1. DHS Kaizen Event “Food Assistance Error Rate” UPDATE: The History – The Present – and... Things Yet to Come – Kaizen Event - - Business Sponsors: Ann Wiebers, Administrator – Financial, Health and Work Supports Division Vern Armstrong, Administrator - Field Operation Support Division Tom Bouska, Service Area Manager - Council Bluffs Area

2. History Leading to the Kaizen Event  In March of 2008 Iowa became aware of an unusually high monthly error rate - for Nov. 2007.  Looking back over time at monthly actual error rates (not the YTD rate), although there is significant variation – there is a multi-year trend of slight annual increases - of about 1% per year. 2

3. What Do We Do About It? The Income Maintenance Business Partners (IMBP) considered various ways to assess the error rate, and to act upon the assessment in a way which would support a significant rapid improvement in Food Assistance Accuracy (reduce the error rate). The IMBP chose to utilize a quality improvement strategy called “Kaizen” to support our quality improvement goals. 3

4. What is Kaizen? A highly focused, action oriented event Clear objectives – and scope, Measurement focused, Data driven and fact based, Uses creativity before capital Five days in length Empowered team takes action to improve a specific process The new process is designed immediately 4

5.  Clear objectives  Team process  Tight focus on time  Eliminate waste  Quick & simple  Creativity vs. capital  Immediate results (“quick wins” to add value)  5S “mindset” – sort, set order, shine, standardize, sustain -- to support event activities Kaizen Methodology 5

6. Prior to a Kaizen a “pre-planning” meeting identifies the membership and focus or scope for the event, and sets a measurable performance goal. Initial analysis illustrated that Wages and Salary errors continued to be the largest error category. 6 Food Assistance Active Error Rate

7. SCOPE : This event will examine Food Assistance benefit determinations for cases with wages and salaries (including self-employment) from application for benefits to determination of benefits, and through Quality Control review. GOALS : Reduce Food Assistance Quality Control error rate from the December 2007 year to date rate of 11%, to rate of 4% for the federal fiscal year ending September 30, 2009. DHS Kaizen Event Food Assistance Error Rate May 19 –23, 2008 7

8. Team: “FAIRwell !!” The Kaizen Team 8 Also: For More Information - Kaizen Share Point: Kaizen Update *remember to click the second tab for Food Assistance

9. What did we learn during the Kaizen? We learned: to change our mindset about our work a new way of working together that our work processes can be changed and improved, some examples follow in the next slides THAT WE ARE ALL IN THIS TOGETHER 9

10. RESULTS: Elimination of FAIR  Standardize and simplify the client review process. 1.Aligning with FIP semi-annual reporting. 2.Expand FA simplified reporting to entire caseload. 3.Manual will be released. 4.Implementing 2/1/09. *Additional information including Notes and Follow-up Items: draft rules and manual will be available in the Kaizen share point. 10

11. Data Brokering  Make effective use of all system data for eligibility process. 1.Field priority. 2.Service Request completed for IT support. 3.Assigning Business Analyst. 4.Implement in phases. 11 RESULTS:

12. Interview Guide/Income Documentation Tool  Support consistent documentation on the treatment of income. 1.Income Documentation Tool is the priority of the two, and is being developed. 2.Request IT support of the tool/form to be supported electronically. 3.Interview Guide remains on hold until further notice. 12 RESULTS:

13. QC Error Resolution Process.  Align Federal Policy, QC Review Procedures, State Policy, and Field Practice and Procedures. 1.A statewide committee met three times and is scheduled to meet once more, in February; summary notes from Error Analysis meetings are posted to the Kaizen share point. 2.A new Error Resolution process is now being piloted, and is planned to start across the state with error cases for the October QC sample month. 13 RESULTS:

14.  All error cases evaluated  Friendly, progressive process  Open communication to resolve discrepancies  Trends analyzed – avoid future potential errors  Overall process reviewed & evaluated October 2009  Revise QC report of error form New Error Resolution Process 14

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16. 16 Best Estimate (self-declaration) of Income.  Streamline process (when and how) to use Best Estimate for accurately obtaining wage information and benefit levels. 1.Plan Do Study Act (PDSA) by each service area to test the IL model. 2.QA&I verify actual income. Recommendation: 1.Implement change in Iowa Food Assistance Budgeting Policy. 2.Adopt from IL model how income verification is asked from the employer. 3.Revise Employer Statement of Earnings. 4.Support development of Income Documentation Tool. 5.Recommend implementing 2/1/09. RESULTS:

17. 17 Generic Release.  Reducing mailings and time delay for requests for client permission to obtain information and verifications. 1.Drafting instructions. 2.Adding addendum to applications and review/recertification forms. 3.Revising FIP, CCA, and Medicaid Administrative Rules. RESULTS:

18. 18 OPTIONAL Release of Information Help Us Help You! RELEASE OF INFORMATION I hereby authorize any person or organization to give the Iowa Department of Human Services requested information about me or other members of my household. A copy of this release is as valid as the original. This release does not apply to protected health information. This release is good for 12 months from the date signed. ________________________________ Name (please print clearly) _____________________________________________ Signature or MarkDate You do not have to sign this, but it will help us get information we need to help you, without having to get your signature on specific requests. You should know that:  We may need more information to decide if you can get assistance.  If more information is needed from you, you will get a letter telling you what we need and the date you must get it to us.  You are responsible to get the information or to ask us for help to get it.  If you do not give us the information or ask for help by the due date, your application may be denied or your assistance may stop.  We may be able to use the release below to get the information we need. But you still have to provide information we request or ask us for help.  We may attach a copy of this release to a form that asks other people or organizations (like your employer) for specific information needed about you or others in your household. Print and sign your name below to give us permission to get needed information.

19. RESULTS: 19 Food Assistance Income Budgeting.  To address QC errors in the wages/salaries element while trying to align with other programs. 1.Revised Chapter F to clarify and simplify prospective budgeting. 2.Rewrote chapter in a new format to make the policy more clear – Policy, Procedure, Comment; added hyperlinks.

20. 20 Additional Strategies Revise Employees Manual on Budgeting – Clarification & consistency. Try to align language across the programs. Webinar Training – Train staff on changes using a more accessible medium and requiring less travel. Implement FIP Semi-Annual Reporting – Eliminate quarterly reporting for FIP cases (which applied to cases with earnings) to match the review periods of FA. IABC generated NODs and associated Calc Sheets will be first to be put in Global 360, planned to implement end of January 2009. Back to the Basics – Documentation; tailor interview to situation; use employee manual; simplify policies and add procedures back into employee manual.

21. Kaizen Participant Experiences: 21 Tom Wakefield, FA Program Manager Kevin Wright, Supervisor, Quality Control Carolyn Farley, IMW, Henry County

22. Also: For More Information - DHS staff see Kaizen Share Point: Kaizen Information *remember to click the second tab for Food Assistance 22 Questions? Please submit any questions to your IMA for IMBP response.

23. Keep up the good work and remember, We’re All In This Together! 23