Can meeting Affordable Care Act mandates open the door to public service delivery transformation? It did for the Commonwealth of Kentucky.

Like many other human services agencies across the country, the Kentucky Department of Community Based Services (DCBS) faced a rise in SNAP and Medicaid case volume, outdated technology that hindered integrated service delivery, employee turnover rates as high as 20 percent, and a decreasing amount of funding to support such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 transformation.

In line with Affordable Care Act (ACA) mandates—it was also 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 transform on a broader scale by taking advantage of 90/10 funding.

The Road to Rapid Transformation

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.

In September 2012, 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 130 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.

Process

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.

People

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 deliver front-line service to clients are highly trained.

Employees have resounding, positive support of the transformation. Through change management and training (guided by supportive and engaged leadership), DCBS has helped more than 2,000 field staff to adopt the new business model and processes within a year.

The organization piloted the approach first before rolling it out across the Commonwealth of 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.”

Technology

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. Since October 1, 2013, the challenge has been managing the workload of two separate eligibility systems, the new HBE/E&E and the 20+ year-old integrated (SNAP, TANF, and current Medicaid/CHIP) legacy system. The Cabinet is actively pursuing its plan to return to a single integrated eligibility system that supports workload management and distribution by incorporating SNAP and TANF into the new HBE/E&E system by 2015. In addition, DCBS also implemented a new SNAP Web portal which was an initiative via a 2011 SNAP participation grant award they received.

Data is now standardized in a way that allows all 2,000 workers to use it. Being data-driven allows the organization to understand how many staff members are at each site, and it allows for redistribution of the work to create a better workload balance across the state to ensure timeliness and accuracy, and enables higher levels of service delivery

Integrated data is also enabling more rigorous measurement. The organization can measure key performance indicators to understand progress, and—in one central place—they can also see how they are measuring up when it comes to state and federal regulations, guidelines and targets. The current Medicaid/KCHIP accuracy rate of statewide metrics is approximately 97 percent, and it’s improving monthly.

Moving Mountains – One at a Time

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 is continually receiving 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.

This article was previously published in Policy & Practice, the journal of the American Public Human Service Association.