Universal Caseloads: A study in continuous improvement

Recently I was contacted by Jacob Kanclerz, a reporter from Michigan’s Independent Source of News & Information (MIRS News) regarding the implementation of Universal Caseload (UCL) models, which the Michigan Department of Health and Human Services (DHHS) has adopted. Although we were not part of the Michigan roll-out, we have had the pleasure of working with many states and counties on continuous improvement of their eligibility business processes. 

As I mentioned to Jacob when he interviewed me, it is difficult to change business processes in a statewide organization the size of Michigan DHHS. Continuous improvement is a process of experimentation. Some experiments don’t work. The key is to learn from those experiments in order to figure out what does work and to continue problem-solving until the root cause has been discovered.   

Also, I was reminded of how small the world of human services can be when I learned Michigan DHHS has a new director at the helm – Robert Gordon – with whom we had the pleasure of working on an assessment project when he was at the College Board. Best wishes, Robert! 



DHHS Case Backlog In UCL Counties Drops To 17% From 40% 

By Jacob Kanclerz  

Shared with permission from MIRS News 


March 14, 2019 - The public assistance case backlog has fallen to 17 percent in counties where a new process has been implemented for handling casework, down from the nearly 40 percent a month ago, according to the most recent data provided by the state. 

The Michigan Department of Health and Human Services (DHHS) acknowledged last month the delays in getting benefits like food stamps or Medicaid -- as well as long wait times for some on the phone -- were "unacceptable," and pledged to make a number of reforms (See "DHHS Head: Public Assistance Cases Backlog 'Unacceptable,'" 2/13/19). 

Among the changes to improve the rollout for the new system -- known as the Universal Caseload (UCL) model -- was to pull staff from non-UCL counties to help with the backlogs in the 50 counties where UCL has been implemented.  

DHHS spokesperson Bob WHEATON said the staff reinforcements have been deployed to handle the backlogged casework, which has been attributed to the increase of client phone calls that have taken caseworkers away from finishing cases. Wheaton said DHHS is prioritizing work related to pending applications so as to improve application processing.  

Since the 40 percent backlog figure from early February, the rate has declined each week to the current 17 percent. In non-UCL counties, the backlog percentage is just below 5 percent, according to the state dashboard on the UCL rollout.  

The staff redirection is one of several strategies being employed by DHHS. Others include breaking up the region that had grouped every Upper Peninsula county into one region, and limiting the times the phone lines are open to the public so caseworkers can spend time tending to cases at the beginning and end of the day. 

Alicia KONE, a Seattle-based consultant who has worked with half the country's states on health and human services matters, said if she were working with Michigan, she would advise the leadership to address the root cause. 

"How can we make the phones ring less?" is the question to be asked, Kone said, instead of having workers handle phone calls quicker, or redirect workers from other places to handle phone calls.  

"Nine times out of the 10, people are calling because they're wondering what's going on with their case because something is late," she said. "And that is a self-defeating cycle for an eligibility agency because the . . . more backlog they have, and the . . . farther behind they are on processing work, the more phone calls that are going to come in and the more people that are going to walk in their door." 

 Wheaton said the DHHS is working to identify the root cause or causes and is "prepared to implement new technology and/or processes to fix them."  

Kone has previously worked for the state government in Washington and has worked with states that have implemented what's also known as case-banking or a task-based model of handling public assistance cases, which is what Michigan has begun with UCL. 

Under the new approach, the old process of assigning a case to an individual caseworker goes away, in favor of a single case being handled by teams of caseworkers. The idea is to increase efficiency and make sure cases don't get dropped when an individual caseworker goes on vacation, for instance. 

As part of the new model, the state has also set up call centers with a universal phone number for public assistance recipients to dial into, rather than leave voicemails with their assigned caseworker. 

But as UCL has rolled out in mostly northern Michigan, people who interact with the system have described long waits on the phone and delays in receiving assistance (See "Calling DHHS In UP? Average Hold Time Is 96 Minutes," 2/11/19). 

Part of the problem has been state workers tending to the incoming phone calls, which has resulted in cases piling up (See "DHHS Bottleneck Causing Long Delays In Food, Heat Assistance Cases," 2/1/19). 

Kone said other states have seen varied results with these types of systems. 

"When it's done well, it's really just beautiful to see, but I've also seen poor implementations of it," she said. 

Kone said the biggest difference-maker in making this process a success is leadership: The leaders need to listen and make sure the people on the ground have the resources they need. 

That was echoed by Rachel CAHILL, an Ohio-based consultant who has done work for the Center for Community Solutions, who also said leadership is a key factor in rolling out this approach, as well as proper public reporting and staffing commitments. 

Cahill said she's seen both the bad and the good in Ohio, which is a county-administered state when it comes to health and human services programs.  

In Hamilton County -- where Cincinnati is -- Cahill said there was initially a bumpy rollout, but eventually, it recovered and the county's timeliness rates made it to the mid-90s. 

However, Cahill said other Ohio counties saw that and tried to replicate it -- like Cuyahoga County, home to Cleveland -- and didn't get the same results. She said they didn't sufficiently forecast the needs, which led to the county not staffing up to appropriate levels. 


As a result, Cahill said people in Cuyahoga County started experiencing similar things that have been described in Michigan so far, like wait times that went "through the roof." 


Despite the challenges, the Michigan DHHS has said "we need to try to make UCL work" and "simply going backward should be a last resort."  


DHHS Director Robert GORDON said most states are heading toward implementing task-based case management systems. That's something both Cahill and Kone confirmed. 


"I don't think that it's realistic that states are going to . . . pump the brakes on the transition to case-banking . . . because it's always going to be seen as more efficient," Cahill said. 


"If I were going to run a health and human services agency . . . people would need to tell me why task-based models of work weren't the best ways to manage eligibility," Kone said.