The revenue reports painted a clear, but startling picture for leaders at Kaiser Permanente Colorado: The organization’s Medicaid line of business was losing more than $100,000 a month in revenue because filing deadlines were missed repeatedly.
A quick investigation revealed that missed deadlines were primarily due to inefficient enrollment processes. A member’s Medicaid ID had to be entered in both the membership and billing systems before the organization could generate a bill—when this wasn’t done, Medicaid claims were automatically denied, leading to a significant loss of revenue for the healthcare organization.
Led by Joseph “JJ” Cassa, the Medicaid Enrollment Project team used Lean Six Sigma methodology to target Medicaid enrollment process inefficiencies. To uncover root causes, the team applied a variety of tools, including value-stream maps, output-process-input (OPI) diagrams, and cause and effect diagrams.
The team validated six final root causes and selected two solutions:
After a two-week trial, the solutions became a permanent part of the process.
Spanning only 90 days, the project achieved the following results:
A cost/benefit analysis showed that the overall implementation cost was just under $50,000 while the benefits topped $1 million; thus the project’s one-year ROI was a remarkable 21:1.
The Medicaid Enrollment Project Team used a variety of forums to share its success story, including delivering a live presentation at the 2008 ASQ World Conference on Quality and Improvement, where it was a finalist in the International Team Excellence Award Process.Read the full case study (PDF, 193 KB, Free Registration Required)