1 / 10

Enhancing Medical Case Renewal Success Through Process Improvement

Learn about Oklahoma's successful transition from Managed Care to Primary Care, reducing automatic case closures and increasing renewal rates. Attend the learning session in Chattanooga, Tennessee for insights into effective strategies.

tave
Télécharger la présentation

Enhancing Medical Case Renewal Success Through Process Improvement

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Increase number of successfully renewed medical cases by decreasing automatic case closures by 80% by March 1, 2004 PIC Oklahoma Remind Educate Process Learning Session 2  Chattanooga, Tennessee  March 30 – April 1, 2004

  2. Oklahoma’s Structure • No 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

  3.  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 Current Events Concurrent Managed Care Transition

  4. Analysis Reminders Alternative Process Action Period 1

  5. Letter reminders include information on calling for phone renewal Reminders Phone reminders made early evening 1st Classletter reminders include Return Receipt Requested PDSA#10- reminder letter sent with information on renewals conducted over the phone Phone reminders PDSA#4- Phone reminders made early evening Letter reminders PDSA#3- letter reminders sent with ‘Return Receipt Requested” PDSA#2- Reminder letter sent to clients who had not returned Benefit Review Form PDSA#1- Calling clients who had not returned their Benefit Review Form

  6. Analysis Phone renewal by dedicated caseworker Focus group survey of caseworkers on phone renewals Analyze case history after closure PDSA#14 - Review reopened cases for impact on managed care enrollment Analysis of form readability and content PDSA#12- Focus Group with caseworkers Analysis of renewal form PDSA#11- Review case history of original PDSA cycles Analysis of return rates medical vs. comprehensive cases PDSA#9- Survey on Benefit Review Form at non-DHS site PDSA#6- Survey on Benefit Review Form PDSA#5- Return rates of medical only and comprehensive cases

  7. Phone renewal by dedicated caseworker Alternative Process Phone renewals on medical only cases PDSA#13- Phone renewals conducted by a designated caseworker Phonerenewals PDSA#8- Conduct phone renewals on medical only cases during business hours PDSA#7- Conduct phone renewals during business hours

  8. Results Percentage of Medical Only Cases Completed Before Deadline ***Caseload A and B (April data sets) contain some cases completed by designated worker

  9. Results for Action Period 1 Analysis Reminders Implemented a process change to better the work flow by designating a worker to complete medical only reviews, including phone renewals. Alternative Process

  10. Summary & Next Steps Implementing alternative process Testing impact on work flow Education and Training

More Related