions/experts and put them „out-front‟ to help their peers
Make use of Bar coding or special markers to reduce the need for separator sheets
Trusted System Certification – seek independent review before destroying paper
Establish an Exec Steering Committee with reps across organization
Plan for and document case storage and case retention/destruction processes
Involve HR and Labor Unions
35
Modernization Initiatives
Kiosks
36
Kiosks – Benefits
Placed in Office Lobby and Community Organizations
Customers use Kiosks to:
(Re) Apply for assistance
Provide documents
Submit updates
Check Benefits
Get Information
37
Kiosks – Best Practices & Lessons
Learned
Connectivity – rural areas have connectivity challenges. Understand
connectivity options and limitations before you decide on a location
Hours of operation – businesses with later hours offer opportunity to the
community to use Kiosks more after hours
Developing informal agreements with Kiosk hosts on moving Kiosks,
reporting technical issues and routinely checking to see that Kiosk is
operating throughout the day (we have had incidents of people
unplugging Kiosks so they can charge cell phones)
Decide on access to which websites are needed and have them
enabled at time of deployment
Install screen saver with a message to ensure Kiosk appears
operational
Educate staff on how to support devices in the field
Consider initially having staff available at the Kiosk to facilitate and
encourage use
Measure usage and survey the Kiosk value with customers regularly
38
Modernization Initiatives
Future Enhancements…
Marketing?
39
Future Enhancements
Assistor Role (Community Partner Portals)
“Click to Chat” Option on websites
eTelephonic Signature
eNOAs (Electronic Notices of Action)
Mobile applications and SAWS Website &
Statewide Portal support for SmartPhones
QR (Quick Response) Codes
on correspondence 40
Marketing – Important?
Strong marketing is one of the most
important things you can do
Having well defined functionality does
no good, if customers don’t know about
it or how to use it!
Make sure to include marketing costs in
the budget and plan appropriately
41
QUESTIONS…?
42
