[PPT] - Efficiency in Providing Public Benefits Supportive Parents PowerPoint Presentation

SLIDE 1

Assessing System Efficiency in Providing Public Benefits

Supportive Parents Information Network (SPIN) Caring Council

February 9, 2012

SLIDE 2

Our Goals

Pr Proposing

posing a pr

a process

cess – no

no a pr a product

duct

To De Develop elop an an aut authe hent ntic ic pa partn tner ership ship amo among ng all all key ey play player ers: s: HHS HHSA A Mana Manage gemen ment, t, Wor

rker

ers, s, Appli licants/ ts/Recipien ipients ts While we are critical – we don’t wish to be adversarial

We want the system to work and we assume the County does as well

To successfully address and remove the barriers to the efficient and compassionate delivery of public benefits

SLIDE 3

Concerns

The here e is n is no sys

systemic, o

temic, objec bjecti tive mea e means o ns of monitoring of the system’s effectiveness

It seems that all “outputs” are assumed to have a positive

utcome – no assessment is made to test that assumption

Data that are reported on the system’s functioning only provide a partial picture – an overly positive picture

The he f fun unda damen mental tal app pproa

ach

h is flaw is flawed ed

“Public assistance eligibility determination processes and

perations needed to be refreshed and aligned with CalWIN

System” Kim Forrester System designed to serve the tool – rather than the tool designed to serve the system

SLIDE 4

Examples

Enrollment v. Participation Rate

The County consistently refers to its enrollment as “participation rate” and points to the significant rise in cases. While enrollment has increased there is no evidence that the participation rate has increased.

Compliance Rate & Pending

The County consistently reports its Monthly Compliance Rate at above 90% but fails to mention that this number is based on less than half the monthly cases. San Diego continues to have an unusually high pending rate in comparison to other large counties and the state

SLIDE 5

Enrollment v. Participation Rate

Estimates of Participation v Actual Participation

25,000 50,000 75,000 100,000 125,000 150,000 175,000 200,000 225,000 250,000

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Months Individual Enrollment

Participation 3% change 9% change Linear (Participation) Linear (3% change) Linear (9% change)

Using Unemployment as indicator of demand – shows County is keeping up with demand – not increasing its participation rate

SLIDE 6

Compliance Rate & Pending

Pending Rate Across Largest Counties

5 10 15 2 0 2 5 3 0 3 5 4 0 4 5 5 0 5 5 6 0 6 5

Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11

Months

% Pending End of Month

San Diego State Los Angeles Orange Riverside San Bernadino

The County has consistently had a pending rate of over 50% since August

f 2009 and peaked at 61% in November 2011

SLIDE 7

Technical v Political

It is important to remember - because this is a public agency this is as much a technical problem as a political problem Politics is – The translation of the ideal into the real

This definition raises the questions:

Who gets to define the “Ideal”
Who gets to create the “real”

Our hope is that we can create a process where the three major players [HHSA Mgt, Workers, Recipients] work together to define the ideal and create the real

SLIDE 8

A Framework HHSA

Outputs Outcomes Impact

Feedback

The Evaluation must be FORMATIVE & SUMMATIVE: It must examine the process (formative) and the outcomes (summative). Quality feedback mechanisms need to be developed and institutionalized: The efficiency of any system is related to the quality of the feedback it gets and its ability to incorporate that feedback. Must expand whose feedback is accepted & incorporated – Management, Workers, Clients.

SLIDE 9

Scope of the Evaluation

Needs to examine the Business Process Re-Engineering (BPR) The Heart of BPR:

The ACCESS Call Center Task-Based Operation

Needs to assess Outcomes

Is it achieving its intention? [Requires Management Perspective] How well is it being implemented? [Requires Worker Perspective] What is the experience of the recipient? [Requires Client Perspective]

SLIDE 10

ACCESS Call Center

Intelegy Report provides assessment of ACCESS Call Center

Valida alidate tes s some some of

f ou
ur

r co conc ncer erns: ns: “There is no evidence of a joint

techanical planto support the current service delivery model, operational needs of ACCESS or the FRC‟s or requirement of a future „online‟ service delivery model.”

Supp Suppor

rts some of

ts some of ou

ur asse

r assessmen ssment t & & rec ecommen

mmenda

dation tions: s:

Migrate work force to flexible work assignments based on customer need
vs. task specialization
Revise processes to minimize customer handoffs
Staffing levels not sufficient
Upgrade FRCs

SLIDE 11

Task Based Operation: Summative Assessment

Evaluation begins with operationalizing Outcomes

Operationalized outcomes provide measureable indicators of how well the system is functioning Examples of Outcome Measures:

Percent of cases disposed of within 30 days
Percent of cases pending each month in relation to other large counties
Changes in the participation rate [not enrollment]
Denial rates in relation to other large counties
Negative error rate [both false positives and false negatives]
Number of appeals – percent reversed
Incidence of lost paperwork

SLIDE 12

Environment

What are the conditions in the FRCs - how well are they functioning?

In particiular:

What are the physical conditions?
What resources are available with in the Center?
How long does it take to complete one‟s business?
How many trips does it take?

What is effect of Early Fraud Detection on client experience & what is its value?

25 to 30% of all food stamps recipients also receive CalWORKs, requiring them to

submit to Project 100%

Anecdotal evidences indicates Project 100% is a deterrent – not for fraud, but fear of

losing children

DA reports millions in “Cost Avoidance” but has no legitimate data to support claim

[See State Auditor‟s report on Anti-Fraud activities]

SLIDE 13

Task Based Operation: Formative Assessment

Evaluation of internal processes must include workers & ability of clients to provide feedback Formative Evaluation needs to examine both the efficiency of the process and its impact on the recipient

Examples of things that make the work harder:

Barriers to correcting errors in CalWIN
No means for tracking misfiled documents
Multiple & conflicting notices of Action sent to client in one day
No single person has overall knowledge of any case

SLIDE 14

Recommendations

SSAB from a workgroup made up of HHSA Management, workers, and clients for the purpose of:

Developing a set of measurable outcomes
Creating a system for monitoring the impact of internal

processes on those outcomes

Developing an ongoing evaluation/monitoring system

that includes regular reporting to the SSAB

SLIDE 15

Cautions

Numbers don’t lie, people do

The value of data is in its interpretation

You get what you measure

Numbers are only indicators of a process or an outcome – they are not the process or the outcome. No indicator is a perfect reflection of what it is measuring. The best interpretation comes when all perspectives come to consensus. The way outcomes are operationalized and measured will affect worker behavior If an ACCESS work is assessed on length of call, s/he will focus on ending calls in the prescribed time. If an ACCESS worker is assessed on the percent of successful resolutions, s/he will focus on finding resolutions to a caller‟s issues