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Moving Mountains With the Help of a Mandate - How Kentucky is transforming benefit service delivery by using its health benefit exchange investment
Can meeting Affordable Care Act mandates open the door to public service delivery transformation? It did for the commonwealth of Kentucky. Kentucky decided to make the most of the opportunity and resources around ACA to rapidly implement a state-based exchange and, in parallel, transform its state Medicaid/CHIP offices.
The end goal? Offer affordable insurance for citizens and improved access to benefit programs across Kentucky.
The organization piloted its integrated service delivery approach first before rolling it out across Kentucky. Through ongoing status calls and meetings, leadership fielded complaints and also cheered on staff. Now, caseworkers have better work/life balance, and customers are happier because they are waiting less, and getting benefits faster. One field supervisor said, “Staff has really embraced the change, they make suggestions for improvements and it has made the transition more manageable.”
Read the full story about how Kentucky is integrating service delivery to help families across the commonwealth.
Like many other human services agencies across the country, the Kentucky Department of Community Based Services (DCBS) faced a rise in Supplemental Nutrition Assistance Program (SNAP) and Medicaid case volume, outdated technology that hindered integrated service delivery, employee turnover rates as high as 20 percent and a decreasing amount of funding to support such increasing demand. These combined issues created the perfect storm for human services transformation.
In line with Affordable Care Act (ACA) mandates—it was also the time to transform. Kentucky was working toward developing a health insurance exchange that would be ready to enroll consumers by October 1, 2013. The process of developing the Kentucky Health Benefits Exchange (KHBE) uncovered opportunities to drive change on a broader scale by taking advantage of 90/10 funding.
Download the PDF to read about how the Cabinet developed an integrated Health Benefit Exchange and Medicaid eligibility and enrollment system for the MAGI population.
DCBS teamed up with Accenture to redesign processes and build an organizational design that would help to reduce transaction costs and complexity across the organization’s 140 field offices, enabling DCBS to absorb new ACA administrative activities while only incrementally increasing organizational size. This ambitious effort focused on three key levers: process, people and technology.
The team mapped out, analyzed and redesigned processes to enable a transition from case management processes to functional process. For example, previously, each worker managed his or her own cases and clients. Now, processes are standardized across offices so that work can be distributed to teams that can perform the task, regardless of their location.
Through a new client-centered service approach, DCBS has improved virtual access to information and services. Workers are assigned to where they demonstrate the highest capability, and staff that delivers front-line service to clients is highly trained. Through change management and training (guided by supportive and engaged leadership), DCBS has helped more than 2,000 field staff adopt the new business model and processes within a year.
An outdated technology infrastructure hindered DCBS from being proactive with its data to plan for the ebb and flow of demand, and to be more customer-service oriented. Using 90/10 funding, the Cabinet developed an integrated Health Benefit Exchange and Medicaid eligibility and enrollment system (HBE/E&E) for the MAGI population.
The DCBS transformation has yielded reduced wait times in offices, faster access to benefits—all of this while Kentucky has opened the door to affordable health insurance for its citizens. DCBS continually receives positive feedback from clients on the additional opportunities to access services and information. The new system allows clients to reach DCBS via the web, phone, or in person.
The call services team answered 184,000 calls from clients in locations that had implemented the transformation, and 80 percent of those calls were resolved on the first call. There has also been a significant reduction in foot traffic—in some cases a 60 percent decrease—at field offices as more program re-certifications are conducted via phone.
DCBS has achieved great strides, but there are still challenges to overcome. Successful transformation will continue to be achieved as core leadership, field staff, IT, business partners
and the Cabinet work together and stay committed to delivering timely and quality services that help Kentucky families.
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