Healthcare Access, Eligibility & Enrollment Unit (HAEEU) and 1 more...less...

Case Resolution

% of Customer Requests Resolved in 10 Business Days

85%Sep 2020

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Story Behind the Curve

This metric measures the speed at which customer requests are processed. It includes requests related to Qualified Health Plan (QHP) and MAGI-Medicaid members in the Vermont Health Connect (VHC) system as well as those related to Medicaid for the Aged, Blind and Disabled (MABD) members in Green Mountain Care (GMC) programs in the State's legacy ACCESS system.

The goal for 2019 is to complete at least 95% of customer requests within ten business days.

All Vermonters who are served by DVHA-HAEEU should expect that their requests will be addressed promptly. And yet, for the first few years of VHC, many requests took several weeks or months to complete. In the first quarter of 2016, fewer than 60% of requests were completed within ten business days. That spring HAEEU set a goal of completing 75% of customer requests within ten business days by October 2016 and 85% by June 2017.

In March 2016, the State of Vermont and VHC Systems Integrator Optum deployed their final major release to enable the processing of Medicaid renewals. With the completion of major system development work, the teams no longer had to manage continual cycles of major code changes. Instead they could focus on identifying and remediating defects and making process improvements within a stable system. This effort came to be known as the Maintenance and Operations (M&O) Surge. The M&O Surge began in March 2016 and continued into the summer of 2016.

The results of the M&O Surge were clearly visible by late spring 2016. Escalated case inventories fell 80% from March levels. Integration errors were also cut 80%. Customer requests were processed in an increasingly timely manner.

In June 2016, HAEEU surpassed its October goal of completing 75% of requests in ten business days. In October 2016, they surpassed their June 2017 goal of 85%. Over the following months, performance continued to improve. With the 2017 QHP Open Enrollment and Renewal Period's successful completion, system integration improved over prior years and errors fell. As a result, customer requests were promptly completed on a more consistent basis.

The second week of March 2017 marked the first time that 95% of VHC requests were completed in ten days. Since that time, VHC requests have consistently met this threshold. The last 18 weeks of calendar year 2018 all exceeded the 95% threshold, with 17 of 18 weeks hitting at least 97%. It's also important to note that the 3-5% delta includes cases that can’t be worked for a couple months by rule, such as post-partum cases.   

GMC requests have not had quite the same level of consistently strong performance as VHC requests over that time, typically resulting in the combined result for HAEEU requests (i.e. this metric) being lower than the results for VHC requests.

Strategy

For VHC cases, monitor the weekly results. If the metric dips, convene business teams to determine the root cause and take steps to return to high performance.

For GMC cases, in the short-term, cross-train VHC staff on ACCESS system. In the longer term, having one system will enable staff to more easily meet the targets for all populations.

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