Backlogs Up Then Drastically Down

With the passage of the Affordable Care Act, the process of enrolling medical providers became much more challenging. For Utah, the new requirements resulted in approximately 30% more work per medical provider enrollment, created a backlog of about 700 full provider applications, and caused a delay in provider enrollments of two to three months. By implementing strategies associated with the SUCCESS Framework, the backlog for provider applications has been eliminated and new reliability standards have been established–without any additional cost. Based on recent data, the total time to enroll a provider has been reduced by about 60 percent. This equates to a reliability standard of just 20 business days—an exceptional feat given the higher demands of the Affordable Care Act.

The provider enrollment team in Medicaid Operations takes pride in helping medical providers join the panel that offers services to Utahns enrolled in Medicaid. Seth Fuentes, Audra Solovi, Corina Pace, and Linda Robinson implemented several strategies to achieve these significant improvements. The first strategy focused on developing a set of operational data that provides close to real-time management data including the number of full provider applications received per week, the lead time of each application, and the number of completed applications per week. This data is represented in the cumulative flow diagram and helps the team manage their capacity to meet the demands of enrolling medical providers.

Other improvement strategies included:

  • Reducing multi-tasking by assigning specific employees for telephone coverage and allowing more focused time on applications
  • Organizing incoming work (triage) so more senior staff took responsibility for complicated applications that are the most time-consuming
  • Reducing rework and double entry on applications
  • Reassigning workload capacity from tracking backlog cases and issues to the blue light activity of completing new enrollment applications
  • Analyzing and updating individual performance data as new reliability standards were set to determine time needed to work with various provider types.

The Department of Health’s provider enrollment team has done an outstanding job developing strategies to decrease enrollment times and increase the reliability of their system. Congratulations to Medicaid Operations and the provider enrollment team for their leadership and efforts to improve reliability and increase service levels for their customers.