2018-10-05 00:00:00 +0000 - Chaeny Emanavin
Tl:dr - We worked with the Dept of Managed Health Care to improve the cumbersome, inexact and time intensive process of collecting data on the relative burden to accessing health care (the distance between a medical provider and given client). Working shoulder to shoulder with subject matter experts OI prototypes removed redundant steps, better utilized existing tools and created a process to improve process time by 70%. The reduction in staff frustration creating a more effective work environment that continues to pay dividends.
Team Members: Marni Sager, Dorian Rodriguez, Kerry Gantt, Isabella Blassi
Office of Innovation Director: Chaeny Emanavin
Department Engagement Champion: Michael Hodnett
The California Department of Managed Health Care protects consumers’ health care rights and ensures a stable health care delivery system. DMHC responds to consumers’ disputes with their respective DMHC-regulated health providers through independent medical reviews and complaint resolution processes. This makes DMHC a critical part of success delivery of the managed health care system.
Medical care must be a reasonable distance from the enrollee to the provider. As such, DMHC is responsible for checking these distances and the relative burden of access health care for a given provider’s network. DMHC was having difficulty finding a software solution to improve the Department’s ability to analyze health plan provider networks for adequacy and to measure and explicitly define the geographic distance from enrollee to provider.
Their software solution, Quest Analytics, did not allow the Department to definitively point to where potential enrollees live or work, as well as where the closest provider is in relation to that potential enrollee. Additionally, health plans could define their service area by ZIP code. ZIP codes are developed by and for the USPS for mail routes, and do not have map defined boundaries. Thus, no two map programs draw a ZIP code areas in the same exact way. This presented a data challenge on many different fronts.
To determine where potential enrollees might live in a given service area, the DMHC relies on 2010 US Census data in conjunction with Quest Analytics’ ZIP code centroid model to approximate population density in each ZIP code. The DMHC relies on this method because actual enrollee location data is not something the Department can currently collect from health plans. Ultimately, relying on this method analysis leaves the Department’s findings open for debate as to whether their analysis is accurate and reasonable. We’ve defined this problem by three parameters:
When the OI team arrived to work on the initial challenge statement, we were unsure of how to approach an issue that seemed on the surface to be comprised of a contract issue, software development need and lack of IT resources. It wasn’t clear initially if we could effectively tackle any of these issues during a six-week engagement. However, using our process after discovery, we were able to identify aspects that we could effectively tackle, along with some other opportunities worth exploring further.
The challenge statements we initially generated changed quite significantly during the process.
Office of Plan Management (OPM) needs to create a standardized process for initial data analysis in order to increase efficiency.
How might we create a process or tool for OPM to help address their need for sharing of institutional knowledge and/or to assist in continuous process improvement?
OPM needs an analysis of potential technical tools to help assess which tools may best meet their business needs. How might we create a roadmap for OPM that will help detail small steps toward achieving their goal of automation?
Through our methodology of engaging the users in brainstorming and in workshop sessions, we created prototypes of a refined process flow, a form modification, resource lists, a software mock-up, and a product roadmap. We user tested and iterated on these prototypes until we found something that worked well.
The main improvement was not a technological solution, but a workflow improvement that reduced work time by up to 30% and reduced staff frustration by greatly reducing the need rework.
The team created a checklist, which included documenting a pre-meeting process for the assigned analysts and attorneys as well as modifications to the checklist they were using. The OI team did user testing of the new checklist prototype with a mix of attorneys and analysts. The OI team was able to test on a real world scenario when two staff were assigned a new filing. This allowed the team to do a head to head comparison of the pre-meeting process using the prototype on an actual filing.
With this data, the team created several prototypes including a product roadmap prototype for e-filing automation based off the workshop; a process prototype for building a “knowledge bank” for staff to share institutional knowledge, best practices, and health plan history; and a digital prototype of a new automated e-filing system using Marvel.
The survey tool to measure satisfaction with the existing processes against prototyped changes
The OI Process was particularly effective for us and the department was quite forward thinking and introspective, and willing to engage even though they hadn’t yet necessarily dedicated resources to work specifically on these challenges, nor had they gotten input from user groups There was also a benefit to people with “outsider” eyes, seeing the process that many in the group had been doing for years, allowing “unspoken” ideas to be heard and opening the lines of communication at different levels of the organization
Additionally, our ability to leverage the influence of CHHS and our partners, may have pushed processes forward for DMHC that had been stuck in various bureaucratic logjams.
During the course of the engagement, DMHC reached an agreement with ESRI to be able to test the ArcGIS software they had been trying to obtain for 18 months
A matrix comparing technical tools since they mentioned that would be helpful and they were not sure if ArcGIS was the best tool for them.
For knowing nothing about our struggles six weeks ago, I am amazed at what you were able to comprehend and accomplish in such a short amount of time. I will be thinking of our next innovation project to have you come back and assist. Dan Southard, Deputy Director- OPM, DMHC
It was wonderful to work with you and the rest of the innovation team and we’re so pleased with the changes we’ve already been able to implement based on your work. Depending on the complexity and background of the filing, our [pre-work] process has effectively reduced work time up to about 30% . . . but we’ve seen real efficiencies in cases where there might otherwise have been misplaced focus or duplicative work. The reduction in ambiguity and staff frustration due to [our pre-work process] is less quantifiable, but not less important.
Michael Hodnett, Lawyer- OPM, DMHC
It was an awesome experience for us as well. We will be looking forward to that next opportunity to work together. Until then, rock on!
Chris Wordlaw, SSM II- OPM, DMHC
How invested the innovation team really became. They brought a ton of fun energy and were sincerely interested, scrambling to get real positive results for us instead of just some deliverable report
The level of knowledge that each of the CHHS team members possessed about our specific challenge We were focused on one solution. The team made us think about other solutions to our challenge
This was a great and productive experience. I am looking forward to another future innovation project with CHHS
We got more than we bargained for
Our work with the innovation team got the creative juices flowing! As a team, we worked really well to problem-solve and brainstorm ways to improve our process. It was a great way to get to know our co-workers better and to make everyone feel like they could contribute to the future of the project. I think that sense of “belonging” continues. We also have a lot of great ideas, some of which are potentially going to be acted on (e.g. asking standardized comments up-front)
I feel like interacting with the Innovation Team not only allowed me to understand eFiling better because of the depth in which we analyzed it, but I also feel like it changed the way I look at my work in general—I want to ask more questions and figure out why we do the things we do. It also encouraged me to think of innovating other processes I touch and not settle for the status quo.
And we even got some new staff recruits out of the engagement!
Given the workload in my office, the time commitment requested by the CHHS Innovation Team, not knowing the return on investment or value add to my office, I was hesitant to volunteer one of my staff to participate. Now that understand and have seen firsthand the benefits of participation, I will gladly voluntell one of my staff during the next recruitment process.
Dan Southard, Deputy Director- OPM, DMHC