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Home My WebLink About20072503.tiff STATE OF COLORADO Colorado Department Health Care Policy and Financing Joan Henneberry, Executive Director r. a Colorado Department of Human Services Karen L. Beye, Executive Director Bill Ritter,Jr. Governor July 20, 2007 Dear Board of County Commissioners: The departments of Human Services and Health Care Policy and Financing contracted with Deloitte Consulting to conduct a County Workload Study for programs within the County Administration Appropriation. The affected programs include food assistance, adult financial, medical services, adult protection services, and personnel costs that support county operations. The Joint Budget Committee had recommended this study to be undertaken, and the departments received the completed report on June 30, 2007. Enclosed please find a copy of the Workload Study. In the addition, the report can be accessed through the following link: http://vvww.cdhs.state.co.us/cbms/PDFs/COWorkloadStudyRePortvdf The Workload Study required a great deal of time and commitment on the part of the affected county departments and state participants. Thank you for your hard work; we believe the results will provide reliable data needed to adequately address county administration now and into the future. We truly appreciate the spirit of cooperation evidenced in the study and look forward to working with you on this and other issues. Your work is a credit to the State of Colorado. Sincerely, OWL `1ct-w,,J 4 2t, y Henneberry Karen L. Beye Executive Director Executive Director Department of Health Care Policy and Financing Department of Human Services Enclosure l 'Osrymw1f r-Ahe'!S (n./P-2 P-2/ �SJ 2007-2503 P18= Cllo-off Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study 9O DEPART 1 Ls 4 ra _Z G = Colorado Department of ado Services �RFPOLIC� �`�P CdI1S peaplewhohelppcople Colorado Workload Study Final Report CO Workload Study Project—6/25/2007 Page 1 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing _ Workload Study Table of Contents 1.0 EXECUTIVE SUMMARY 3 2.0 INTRODUCTION 12 2.1 BACKGROUND,PURPOSE AND SCOPE 12 _. 2.2 WORKLOAD STUDY STEERING TEAM 12 2.3 PROJECT ASSUMPTIONS 13 2.4 WORKLOAD STUDY APPROACH 14 3.0 COST MODEL,RESULTS AND ANALYSIS 26 3.1 ABC COST MODEL BUILD-UP 27 3.2 RESULTS OF ABC MODEL 51 3.3 COST ANALYSIS 57 4.0 OVERVIEW OF FIELD OBSERVATIONS,SUMMARY SURVEY,BUSINESS MODELS,AND HUMAN SERVICES MODERNIZATION 61 _ 4.1 FIELD OBSERVATIONS 61 4.2 KEY FINDINGS FROM SUMMARY SURVEY 72 4.3 OUR INTERPRETATION OF FIELD OBSERVATIONS AND SUMMARY SURVEY RESULTS 82 4.4 TRENDS IN HUMAN SERVICES MODERNIZATION 83 5.0 APPENDIX 113 CO Workload Study Project-6/23/2007 Page 2 _ Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study 1.0 Executive Summary This report is the result of a project undertaken by the Colorado Department of Human Services (CDHS), Health Care Policy and Financing (HCPF) and County Departments of Human/Social Services.The CO Workload Study Project was performed to project Colorado counties'costs for administering public benefits. Additionally,the project helped identify business process trends and determine opportunities for modernization of the administration of human services in Colorado. Additionally, the base cost to "open the door" of a county department of human/social services "base" county was determined. Deloitte Consulting used an Activity-Based Costing(ABC) methodology,a proven data gathering and modeling technique for activity and time-based analysis, as a means of projecting the cost of County Administration activities as currently performed,without any modifications to existing business practices. The contract was awarded in January 2007,and the CO Workload Study was performed from March though June 2007. 1.1.1 Overview of CO Workload Study Project The CO Workload Study Steering Team (including members from the State,Counties and Deloitte Consulting LLP)) officially commenced the project in March 2007.The Deloitte Consulting Team included Colorado state government specialists, Human Services specialists,Supply Chain and Finance specialist, and Activity-Based Costing(ABC) resources.In addition,web-based developers and technical support built and supported automated online tools used to collect data during the project. In addition to Deloitte Consulting resources, there were State and County executives serving on the CO Workload Study Steering Team (Steering Team).The Steering Team was an involved and dedicated decision-making body for the study,providing project context and a forum for dialogue, feedback,direction, and approval of all key outputs, documents, and deliverables. As such,the results of this project are largely based on the active participation of the Steering Team and other stakeholders who provided timely and thoughtful input throughout the study period. A list of Steering Team members can be found in Appendix A. Upon initiating this project in March 2007,we worked with members of the Steering Team to communicate a consistent understanding of the CO Workload Study goals and objectives.To create our ABC Cost Model and analyze county business practices,we used a Detailed Survey,Field _ Observations and a Summary Survey as our main data gathering tools. A detailed explanation of our approach is presented in Section 2.0. We initiated our data gathering efforts by interviewing Steering Team members,providing detailed and focused insight into our approach. Concurrent with these interviews,we developed the Detailed Survey and companion materials with the Steering Team.The Detailed Survey,given to all counties (except for Kiowa,Pitkin and Yuma,who voluntarily did not participate), captured information from — selected county staff about the time it takes to perform daily activities. During our Field Observations we met with all levels of county office staff and leadership to gather additional information about activity times,workload issues and their business models. We administered the — Summary Survey statewide to a larger group of county Social/Human Services staff and gathered qualitative information regarding county business processes,workload and worker opinions. Importantly,data gathered through these methods provides consistent views of county operations. The ABC Cost Model was populated with time and activity data provided by the counties to project the cost of County Administration. Instead of analyzing costs from a resource perspective (traditional cost accounting),ABC enables a cost analysis from a business process perspective.We translated data related to discrete activities and related time into county costs.This translation of activity times CO Workload Study Project-6/23/2007 Page 3 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study — into costs is the foundation for building the ABC Cost Model. We have been able to determine overall cost of the County Administration workload as well as total cost per full time equivalent employee (FTE) and unit costs (cost per case program).A detailed explanation of the Model and our results are presented in Section 3.0. Overall,the results of the CO Workload Study determined that current funding of County Administration does not cover the counties' costs of administering public benefits. Our analysis projects the cost of doing business in Colorado to be almost $85.2 million.This total cost reflects the additional amount required to bring all of the base counties up to the base level of funding (the difference between those counties'projected cost and the base level).The FY 2007 County Administration appropriation was about$57 million, leaving a funding shortfall of approximately $28.2 million. In response to this funding gap, counties have created a variety of business processes to meet the unique needs of their clients.These operational modifications, sometimes including"work arounds," are often used by counties to meet their workload demands. Based on our findings from the Field — Observations,we illustrate and analyze key county operational trends. In addition,we are also providing examples of techniques and options to more efficiently and effectively manage workload. We share some innovative practices that we observed in the counties, as well as additional modernization strategies taken from human services agencies in other states. Some of these options are focused on technology enhancements,while others identify new tools to improve the everyday operational aspects of the business model. This study may be used as a means to provide an evidence-based justification for County Administration funding requests.At the conclusion of our report,our team worked with CDHS Accounting staff to further explain and effectively transfer our knowledge on using the ABC Cost Model. Overview of Results Below,is the summary of results of the CO Workload Study.Detailed analyses of these results are provided in Section 3.0 and 4.0. From our cost analysis,we include the following tables:Total Cost for each In-scope Program by County,Total Cost for Out of Scope Programs,Cost to"Open the _ Door"in a base county,Unit Cost per Process,and Total Cost per Cost Lever. Cost levers are segments of workload that respond similarly to business process changes, subsequently driving costs up or down. In addition to the cost results,we provide a summary of our key findings related to opportunities for business process modernization (Section 4.0). Administration Cost for each In-scope Program by County The following table shows total cost for each in-scope high-level program group and county based — upon the build-up of workload in the ABC Model. In addition,we have provided the incremental cost to meet the "Open the Doors" threshold costs in every base county.The calculation of base county costs is provided in the next section. Please note that this calculation of total cost is a cost projection based upon the Detailed Survey inputs to the ABC Cost Model;it is not the County Administration allocation. Totals may be nominally incorrect due to rounding. CO Workload Study Project—6/23/2007 Page 4 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing — Workload Study Total Administration Cost for Each In-scope Program and County Adult -- Food Protective Assistance Medical Adult Financial Services County (FA) (MED) (AF) (APS) Total — Adams $ 2,833,336 $ 2,916,899 $ 383,539 $ 243,496 $ 6,377,270 Alamosa 196,278 205,623 28,798 74,871 505,570 Arapahoe 3,515,968 3,385,865 400,099 846,040 8,147,973 — Archuleta 35,709 32,869 4,126 7,693 80,396* Baca 58,960 55,656 7,816 55,700 178,133 _ Bent 67,291 52,346 7,367 10,788 137,792 Boulder 2,128,177 2,099,765 288,296 509,457 5,025,694 Broomfield 297,883 348,117 43,121 121,224 810,345 — Chaffee 121,276 151,078 21,351 16,107 309,812 Cheyenne 25,301 22,944 3,402 755 52,402* Clear Creek 90,690 73,072 10,559 4,262 178,583 — Conejos 51,176 63,112 9,002 7,489 130,779 Costilla 82,675 62,162 10,691 9,506 165,033 Crowley 63,503 52,143 7,732 169 123,547 Custer 8,528 7,131 973 1,863 18,495` Delta 185,033 224,050 29,143 93,962 532,188 — Denver 10,608,052 8,657,152 1,423,082 2,282,368 22,970,654 Dolores 13,932 12,357 1,696 92 28,077* Douglas 308,003 379,054 44,055 78,041 809,153 — Eagle 138,275 223,000 24,415 30,247 415,937 El Paso 3,661,574 3,160,330 410,142 588,726 7,820,773 Elbert 50,971 44,792 5,280 5,946 106,989 — Fremont 219,543 275,132 35,641 58,039 588,355 Garfield 266,651 417,612 46,898 76,898 808,060 — Gilpin 44,793 35,935 4,582 326 85,637* Grand 41,918 42,952 4,164 1,144 90,179 Gunnison 94,647 87,315 9,051 9,872 200,884 Hinsdale 268 244 36 - 548* Huerfano 74,716 83,405 11,550 8,479 178,150 — Jackson 3,842 3,318 422 - 7,583* Jefferson 2,287,139 2,315,139 306,089 583,376 5,491,743 Kiowa 29,319 28,365 4,131 118 61,933* Kit Carson 75,511 71,108 9,380 4,039 160,039 La Plata 243,603 286,414 38,435 114,691 683,143 Lake 47,249 46,794 6,031 4,398 104,472 CO Workload Study Project—6/23/2007 Page 5 — Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study — Adult Food Protective Assistance Medical Adult Financial Services _ County (FA) (MED) (AF) (APS) Total Larimer 2,177,440 2,046,424 291,350 781,744 5,296,958 Las Animas 133,482 169,340 23,268 49,828 375,918 — Lincoln 50,385 43,105 5,385 9,192 108,067 Logan 155,844 178,744 23,401 59,881 417,870 Mesa 1,339,080 1,243,002 171,832 290,833 3,044,747 Mineral 9 9 1 - 19" Moffat 62,153 75,505 9,384 461 147,502 — Montezuma 136,111 161,559 20,216 58,645 376,530 Montrose 317,150 408,280 42,995 120,778 889,202 Morgan 213,637 283,370 38,260 134,930 670,197 — Otero 151,395 174,191 25,006 112,563 463,154 Ouray 23,675 22,402 3,168 11,260 60,506* Park 62,810 46,181 5,719 12,674 127,385 Phillips 29,550 27,550 3,364 7,998 68,461' Pitkin 30,107 36,854 3,994 246 71,200* — Prowers 174,361 215,279 28,745 35,953 454,337 Pueblo 1,422,094 1,153,832 181,705 122,664 2,880,295 Rio Blanco 50,828 50,299 5,890 502 107,519 — Rio Grande 118,183 125,114 17,439 485 261,222 Routt 107,800 102,282 10,470 1,276 221,828 — Saguache 74,764 80,883 11,346 8,380 175,372 San Juan 9,005 7,618 1,025 3,582 21,229* San Miguel 41,036 36,474 4,463 2,114 84,086* - Sedgwick 25,036 22,646 3,456 13,500 64,638* Summit 81,740 99,636 7,423 1,491 190,290 Teller 142,499 159,218 20,629 31,185 353,530 — Washington 72,779 70,145 7,990 65,289 216,204 Weld 1,683,033 1,662,853 220,662 238,227 3,804,775 _ Yuma 131,419 127,030 16,026 20,894 295,368 Subtotal $36,989,196 $34,753,075 $ 4,845,708 $ 8,046,755 $ 84,634,733 'Base Counties-Incremental cost due to threshold cost to"Open the Doors" $611,409 Total $85,246,142 — Table 1.1:Total Cost for each In-scope Program and County CO Workload Study Project—6/23/2007 Page 6 Copyright©2007 Deloitte Development LLC.All rights reserved. ..... Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Base County Cost Calculation The following table identifies the costs to"Open the Doors"to conduct business for one year based on the data collected in two base counties (Cheyenne and Jackson).This can be considered a minimum threshold of cost required for a County to have an office in operation.Totals may be nominally incorrect due to rounding. "Open the Doors"Cost in a Base County 0/, of Resource Pool Cost Total Capital Outlay $ 1,265 1.4% Labor 21,553 24.6% -- l Cost of Office Space 15,869 18.1% Operating Expenses 30,186 34.4% Travel Expenses 18,901 21.5% Total $87,774 100% Table 1.2:"Open the Doors"Cost in a Base County Unit Cost per Process In addition to the total projected cost,the unit cost per case-program (portion of a case that includes a particular program) by county size has been determined by dividing the total cost per program by the number of case programs. The following table shows the average unit cost for County Administration,broken out by high-level -` program group and county size based upon the build-up of workload and costs from the ABC Model.A unit cost for County Administration for each county by high-level program group is provided in Appendix V. ilnit Cost for each County Size and High-Level Program Group County Size FA MED AF APS Large $ 373.48 $ 146.64 $ 168.76 $ 931.98 Medium $ 250.30 $ 123.33 $ 124.39 $ 677.51 I Small $ 410.61 $145.19 $ 163.09 S 1,544.89 Table 1.3:Unit Cost for each County Size and High-Level Program Group The following table summarizes the total number of case programs for County Administration, broken out by high-level program group and county size. Total number of Case programs for each County Size and High-Level Program Group County Size FA MED AF APS i Large 84,759 195,323 24,158 13,930 Medium 15,110 38,013 4,768 5,080 Small 3,778 9,806 1,078 836 Table 1.4:Total number of Case programs for each County Size and High-Level Program Group CO Workload Study Project—6/23/2007 Page 7 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Key Cost Levers The following table reports the cost of key groupings of activities and high-level program groups that describe the cost levers or areas of workload for the County Administration. Cost levers are areas of an end-to-end business process that are grouped because they are reactive or dependent upon similar drivers that can drive costs up or down. Totals may be nominally incorrect due to rounding. Total Cost for each Cost Lever %of Key Cost Levers FA MED AF APS Total Total Case Related Activities (e.g. Case Review, Change in Circumstances,Alerts) $12,818,385 $10,292,172 $ 1,854,736 $6,592,204 $31,557,498 37% Client Communications and Information 6,007,099 7,904,088 762,946 85,689 14,759,821 17% Intake(Both Completed — and Failed) 6,264,509 7,098,079 513,884 295,491 14,171,963 17% Eligibility Recertification (RRRs)and Periodic Reporting 4,787,296 4,620,012 341,241 9,748,548 12% Administrative Activities (Non-Case Related) (e.g.Administrative — Tasks, Meetings, Training, Reports) 2,883,694 3,331,735 973,114 73,444 7,261,987 9% Claims 2,549,812 1,226 192,297 2,743,335 3% Management Activities 1,385,216 1,119,605 164,666 33,195 2,702,683 3% Other(e.g.Travel, Referrals, ICTs,APS specific Activities) 293,185 386,158 42,824 966,732 1,688,899 2% Total $36,989,196 $34,753,075 $4,845,708 $8,046,755 $84,634,733 100% Table 1.5:Total Cost for each Cost Lever Business Process Improvement Results Business model trends and innovative county business practices are described in detail in Section 4.0 of this document. This section also contains technology enhancements and tools to help counties better manage their workload. — While each county puts a unique stamp on its own business model,we have noted trends emerging by county size.Accordingly, we have developed the Business Model Continuum to explain these — trends. One of our observations is that generally specialization increases with increasing county size. The Business Model Continuum is illustrated in Figure 1.1 below: CO Workload Study Project-6/23/2007 Page 8 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing —' Workload Study Business Model Continuum More Generalized More Specialized Generalist ( Rs 4 l� iL L �p i'; • Staff conduct work in +'staff#re*id12.7:17 Guteg g , &�, t " s . ¢� r i most!all Generalist subset'Caf" Fut cttt' n d �i�' {. i !11' 'i', — Maintenance Program11: 177 1' � ti." a s t ,till Areas • Sataff`spe elta ' lice 4��ro a pl 145n uIi'. • Staff have less distinct y p gg �` — roles and dsii'` a:;'., $011-401,410": responsibilities and ft.3` "Gte41 '4Srt7.t ' its 42 Pi „, ,, ; af�.�' typically do multiple h l l i" Work FunctionsiiiillE r s „ (Intake, Ongoing, n j{ti II� Clerical) 5t3 'd �4t q 'Eadi! ' :, • Organizational te Structure is flatter in i ,,.,i t small ex counties(duties • d.v ,�lr $ 3 ' overlap administrative e � * : , ' fur rl d ( l �p and execcun 0�, - B , ' boundaries) f11 ,i 1 Smaller Size of County Larger — Figure 1.1:Business Model Continuum Smaller counties,having fewer employees,typically employ a generalist business model.These count es have relatively experienced staff with deep program knowledge,but often struggle with workload distribution and backlog. Medium counties typically employ a hybrid model,whereas large counties are increasingly specialized. Some medium and many large counties are experiencing problems with staff turnover. Exiting staff often indicate the stress of the workload was unmanageable, and/or they were able to find less stressful work for higher pay elsewhere. Consequently, scarce resources are being used to continuously hire and train new staff while vacant positions abound. Our Field Observations also identified innovative practices that have been developed in some of the counties. For example,one medium county,Fremont,is not currently experiencing backlog problems because of its proactive approach to addressing pending cases that are • near or have passed their deadline. Another example is the IT staff in Adams County has produced innovative technolog solutions such as their user-friendly scheduling system. For the most part,the count es we visited are interested in improving service delivery and are willing to try new business practices toward that goal. We discovered a strong commitment to customer service in all of the county offices we visited. Clients are the first priority,which often drives organizational decision mak rig.Though each county CO Workload Study Project-6/23/2007 Page 9 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study institutes different methods of achieving customer service goals, their intentions are clear. One county indicated that their business model is geared toward customer service, and secondarily focus on efficiency.We provide analysis, however, that these goals are not mutually exclusive;in Section — 4.0 we offer a number of tools that not only streamline business processes,but improve customer service as well. By observing county operations first hand, we were provided the information necessary to help us understand why counties choose to operate as they do.Information gathered through the Detailed Survey, Field Observations and Summary Survey helped us identify key areas for modernization. In Section 4.0,we identify three key areas of modernization considerations: (1) technology, (2) operations/service delivery and (3) people.The tables below outline the corresponding solution options we are offering to the state and counties for consideration: Technology Options Area of Opportunity Option Cost Lever Impact Web-Enabled Access 1.Provider Access • Intake _. 2.Community Partners Access • Case Related Activities 3.Client Access • Client Communication and Information CBMS Enhancements 1.Increased Automation of CBMS • Intake 2.Improvements to Existing • Case Related Activities CBMS Sub-Systems • Client Communication and Information 3.Additional CBMS Subsystems • Non-Case Related Administrative Activities — • Management Activities Table 1.6:Technology Options O erations/Sen-ice Delivery O Lions Ar •f •...rtunity • .ns C•stL v rim• ct Communication/Change 1.Project Management • Intake Management 2.Help Desk(IT Service • Case Related Activities Management) • Client Communication and Information 3.Change Management(Tracking • Non-Case Related Administrative -- change requests, bug fixes, Activities release notes) • RRRs and Periodic Reporting 4.Strategic Communications and • Claims Training — • Management Activities • Other Governance 1.IT Program Management Office • Intake 2.Policy Program Management • Case Related Activities — Office • Client Communication and Information 3.Subcommittee Structure • Non-Case Related Administrative involving both Executive Activities — Groups • RRRs and Periodic Reporting • Claims • Management Activities — • Other Table 1.7:Operations/Service Delivery Options CO Workload Study Project—6/23/2007 Page 10 _ Copyright©2007 Deloitte Development LLC. All rights reserved. • Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study People Options Area of Opportunity Options Cost Lever Impact Business Model 1.Role Re-Definition • Intake 2.Business Model Re-Design • Case Related Activities • Non-Case Related Administrative Activities • RRRs and Periodic Reporting • Claims • Other Governance 1.Centralized Statewide • Case Related Activities Customer Service Center for • Client Communication and Information Generalized Questions/Inquiries Table 1.8:People Options Section 4.0 describes these options in detail,and provides an explanation of their relevance and impact to Colorado. We understand that initiatives undertaken by other states are only useful if they can make a positive impact on service delivery locally. Accordingly, Section 4.0 provides a detailed analysis of each option's value potential (optimizing staffing, streamlining business processes, reducing workload/increasing productivity, and improving customer service) and applicability to Colorado. The systems in place throughout the counties are inextricably linked to an employee's ability to perform his or her job. Improving on existing technology,and implementing new innovative technological enhancements can lead to dramatic results. For example,web-enabled access allows clients to have easier access to services and reduce County Administration Staff workload. In addition,clients have greater input and responsibilities associated with their benefits because they can inquire about and update their cases without needing to meet with County Administration Staff. Including CBMS enhancements that were not included during implementation could also improve service delivery. On the "people" side of business operations, counties could benefit from business model modernization through leveraging technology,reducing duplication and standardizing processes. Though similarities exist between county businesses models, most offices have their own unique organizational approach. Consequently, opportunities for standardization could also help manage workload issues. Strong leadership is a key to effective change management, and is especially relevant at the state level. Improving IT governance and program management can foster accountability and help make sure future initiatives undertaken by the State are executed correctly. The following sections of this report include Section 2.0,providing background information and a detailed description of our approach; Section 3.0, an in-depth explanation of the ABC Cost Model and cost analysis;and Section 4.0, an overview of our key findings from Field Observations,business model analysis and modernization opportunities. CO Workload Study Project-6/23/2007 Page 11 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study 2.0 Introduction 2.1 Background, Purpose and Scope To determine the projected level of funding for County Administration based upon current business practices and the cost to "open the doors," the existing process of distributing county allocation — funding must be understood. Public benefits in Colorado are provided through a County Administered System. CDHS is responsible for allocating the legislated administrative funding to all 64 counties. The current appropriation is comprised of twenty percent local/county funds and eighty percent State and federal funds. HCPF and CDHS are responsible for determining the annual County Administration allocation, distributing the level of funding approved by the Colorado General Assembly through to counties via the State Treasurer on a monthly basis as earned by each of the counties. Currently, CDHS uses a time-study based upon case activity data last drawn from the legacy systems preceding the implementation of CBMS (Colorado Benefits Management System) as the — basis for the allocation. In addition to determining the annual appropriation,the State is an indirect steward of these funds through the promulgation of rules and regulations, as well as through other guidelines. Counties are responsible for using those funds to cover the costs of administering public benefits to their clients. Counties and other stakeholders including the impacted State departments and the legislature have expressed concerns with the current appropriated funding level of County Administration funds, stating that recent appropriations are currently inadequate to cover the costs of administering public benefits. This CO Workload Study is intended to be a means to determine the appropriate level of county funding based on current business practices. To provide a data and evidence-driven justification for the projected County Administration funding, — the study analyzes the current workload of all counties in Colorado.This is accomplished by defining a representative list of activities related to Intake and Ongoing Case Management,as well as supervisory,administrative,and clerical support and Adult Protective Services. Specifically, the high — level program groups included in the scope of this project are: Food Assistance, Medicaid and Other Medical Programs,Adult Financial Programs,and Adult Protective Services. Colorado Works (TANF) and Old Age Pension (OAP) Financial are not included in this study. 2.2 Workload Study Steering Team The Workload Study Steering Team serves as the primary conduit for providing context, feedback,guidance and formal approval for the study. Weekly two-hour Steering Team meetings offered a forum for detailed discussion and feedback, and individual interviews provided additional detailed information and context in preparation for the Field Observations. A list of Steering Team members is provided in Appendix A. The Steering Team is the result of a thoughtful process on the part of the State. A broad spectrum of key participants from both the State of Colorado and the Counties served as team members. In —' addition to key state government participants, key county stakeholders were invited to participate as members of the Steering Team. Including representation from counties across Colorado of varying CO Workload Study Project—6/23/2007 Page 12 Copyright©2007 Deloitte Development LLC. All rights reserved. "' Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study size helped to provide a variety of perspectives from across the state,allowing us to continually refine our approach. AU abovementioned invitees and participants were provided weekly Steering Team minutes and all key outputs and deliverables were discussed in Steering Team meetings. Though our weekly formal Steering Team meetings and scheduled interviews provided essential feedback and direction to the project,our ad hoc conversations proved invaluable as well. 2.3 Project Assumptions The following list of assumptions were identified and validated by Steering Team. 2.3.1 The County Administration cost extrapolation is based on existing county business processes, current technologies and staffing composition. The results of this first phase of the study reflected the cost of doing business as determined using existing (status quo) county business activities and processes. Simply stated,our results reflected the cost of doing business in counties across the state based upon the way business is being conducted today. Consequently, the cost extrapolation does not vary based on "if, then" statements related to business process changes,as many solution options for potential change are possible and would need to be identified by the State and Counties prior to determining cost/benefits to these changes. In Section 3.0, opportunities for business modernization strategies specifically for Colorado counties are identified and a high level impact analysis has been conducted. 2.3.2 Grouping counties based upon size (using generally accepted State defined categories)is an acceptable basis for comparison The Steering Team approved grouping counties by size based upon the categories generally accepted by counties in Colorado.The State and county members of the Steering Team approved using this list versus the categorization originally listed in the RFP because it is a more universally accepted way of grouping counties.This method of segmenting counties by size is consistent with other county- based program areas and consistent with the means of segmenting counties within County Administration programs for many years. 2.13 Using information gathered though financial data prodded by the State (over a 12 month period) and Detailed Survey data (April—May 2007)provides an accurate representation of county costs This study was performed over a period of approximately four months; thus,we needed to combine the data we gathered from the State (one year's worth:April 2006—March 2007) with our data gathering tools (Detailed Survey and Field Observations).The sum of this data was considered an appropriate method of determining county costs. 2.3.4 Counties prodded adequate access to County Administration Staffperforming activities within the scope of this project for data gathering purposes. To adequately develop our data gathering tools and ultimately gather the data needed to create the cost extrapolation,access to County Administration Staff was essential to the success of this project. Our approach depended on input from County Administration Staff who work with our team to create a standard activity list,developed and participated in the detailed and summary surveys,and allowed Team members to observe staff as they perform the activities analyzed in this study. CO Workload Study Project—6/23/2007 Page 13 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study 2.3.5 CDHS and HCPF provided true, accurate, complete and representative data To supplement our data gathering approach and adequately populate the model, financial and other data gathered from the State was considered accurate and complete and representative.This data — helped develop a complete understanding of current county costs. Constant communication with CDHS and HCPF provided the guidance and feedback necessary to protect the integrity of the data used in our study. 2.4 Workload Study Approach The overall approach to the CO Workload Study is to determine the length of time staff spend on a standardized list of discrete activities,and translate those times into costs to the counties using ABC. Key components of this section include the Preliminary Approach: developing an understanding of the current allocation process and interviewing Steering Team members; and ABC Cost Model — Development: gathering data through a time study consisting of a Detailed Survey, Field Observations and Summary Survey.We used this multi-pronged method of data gathering to gather consistent and complete information about county operations. _. The following outlines our approach to determining the projected level of funding for the Count' Administration appropriation. 2.4.1 Preliminary Approach Develop an Understanding of County Administration Process, System and Related Materials — Before development of the Model could be initiated,we gained a general understanding of County Administration program delivery processes by attending CBMS,County Financial Management System (CFMS), County Employee Data Store (CEDS), and Random Moment Sampling (RMS) training, meeting with State government staff and reviewing program and financial information. Understanding the current County Administration process provided us with a foundation from which to build our study components. Conduct Steering Team Meetings and Interviews An essential aspect of the approach is conducting Steering Team meetings (meetings were available — via teleconference as well).The central purpose of these meetings is to "steer" the approach of the project. These meetings provide a forum for guiding the development of the model and its data gathering components. To provide substantial time for discussion and feedback, the majority of these meetings lasted nearly nvo hours or more. For facilitation purposes,we provided an agenda,developed PowerPoint presentations to guide the conversation, and recorded discussion and action items each week. In an effort to provide consistency,each week's meeting agenda included a similar framework, reviewing the past week's minutes and items. All work products were developed with Steering Team input and approval. — Upon initiating this project in March 2007,we worked with all active members of the Steering Team to communicate a consistent understanding of the CO Workload Study goals and objectives. — Following approval of the project work plan, the State and county Steering Team members selected the 17 counties for the Field Observations phase of the study— 16 were visited and one county conducted the interview via teleconference.The selected counties included five large, seven medium, — CO Workload Study Project-6/23/2007 Page 14 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study three small, and two base counties,and covered all eight Department of Local Affairs (DOLA) regions. Visiting base counties allowed us to obtain an accurate representation of what it takes to operate a very small office. A list of the counties visited can be found in Appendix B. Originally, these counties were selected based upon the county size categorization in the REP. After the Field Observation period,but prior to finalizing the ABC Cost Model, Steering Team approved switching to the traditional categorization.This categorization is reflective of the historical density of human services involvements (not gross population). Consequently, two of the counties considered "small"in the RFP (Huerfano and Saguache) were re-categorized as "medium" for purposes of the cost calculation Interviews with Steering Team members were conducted over the course of the project.We were successful in scheduling 60 to 90 minute interviews with all but two Steering Team members. Interviewees provided insight into their unique subject matter expertise, allowing us to gather information related to current challenges, notable trends,and potential pitfalls regarding the county administration of public benefits and our approach to this project. In addition, we are able to obtain needed financial and program data from Steering Team members through these interviews. Interviews were ongoing throughout the project and provide an additional layer of communication and feedback as the project progresses from data gathering through model building and analysis. 2.4.2 Overview of an Activity Based Approach to Determining Costs The methodology utilized to buildup the cost of County Administration is ABC methodology,a measurement approach that involves relating costs to an organization's processes by separately identifying the "activities"involved and resulting cost impact.The following sections discuss the ABC methodology in detail, and explain the data gathering tools used in this approach. The ABC methodology we use to determine County Administration costs is based upon the traditional ABC methodology, but altered to fit the purpose of the workload study.The change is based upon a divergence from the traditional ABC purpose of allocating an organization's operating expense to the activities it performs and the products/services that it produces. The goal is to perform a cost build-up based upon the amount of County Administration workload.The methodology discussed in this document is specific to the CO Workload Study and represents the calculations and the steps taken based upon the purpose of the study. One benefit of the ABC methodology is the ability to provide transparency and comparability around activities,processes, and costs.The outputs of the ABC model help identify and quantify cost reduction opportunities, support process improvement efforts and enable more accurate allocation of shared services costs by aligning expenses with resource consumption. An Activity-Based Costing(ABC) model is the method we used for calculating costs associated with activities performed and the products/services produced. Instead of analyzing costs from a resource perspective (traditional cost accounting),ABC enables a cost analysis from a business process perspective. In short,ABC evaluates how resources are consumed by the discrete activities;it associates operating expenses with business model activities, and/or processes performed by an individual or unit. CO Workload Study Project—6/23/2007 Page 15 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing _ Workload Study ABC Methodology Activity Based Costing a o° rnirli 02. c Lip 3 \`°4 4 \any g ' Funding Requirements Figure 2.1 —ABC Methodology As depicted above in Figure 2.1,the ABC methodology assigns operating expenses to activities to understand how resources are consumed. It derives unit costs at the activity level to outline volume sensitivity. For the counties,volume sensitivity is the effect that an increase or decrease in the number of cases per program has on the total cost.The cost of each activity is linked to the cost objects (the units that require a separate cost measurement) to understand the pricing, budget,or funding requirements for each of those cost objects. Cost objects are typically the customers, — products, services,contracts or business units as shown in this model. Key ABC Model Components _ The ABC methodology uses four key components related to data inputs, assumptions,and calculations.This section explains these key components,and provides an overview of how they are defined in the study. — Resource Pools The resource pools included in the ABC model represent all costs related to the end-to-end business processes within the scope of the workload study.The resource pools are similar categories of costs from existing financial / cost systems that are grouped together,making it easier to group activities (e.g., salary and benefits are often grouped into a resource pool called compensation). Data for the resource pools is drawn from: CFMS for non-labor costs (i.e. capital outlay,office space, travel and operating expenses),and County Employee Data Store (CEDS) for labor costs (i.e. salary and benefits).The resource pools are defined by the CFMS cost categories,listed in Appendix D. The resource costs are presented in terms of the resource driver, or the measure of the quantity of costs being consumed by a particular activity.The resource driver for this study is time given in minutes. _ Activity List An activity is a definable event within an organization that consumes resources (e.g.,set up a new account). The set of defined activities are intended to be material, easily tracked, and readily identifiable in each program. CO Workload Study Project—6/23/2007 Page 16 _ Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study The Steering Team agreed upon the list of activities and their corresponding definitions. Input from the Steering Team and a group of end users validated this list.The Activity List Dictionary,including the 35 identified activities with definitions, is presented in Appendix E. The resources required for each activity are driven by the resource driver, "time in minutes".To obtain the standard time in minutes for each activity, we received direct input from the individuals performing the activities through the Detailed Survey (validated by Field Observations). All activity times,if defined for more than one program, are calculated in terms of case programs to reflect the correlation between the number of programs within a case,its complexity and resulting additional time. Activity Drivers Activity drivers measure the frequency or intensity of activity demands, quantifying the amount in a time range that an activity occurs.The activity drivers for this study are primarily the number of occurrences for each process or set of activities. System driven data is primarily used to identify the number of occurrences in one year's time for each county and program. Diagrams of the defined processes and related activity drivers are presented in Appendix F. All activity drivers,if defined for more than one program,are calculated in terms of case programs to match the way activity time is calculated. Cost Objects Cost Objects are separate work units that require a cost measurement and to which activity costs are allocated.The cost objects for this study are each in-scope program for all 64 counties. A list of the in-scope programs is provided in Appendix G. Data Gathering: Detailed Survey, Field Observations and Summary Survey Our approach includes three data gathering tools to develop workload standards for the defined list of activities: the Detailed Survey, Field Observations and Summary Survey. These tools gather quantitative and qualitative information related to costs,workload and business processes. By identifying County Administration activity processing times,we use the ABC Cost Model to attach costs to those activities. We used these data gathering tools to gain a complete understanding of all county activities,and therefore costs. Gathering information at the discrete activity level (Al,client communication,break, RRR,etc.) was essential to understanding all of the costs associated with county workload.The ABC Cost Model requires this level of detailed information to calculate an accurate cost projection. Detailed Survey The Detailed Survey is the primary data gathering tool utilized to collect processing times for the defined list of activities. It is an online data gathering tool that county-selected staff utilized to track the time it takes to perform all daily activities and to conduct each activity individually.The survey took inventory of all activity times within the assigned day. Great care was taken to prepare counties for the Detailed Survey. Multiple opportunities for preparation and feedback were provided to assist in making survey participation as smooth as possible.A list of these opportunities for county involvement is included in Appendix C. The Survey Activity Workbook, an instructional guide distributed to survey participants, as well as screen shots of the Detailed Survey can be found in Appendix H. CO Workload Study Project-6/23/2007 Page 17 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study The Survey Activity Workbook includes a paper log book with detailed instructions that participants use to record their daily activities and times.The information from the log book is subsequently entered into an online survey. The Detailed Survey captured detailed information regarding discrete _ activities County Administration Staff performed and the time it takes to perform them, as well as the programs associated with those activities. We gathered information beginning at this level, and then built up the projected cost based on this information. Counties actively participated in the _ Detailed Survey, providing the depth and breadth of information needed to determine the cost of doing business in Colorado. Below we provide an overview of how survey participants were selected and prepared to take the — survey. Additionally,we explain how the Detailed Survey was administered to all participating counties. Survey Participant Selection Survey participant selection was completed by the County Director,or assigned delegate, in each County under the direction of the Workload Study Team. Two conference calls were conducted to provide verbal direction, in addition to the County Participation Guide (included in Appendix I) provided to each of the County Directors. The following instructions were outlined for survey participant selection: • Counties selected no less than 25%of a cross-section of staff to participate in the survey. County size was the determinant for the percentage of staff participation. For example, due to a relatively low number of employees, small and medium counties often selected close to 100% of staff to participate multiple times over the four weeks. Conversely, larger counties were able to select a variety of staff(25-30% of total staff in all large counties) each — participating one or more times over the four weeks. Different staff participants took the survey over the four weeks, as opposed to small counties where the same person may have participated in the survey all four times. Though a smaller percentage of staff participated in the larger counties, the actual number of staff was larger. For example,25°/s of staff in Denver is larger than the same percentage in Adams. Consequently, the responses in larger counties are naturally weighted to represent their larger number of staff within each County Classification.This is called a "proxy"weighted average. We determined that these — percentages provided an accurate representation of the activities and programs involved in the spectrum of staff workload. • To the extent possible, distribute evenly the selected participants across the five days within each week and across the four week period. In small and medium counties it required some participants to participate in the detailed survey more than once. • The survey participants are front-line staff or are directly involved with the intake, processing,and management of a case, including fraud investigation,hearings and appeals. • All programs included in the CO Workload Study are represented by the group of staff participants selected. • Activities A to T (see Activity List Dictionary attached in Appendix E) included in the study are represented by the group of staff participants selected. • To the extent possible, represent varying levels of proficiency in program policy, technology, and procedures are represented by the group of staff participants selected. • To the extent possible,represent varying levels of experience working in his or her current or similar role should be represented by the group of staff participants selected. CO Workload Study Project—7/20/2007 Page 18 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study • If the office is divided by units or functions within the list of activities, select the staff participants across the various units or functions. Survey Participant Preparation The Detailed Survey required significant preparation by each survey participant. Every effort was made to adequately prepare counties for the Detailed Survey. Several calls and meetings were held in advance of survey administration, and a pilot period helped us refine the survey with county input. As mentioned in the Executive Summary, a detailed list of opportunities for county participation in the Detailed Survey and Field Observations is included in Appendix C. We conducted pilot surveys in Adams and Denver Counties to assist the development of the survey questions and companion materials.This effort included a pilot county participation call, a structured material review session with survey participants hosted by the Project Champions,and a feedback meeting with both the survey participants,Project Champions and County Directors. Each county selected a`Project Champion' to be the `resident expert'on the detailed survey,to be Tier 1 support for all survey participants in each county,and to be the point-person to escalate issues to our team.The project champion,in addition to the county director, subsequently became the main point of contact for the CO Workload Study Project. Project Champions were assigned in each county to help participants understand what information needed to he tracked throughout the day,and,importantly,how activities were defined for the purposes of the CO Workload Study. Project Champions acted as liaisons to our team during the administration of the survey.Working together to answer questions and quickly solve problems proved to be a useful approach to mitigating issues during the survey period. In advance of the scheduled survey dates,the Project Champions were instructed to hold facilitated sessions to review the survey preparation materials and help answer questions from survey participants. In addition to the project champion facilitated sessions,each county director was requested to provide two hours of protected time for each survey participant to review and understand the survey instructions in preparation of the Detailed Survey. Finally,our team cell phone numbers and e-mail addresses were provided to each of the county _ directors and Project Champions to contact if they had any issues or any questions related to the survey. Detailed Survey Questions The Detailed Survey utilized the defined set of common activities across counties and programs,with definitions and examples to guide each survey participant in tracking all activities that they performed only on the assigned day.The Detailed Survey included all of the activities from the time the survey — participant's work day began until the time the workday was completed.This included the activities for program related work,as well as all other non-program activities conducted while at the office such as office meetings,coffee breaks,and training. Survey participants were requested to use a log book to accurately and completely record his or her activities throughout the day. Next, the survey participant was asked to take the information from the log book and enter it into the Detailed Survey on the internet the next morning.The online survey was structured to match the log book to the extent possible, so each participant could enter the information directly from the log book in a user friendly format.To assist in translating information from the log book into the online survey format, CO Workload Study Project-6/23/2007 Page 19 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study a tally sheet was provided for the survey participant to record the number of times certain activities are performed during their scheduled day. The log book and subsequently the online survey track the following: 1) A list and description of activities worked on during the participant's scheduled day 2) The programs that are worked on during the work day 3) The number of minutes spent conducting each activity — 4) The completeness of each activity performed; and 5) The anticipated time the activity should take,and whether any issues arose that affected that anticipated time 0.e. case complexity, technology issues) We gathered data from all survey participants and validated this information through Field Observations. Survey Participation Results As our main data gathering tool,the Detailed Survey was administered in 61 out of the 64 counties and included over 700 survey responses.Three counties voluntarily did not participate: Kiowa, Pitkin, and Yuma Counties. Survey administration is being conducted over a four-week period and _,, across the five days within each week for small,medium,and large counties. Assumptions In addition to the key assumptions referenced above to be applicable to all data inputs, the following assumptions were made: The defined list of activities,agreed upon by the Steering Team, represents the universe of —. material activities and processes conducted by direct FTEs. • The sample size of 25%-100%of County Administration direct staff in each of the counties over four week period was sufficient to provide representation of overall County _ Administration activities time allocation.Though a smaller percentage of staff participated in the larger counties,the actual number of staff was larger. For example,25% of staff in Denver is larger than the same percentage in Adams. Consequently, the responses in larger counties are naturally weighted to represent their larger number of staff.This is called a "proxy" -- weighted average. • The sample size of County Administration direct staff and survey period was sufficient to provide representation of all high-level program groups within the project scope. — • The sample size of County Administration direct staff and survey period was sufficient to provide representation of all material activities within the project scope. • County information and data can be extrapolated by population size.That is,data gathered _ through the Detailed Survey and Field Observations is an accurate representation of the time and costs experienced by counties within the approved groupings. Results As the graph below shows,information from the survey participants was captured over a four week period and across all five days within each week for small, medium,and large counties.The CO Workload Study Project-6/23/2007 Page 20 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing �— Workload Study distribution of survey responses was coordinated to capture all intra-month seasonality and intra- week traffic flow in the collection of data. ^ Detailed Survey Participation Detailed Survey Participants 60 50 6 _ Large a 30 - ■Medium y20 i- ` D Snall O 5/7 5/10 5/14 5/16 5/18 5/20 5/22 5/24 5/26 5/28 5/30 6/1 6/3 Days ^ Figure 2.2:Detailed Survey Participation The detailed survey participants represent a range of experience levels. As the chart below illustrates, out of the 716 participants responding to the survey,23%had 0-1 years of proficiency,28% had 1-5 years of proficiency, 19% had 5-10 years of proficiency,and 30% had 10+ years of proficiency. .� Detailed Survey Representation of Experience Level Survey Participants By Experience Level 1 0 0 1 Years •1-5 Years ❑5-10 Years ❑10+Years Figure 2.3:Detailed Survey Representation of Experience Level The survey participants in the detailed survey represent the four in-scope high level program groups within large,medium,and small counties. As shown in the table below, the total number of survey participants who selected each high-level program that they work on was comparable to distribution of workload in each County as shown in the results of the ABC Cost Build-up in Table 3.14. r., Detailed Survey Representation of Programs Programs Large Medium Small Food Assistance 255 140 147 CO Workload Study Project—6/23/2007 Page 21 ^ Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing — Workload Study Programs Large Medium Small Medical 272 149 147 — Adult Financial 109 65 55 Adult Protective Services 37 23 32 Table 2.1:Detailed Survey Representation of Programs "- The County Administration staff that participated in the detailed survey provided a sufficient sample size of the Direct County Administration Activities for the ABC Model (as defined by the Activity List Dictionary provided in Appendix E,within the large, medium, and small counties). As shown in the table below, close to 50 occurrences of the high volume activities are performed in each county (regardless of size) during a four week time period.These high volume activities are identified in — references A, C-I,R,S,V and W, also denoted with a*. Detailed Survey Representation of Activities ... Activity Large Medium Small a)Application Initiation(Alt 118 93 105 b)APS-screening — (APS specific activity) 13 3 7 c)Interactive Interview(II)' 179 104 101 d)Eligibility Determination and Benefit Calculation(EDBC)Wrap-up and Authorization' 206 105 107 e)Investigation,Claims Research, — Establishment,and Recovery(Benefd Recovery)* 65 54 47 f)Eligibility Recertification(RRR)' 146 97 87 — g)Medicaid and Food Stamps Periodic/Income Reporting(e.g. Monthly, Quarterly,etc.)* 67 54 37 — h)Change in Circumstances Reported by the Client' 113 81 84 i)Client Communications and Information` 272 149 143 _ j)APS—Information and Referral (APS specific activity) 6 8 5 k)APS-Referral Not Requiring Face-to-Face Intervention 6 5 5 I)APS-Service Provision 19 12 8 m)APS-Guardianship/Conservator ship/ — Payee(APS specific activity) 21 10 11 n)APS-Investigation and assessment(APS specific activity) 23 15 8 — o)Appeals and Hearings 17 3 6 p)Make a Referral 53 34 42 r)Alerts Management• 71 92 83 — CO Workload Study Project—6/23/2007 Page 22 Copyright©2007 Deloitte Development LLC. All rights reserved. — Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Activity Large Medium Small s)Case Review* 120 67 63 t)Activities for Programs Outside the Study (e.g. LEAP,CRSP,Child Welfare, Core Services,Child Support Enforcement, —. Child Care,General Assistance, Public Health Programs) 31 34 76 u)Reports Management 28 31 28 --- v)Administrative Support Activities* 216 102 142 w)Seeking/Receiving Assistance* 186 86 96 x)Management Activities 58 29 47 — z)Breaks 290 155 162 bb)Training 69 23 23 cc)Meetings(e.g. Unit Meetings, Office Meetings,and Conference Calls etc.) 97 28 55 dd)Materials Development and Outreach _ (e.g. Developing County Training Material,Policy Documentation, Community Outreach Sessions etc.) 10 6 8 ee)Non-Activity Specific Reading(e.g. Reviewing Regulations, Policy Manuals, Rules Lookup) 31 24 49 ff)Travel(Job-Related) 39 20 24 gg) Benefit Issuance/EBT Activities 22 11 19 hh)Inter-County Transfers 36 10 17 Table 2.2:Detailed Survey Representation of Activities Based on this high level of participation across all high-level program areas and county sizes,we were able to obtain useful and complete information about activities performed by County Administration Staff.This information was sufficient to populate the ABC Model. Ultimately,along with data gathered from the Field Observations and Summary Survey,we were able to use this detailed information to project the total cost of County Administration. Data Validation and Business Model Analysis: Field Observations The Field Observations conducted in 17 counties (i.e. two base, three small,seven medium, five large) validated the responses received from the detailed survey. We gathered data in "base" counties determine the cost for a county to"open the doors"and conduct business.The selected counties represent all eight geographic areas defined by the Department of Local Affairs. Field Observations not only allowed us to validate time and activity information from the Detailed Survey,but also provided first hand information related to how and why counties operate the way they do. — Pilot Field Observations were conducted in Denver and Adams County. Upon conclusion of those site visits,we conducted a feedback session with the counties. After incorporating the information and lessons learned gained from the session, Field Observations were conducted in the remaining counties over a period of two weeks. CO Workload Study Project-6/23/2007 Page 23 —' Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Based upon feedback received from our pilot Field Observations in Adams and Denver Counties, site visits were divided into four key components explained below. Though times vary based upon county size and complexity (office tours in some counties lasted only a few minutes),these components are consistent across all Field Observations. In advance of our site visits we conducted conference calls with the selected counties to explain the purpose and expectations of the Field Observations,and to allow participants to ask questions in advance of our visit to their county. — Preliminary Interview with the County Director Each Field Observation visit began with a brief interview/discussion with the County Director and any designates s/he deemed appropriate (maximum 6-8 county participants to keep the discussion as -- focused and interactive as possible). At this meeting,we obtained information on the county's business model (i.e. high level organizational structure, understanding of roles/responsibilities by key positions, subcontracting staff(if any),attrition rate,hiring/retention practices, etc). _- Tour of County Office After completing the Preliminary Interview,we toured each county office. We asked to initiate our tour in the area where applications come into the office (either via mail,walk-ins,telephone, etc), moving through the Intake, Eligibility,and Ongoing areas of work. In addition,we requested having someone guide our tour who could explain the key processes of each area of work. During the tour, we gathered important information regarding the key steps taken in each process by program. — Interview with a Small Group of Front Line Managers In addition to meeting with county directors,we asked to meet with a small group (i.e. 1-5 front line supervisors) to talk to them more generally about the activities conducted in their units/areas of work. Ideally,these supervisors had knowledge of the type and volume of work related to the activities and programs outlined in the Detailed Survey.We asked specific questions regarding these activities and the amount of time needed to complete many of them. Time in Motion Study with Staff Either concurrent with or following the front line manager interview, a Deloitte Consulting — representative sat with a staff person or persons of the county's choice. Preferably,this person completed one of the detailed surveys in weeks'past.This provided us with an opportunity to validate the useful information that was recorded in the detailed survey,ask additional questions,and collect any other information that may prove useful to the CO Workload Study Project. At the end of the day,we requested a 30-45 minute debriefing session with the county director and any other staff deemed appropriate to summarize our day's work, answer any outstanding questions — County Administration Staff may have and identify any areas that may require follow up information. In addition to providing data validation,Field Observations put survey data in context and supplied — information related to current county business processes. Gathering this information was essential to analyzing county business models, allowing us to identify innovative practices and opportunities for business improvements across the state. Qualitative Data Gathering: Summary Survey The final tool employed as part of our approach was the Summary Survey. County Administration Staff of all levels were given access to this brief online survey to provide additional qualitative information for consideration in the study. Data gathered through the Summary Survey provided further context of the day to day operations in county offices and reached a broader spectrum of participants to supplement data gathered through the Detailed Survey and Field Observations. A — CO Workload Study Project—6/23/2007 Page 24 _ Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study copy of the Summary Survey is included in Appendix J. For example, the Summary Survey asked participants to rate themselves on their level of knowledge and ability to perform their job. Additionally,we asked about factors making their jobs easier or harder,whether information is gathered through paper/paperless forms, and other subjects to provide further opportunity for county staff to provide important input into the CO Workload Study. The following two sections provide detailed explanations of the results of our approach.Section 3.0 details the creation of the ABC Cost Model and a more detailed description of the projected level of funding for County Administration. Section 4.0 provides key findings from the Field Observations, — results of our business process analysis,and identifies opportunities and tools for county business process modernization. CO Workload Study Project—6/23/2007 Page 25 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing — Workload Study 3.0 Cost Model, Results and Analysis The ABC Model is composed of four elements: (1) Resource Pools, (2) Resource Drivers (3) — Activities, and (3) Activity Drivers and are defined as follows: Resource Pools: The resource pools included in the ABC Model are all expenses reported by the — counties related to the in-scope, end-to-end business processes which includes both labor (salary and benefits) and non-labor (capital outlay,office space,and operating) costs. Resource Driver:The resource driver is the time (given in minutes) spent by each Direct Full-time- Equivalent (FTE) staff person. Direct staff are defined as staff having direct client contact or directly providing service to clients, such as eligibility technicians or supervisors who carry a case load. Activities:The activities are segments of direct time being spent completing the County Administration workload.The data gathered through the Detailed Survey and Field Observations provide an average time for each instance of an activity for every high-level program group within _ the scope of the CO Workload Study. Activity Drivers: The activity drivers are the number of occurrences in a year of each process, sequence of activities, or singular activity, for each county and high-level program group. The ABC Model calculation can be broken down into five steps: Step 1:The County Administration expenses are aggregated into resource pools; Step 2: The aggregate resource pools are divided by the total direct FTEs, and then divided again by a standard number of minutes per year to determine the resource driver,or cost per minute; Step 3:The cost per minute is multiplied by the per instance time of an activity(determined by the Detailed Survey) to calculate a total cost per instance of an activity; Step 4: The per instance time of each activity is multiplied by the activity drivers (i.e. number of intakes,case programs,etc) to determine the total workload,in minutes,required to perform County Administration functions.This total time is used to calculate the number of F'1'Es required to complete the County Administration workload; Step 5: The cost per minute (from Step 3) is multiplied by the total workload in minutes (from step 4) to calculate the total cost of County Administration Programs. The step by step calculation is shown in the graphic below. ABC Model Build-up Step by Step Process Step t Step 2 Step S Step d Step 5 Aggregate Cost —� Calculate Workload Determine —� Link Activities to Calculate Cost into Resource Cost per Minute Workload Cost for Activity Drivers Object Pools Activities — Figure 3.1:ABC Model Build-up Step by Step Process CO Workload Study Project-6/23/2007 Page 26 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study 3.1 ABC Cost Model Build-tip This section provides an explanation of the build up of the ABC Cost Model, the results/outputs of the ABC Cost Model, and an analysis of those outputs. Each part of the cost analysis section includes an overview of the data inputs, key assumptions, calculations and results. 3.1.1 Key Assumptions The following key assumptions are made in the development of the ABC Cost Model,including data gathering,design of the model structure, and calculation of the model outputs. • For all data inputs, the data provided is complete and is representative of all the counties and high-level program groups included in the CO Workload Study. • For all data inputs,the data provided is accurate. Accuracy is validated by the person who provided it,regardless if it was a manually calculated or system calculated. Every effort is made throughout the project to protect data integrity,including scheduling regular meetings with CDHS Division of Accounting staff. • For all data inputs and any outputs where it is presented as a full year's calculation, the time range used is April,2006 to March,2007. • For data inputs where information is not sufficient to represent all counties independently,we utilize the county size classification that was defined by the Steering Team and aggregate the data to be representative of the counties included in each category. This county classification is provided in Appendix K. • For all outputs and calculations, 1,776 hours is used as the standard number of productive hours in one year for one Fit. This assumption is based upon the OMB circular A-76 as listed in attachment C, section B.2.d.(2)included in Appendix L. 3.1.2 ABC Cost Model Detailed Steps This section discusses the approach of the ABC Cost Model build up in detail in five steps.These steps include: Step 1:Aggregate Costs into Resource Pools The resource pools included in the ABC Model include all costs,both direct and indirect, for all high-level program groups within the scope of the CO Workload Study. The resource pools are structured in a standardized format across cost objects (all in-scope programs). All costs are _ aggregated into defined resource pools based upon the County Financial Management System (CFMS) defined cost categories.The resource pools are defined by the cost categories provided in Appendix D. Data Inputs County Financial Management System(CFMS) CFMS data,provided at the aggregate level by the CDHS Division of Accounting,is the source for the non-labor cost data used in our study, such as office space and travel costs. The detailed cost information from April,2006-March,2007 is aggregated by the four segment account code which contained the County Code (FIPS),the program code,the function code and the account code, defined as follows: • FIPS:A unique code identifying the county in which the costs are incurred CO Workload Study Project-6/23/2007 Page 27 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing _ Workload Study • Program Code: Identifies the program to which the costs should be charged,whether it is a direct program cost(i.e. C970 Child Support Medical Support Grant) or a pooled cost(i.e. 0560 Child and Adult Protection) _ • Function Code: Identifies the function to which the costs are charged (i.e. 1408 Self Sufficiency) • Account Code: Identifies the account to which the costs are charged (i.e. 62650 Building Ins) After excluding potentially duplicative information, account codes and program-function-account combinations are made to create an accurate picture of the complete pool of costs that is relevant to developing the per FTE cost.These exclusions are implemented under the direction of the CDHS Division of Accounting and are listed in Appendix NI. Once the population of CFMS cost data's accuracy is validated with the CDHS Division of Accounting, the data is summarized by county and by cost category and entered into the model. Cost categories are defined within the CFMS financial system as: • Capital Outlay Expenses • Contract Expenses • Operating Expenses • Personal Services Expenses — • County/Client Provider Payments • Cost of Office Space Expenses • Travel Expenses — The list of account codes by cost category, as provided by the CDHS Division of Accounting,is provided in Appendix D. — County Employee Data Store(CEDS) The County Employee Data Store (CEDS) is the source system for the labor cost data.The CEDS data, for all counties and all programs,is provided at a detail level by the CDHS Division of Accounting.The detailed cost information from April,2006-March 31, 2007 is provided as a four segment account code containing the FIPS, the program code, the function code and the account code, as defined above in the CFMS section. _ The CEDS data provides a detailed look into all personnel costs including (but not limited to) the FICS allocation,retirement pension,health insurance,life insurance and gross pay. The field used to aggregate costs in the model is called "TOTAL ALLOC AMOUNT"which is the total of these and all other personnel compensation. Certain exclusions of the CEDS data are made to remove those labor costs that are associated with — out of scope programs.These exclusions are implemented under the direction of the CDHS Division of Accounting and are listed in Appendix M. Once the accurate population of CEDS cost data is validated with the CDHS Division of Accounting,the data is summarized by county and by cost category and included in the resource pools of the ABC model.The cost category assigned to all CEDS data in the model is "Labor,"with — a code of LBB. CO Workload Study Project-6/23/2007 Page 28 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Assumptions In addition to the key assumptions referenced above,the following assumptions are made: • CFMS data requires exclusions of certain cost categories,account codes and program- function-account combinations,and are made to accurately reflect the complete pool of costs needed to develop the per FTE cost.These exclusions are made with the direction of the CDHS Division of Accounting. • Cost data is provided through both CFMS and CEDS,creating the potential instance of double counting,given that some information that is contained in CEDS is fed into CFMS. These costs are excluded out of the CFMS data by the CDHS Division of Accounting to eliminate the double counting issue. Calculation Each account, from both the CFMS and CEDS,is added into the resource pools for each county (see figure below).Exclusions are subtracted from each of the resource pools to isolate only those costs that are relevant to the ABC Model,as directed by the CDHS Division of Accounting. Aggregate Accounts into Resource Pools Accoirts Resource Pool Account 1 Account 2 Account 3 _1�� Special Compd.-4;1 [ t0rttal I A6P Equp T Vehc Equp Outlay Account 1 Account 2 Contract Contract Payment + Security Semi ce Expenses Account 3 Account -- t Operating Tuition T Vehde Lasses Expenses C Account s liarrtlProvider Cty/CIitt Payment Prvidr Prints Account 7 Account 8111 0 Personal Salaries + Unemployment Comp Services Account 7 Cost of Pent Office Space 'Account 29 Account 30 Miles + Public Carrier Travel Figure 3.2:Aggregate Accounts into Resource Pools CO Workload Study Project—6/23/2007 Page 29 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Results The following table displays the cost input into the model by resource pool.Totals may be nominally incorrect due to rounding. Cost Input into ABC Model Resource Pool Cost %of Total Capital Outlay $3,848,493 3% Labor 75,310,107 58% Cost of Office Space 10,016,700 8% — Operating Expenses 25,033,669 19% Travel Expenses 5,177,807 4% Client/Cty Provider Payments 170,409 0.13% Contract Expenses 10,323,665 7.99% _ Disallowed Cost Recovery -644,281 -0.50% Total $129,236,569 100.00% Table 3.1:Cost Input into ABC Model — Step 2: Calculate Workload Cost per Minute The county costs,reported in CFMS and CEDS, are presented in cost pools that are not mutually exclusive by program. For example, there are cost pools that span both in-scope and out of scope costs (both Child Welfare and Food Assistance).The scope of the Workload Study Project requires us to differentiate those costs that are included in the County Administration funding pools, and tie those costs to the workload of County Administration high-level program groups. We differentiate these costs by taking the entire spectrum (indirect,direct, in-scope and out of scope) and divide them by county.This allows visibility into each county's unique costs. From here we divide each county's costs by the number of direct FTEs. By applying all costs to only those FTEs who are directly performing the work associated with the county admin allocation,only the portion of the indirect costs that support the in scope services are included. Out-of-scope costs are excluded, as the cost per minute calculated is only applied to in-scope workload. Data Inputs The individual County Directors and delegates provide direct FTE information via an email poll. Counties are sent the RMS rosters (from the period 4/2/07-6/29/07) for both income maintenance and social services staff as a starting point and are directed to (1) add any additional staff that are not listed and (b) indicate the percent that each worker is direct and indirect. Direct staff are defined as staff having direct client contact or directly providing service to clients, such as eligibility technicians or supervisors who carry a case load. Indirect staff are defined as staff performing work not directly — attributable to client service,such as accounting or IT staff. Once the FTE data is received, the responses from each spreadsheet (at least one per county, — sometimes one per supervisor in each county) are aggregated into a single population of data. The per-county Direct FTE numbers are calculated using the direct/indirect percentages reported by the counties and the work schedule listed within the roster. For example, a 100°A direct employee with _ CO Workload Study Project-6/23/2007 Page 30 Copyright©2007 Deloitte Development LLC.All rights reserved. '— Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study an 8:00-4:30 M-F work schedule is calculated as 1 direct FTE,assuming a 40 hour work week. If responses are not received from a county it is assumed that all staff listed on the roster are 100% _ directly funded. The Direct FTE numbers are aggregated by county to be pulled into the model. Assumptions In addition to the key assumptions referenced above, the following assumptions are made: • The cost per FTE data provided through both the CFMS and CEDS system may include both Income Maintenance and Social Services staff.This creates the potential for over or under estimating the cost per FTE.The model is based on the assumption that the exclusions remove all Social Services costs from the data. • Approximately one third of counties responded to the request for verification of the total number of direct FTEs. For counties that did not respond we assumed that all FTEs listed on the RMS roster are 100%Direct. Calculation of Per FTE Costs We divided the entire spectrum of costs (indirect,direct,in-scope and out of scope) by county, providing the cost per county. From here we divide each county's costs by the number of direct FTEs.We take each Counties'cost per FTE cost and divide it by 1,776 hours (106,560 minutes) to get a per minute rate. The per-minute rate is multiplied by the total number of minutes for each process,and subsequently the total number of activities for each activity driver.Only in-scope activity drivers are used,to accurately reflect only the costs incurred from County Administration programs. This calculation is shown in diagram below. Steps to Calculate Cost per FTE. Per FTE Calculation Cost of Serrice — -• Baca Cty Costs ---: - Baca Cty FTEs - Baca CostffTE Toth$193,562.96 2.77 = Total$89,878.32 Delta Cty Costs --- - Della Cty FTEs -- .- Delta CostffTE Total$723,220.96 - 18 as = Total$38,185.05 Adam Cty Cols -- Adam Cry FTEs . Adam CosVFTE • Total$8,311,181.46 - 140 l7 Total$56,156.63 Please note:As many as 17 decimal points were caniedforwardfor the cost calculations within the model. Figure 3.3:Steps to Calculate Cost per FTE CO Workload Study Project-6/23/2007 Page 31 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Steps to Calculate Cost per Minute CalculationPer Minute Cost of Service _ Bacacost6TE Baca Costftdin Total$69,678.32 T 1776 hrs X 68 min = Total$0.655765 Delta CostirTE Delta coatMin Total$38,185.05 q 1776 hrs X 60 min p ,. Total$0.358343 _ Adams CostiFTE Adams castMin Total$56,156.63 q 1776 hrs X 60 min = Total$0.526995 Please note:As many as 17 decimal points was caredforwardfa the cost calculations withinthe model _ Figure 3.4:Steps to Calculate Cost per Minute Results A table outlining the cost per minute of each county is provided in Appendix N. Step 3: Calculate Workload Cost for Activities The survey data provides an average time (in minutes) it takes to complete one instance of an Activity for each county Size (small, medium and large) and High-level program group within the — scope of the study.The multiplication of the per minute cost of County Administration, calculated in step 2,and the Activity time per instance provides a per instance cost of each activity. Data Inputs This information is collected through the Detailed Survey and validated through Field Observations. Assumptions In addition to the key assumptions referenced above for all data inputs, the following assumptions are made: • The average time per instance of each County Administration Activity is reflective of the average proficiency level in the counties within each county size. • The per minute cost of County Administration is consistent across the defined list of activities, including proficiency level required or amount of overhead needed. Calculation of Average Time per Instance The following sections provide a detailed description of the calculation to determine the average time — (in minutes) it takes to complete one instance of an Activity and a table providing the results of the calculation. CO Workload Study Project-6/23/2007 Page 32 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Detailed Survey Calculation This section outlines the calculations to determine the average activity time required to complete each activity for every high-level program group and every county size from the information provided in the Detailed Survey. County Size Averaging To obtain a meaningful sample size from the 4 week timeframe of administering the Detailed Survey, all Detailed Survey information is aggregated by county size,per the Steering Team approved county size categorization. The survey information is aggregated and totaled, making the assumption that all participants,regardless of county, are created equal.When the survey participants are selected, the total number of survey participants in each county is reflective as a percentage of the counties total size within each county size category.In large counties each county had approximately 25% of the direct FTEs participate, and in medium and small counties each county had close to 100%of the direct FTEs participate.This means that within each county size classification,the counties with larger offices will inherently have greater representation than the counties with smaller offices providing a weighted average within each county size classification. Allocation to High-level Program Groups The average time for each activity occurrence is divided by the number of high-level program groups associated with the occurrence. For example,if an Al is for both Food Assistance and Medical then the time for that occurrence is divided between the Food Assistance and Medical giving the approximate time for each high-level program group for Als. Non-program Specific Allocation Based on the suggestion provided by Steering Team,when a participant selects "non-program related"option for an activity occurrence,we divide the average time for the activity occurrence by all high-level program groups that the participant selects. For example,if a person performs activities related to Food Assistance and Medical Programs,then all time allocated to Client Information will be divided between the Food Assistance and Medical Programs. Average Amount of Time Spent for Defined Processes Activities that are included in a defined process or sequence of activities,with an output will utilize an average time (by county size) of the occurrences reported for each activity and high-level program group as the average amount of time. For example,Application Initiation (Al) is the first step of completing an Intake.The time for all instances of AIs for large counties that are included in the Detailed Survey results will be summed together and divided by the number of instances of AI for large counties to determine the average time for Al in a large county.The activities included in this classification are approved by Steering Team to he aggregated into distinct processes,and are listed below with the alphabetic reference to the Activity List Dictionary provided in Appendix E. • a) Application Initiation (AI) • b) APS- screening(APS specific activity) • c) Interactive Interview (II) • d) Eligibility Determination and Benefit Calculation (EDBC) Wrap-up and Authorization • e) Investigation,Claims Research,Establishment,and Recovery (Benefit Recovery) • f) Eligibility Recertification (RRR) • g) Medical and Food Stamps Periodic/Income Reporting(e.g. Monthly, Quarterly,etc.) • j) APS - Information and Referral (APS specific activity) • k) APS-Referral Not Requiring Face-to-Face Intervention • gg) Benefit Issuance/EBT Activities CO Workload Study Project—6/23/2007 Page 33 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study • hh) inter-County Transfers This calculation is shown in diagram below. Calculation of Average Time per Instance of Defined Process Activities rood Awislanm ( ,..... Surveysi .._....._ • Survey 02 ..._.. Surrey 03 ........ 20 min :T 7.3 min +... 10 min Lame County lisp i {Serowe, ll '• 14 min a cne{SurvAi ,Somme? lsureerl .. ` Survey t � .� Survey ...._.6� . ..... S ee.�`�l 166 min + 20 min - - 13.3m1nnCougar (al Application ... •...,—► Initiation ... 2Z min Court Survey#t Survey#2 Survey AO J Survey AS Survey Ali Survey WI a min .i- 36 Mn 4. 17.5 min �. ••• •• Smell Casey ave ' 21 min Court t Survey A7 ,Survey AQ r Survey ACt Figure 3.5:Calculation of Average Time per Instance of Defined Process Activities CO Workload Study Project—6/23/2007 Page 34 Copyright©2007 Deloitte Development LLC. All rights reserved. N An (V C • Z Z Z Z Z N Ca Z Z — y 10 `.; : N i— N C C as T. � • z N CD N CO Z Z Z z co• 3 M O d N 4 O — Z M Ai r C+) - A- N A- o w - 'U _ cn a0i N C 'i' CO Q CCn C N CO O Q Q Q N R C a) z CO N CO O a Z Z Z — A U ^p ' N N N N A- aU a a c:i as 0= o O Q Q CO a co Q Q Tr co N .• z O 6 O) M Lo Z Z CO CD — R O e' N M A- M N A- O a u .. U E ca ;?!c; 0.1 r-- Q Q Q Q Q Tr 01 Q Q COE u ''' ce Z Z Z Z Z O Z Z O. — N d 0 ,., 'ii{a' Q Q Q Q Q cn ;ii:liti co c7 ..� n -2,,,:!,{. I Z e- Lei Co CC) Z Z Z Z • a7 !1' N N A- N A- O m E ' ; :;,;,: a. i ''`i;t,s'. CO Q co �' co Q Q Q O CrC 2 ; r- \ CO Ns- Is- N r \ \ \ O 2 `P�':: O Z 00 , N 4 to Z Z Z N c. Am? N N T's N A- T.) 'iq' ,' 0 Q N N LO 00 0) Q •Q M N- alfl` C) \ co N CO O CO \ \ CO tO '144., N z M N N M 4 Z Z N: CD ;3 N N "4O 3.:_1• C "` c; ` Z Z Z Z Z O N• Z Z 61 :. N: N: CO CO 'rn ii lII Cr) - r^ a O Q N N CO CD Q Q •Q Q Nr E O , }�'��f r \ Lc) o) 00 .- \ \ \ \ cc, u �, ii*I. Z C) Co O Z Z Z Z °c. -o C �! r M 1—i o { V a) u A4 l,;! Cr: 3 .�� ii';d ' CD Q ,- Lo N M co '*'• Q Q C) N -- C •• O) \ M A- CO CO CQ \ \ \ N Q I; • CD Z O 00 4 N Z Z Z ti c O� r�� r N A- I- N N C 1>�1rfi� u C •� 4J O Q M CO ti r Q Q 0) II) Q -- ^ j�,3; O \ d ao CO O) CO \ \ O) N .- U .O i i,y.s�!s, M Z O) O ti O) C) Z Z CO N� Q J C! S:N1�'' r r r J a,. iil N r r .S. ca bZ U lfc v: O C v A y!if,I Q N N_ Ii I -0 ccci? t g O > :J7 co ,C^ a a - d to W ITC w o c Q a - oo v, m - o ca v c w v m is $ .� O c co E- c Q m •cw , - Ea) 0 vam as -6 a) m ? tl -�o, o _ o N C'- a c. -- ? cO a o a o fr T o.≥ Z 0 t c c>« R -- d 8 U. o a) eO . ca c o _AN- to Q C aa)) O O 7 o o N N O C 0 CI Em d to c E- Cn O C .,, O > U L W CO IY CO V J O - Q) U N O v -O N vv, Z'c S o) co c o 1Y (O U coO y �' cd v Q ac _ W c D. c 0)) o W aci o ¢ a Q n :� y a -" m M( i) -am 3 QLX ) rnd2 �a .LL C))< .C (jQ Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Average Amount of Time Spent per Caseload Size Activities that do not have a quantifiable output at completion of an activity or series of activities, such as Client Communication or Change in Circumstances Reported by the Client,we utilize an _ average amount of time spent per caseload size. The per-case workload method is based upon the assumption that every participant who administers a program will spend an amount of time on these activities which correlates to their caseload size.Each participant may not conduct every activity even'day, so we utilize an average of all survey participants to represent the average per day amount of time spent related to the county caseload size. — The time spent on each activity for one day, collected through the Detailed Survey, is identified as the average amount of time spent for each activity for each high-level program group. For example,this average is calculated by summing the time (reported in the Detailed Survey) for all instances of Change in Circumstances for Food Assistance in large counties and dividing it by the total number of survey participants that select Food Assistance.The average amount of time spent is applied to the average caseload size (in case programs) per each Direct FTE.The activities that are included in this classification are approved by Steering Team to be aggregated to reflect the amount of time on average for each caseload,and are listed below with the alphabetic reference to the Activity List Dictionary provided in Appendix E. — • h) Change in Circumstances Reported by the Client • i) Client Communications and Information — • 1) APS-Service Provision • m) APS- Guardianship/ Conservator ship/ Payee (APS specific activity) • n) APS - Investigation and assessment (APS specific activity) _ • o) Appeals and Hearings • p) Make a Referral • r) Alerts Management • s) Case Review — • v) Administrative Support Activities • w) Seeking/Receiving Assistance(Seeking/Receiving Assistance includes both solicited and un-solicited assistance) This calculation is shown in diagram below. CO Workload Study Project—6/23/2007 Page 36 Copyright©2007 Deloitte Development LLC. All rights reserved. — Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Calculation of Average Amount of Time Spent per[TE SIOL1 Food Assstenw rr ....._.Survey#I _ • Survey 112 Survey S] .._... 3 mrr T17 min 4• 25 rr,n ... Large County Ayg '. hotel Out Survey Participants er a Large County seiectng Food Assistance f • .. ................... Survey 7390 Survey#41 Survey#42 (h)Change ir 4u mo- 4 _.c min -4- 12 min : Madam County*so CircurlOhlaaas r . Reported by the 11 min Client Total#of Survey Participants n a Medium County ( • • selectny Food Assistance j unsay 045 Survey 3RS Survey Ail 30 min 21.8 sin 4. 12Smin .... ... Sinai County dog M 10 min 'hotel S of Survey Participants it a Small County selecting Food Assistance Figure 3.6:Calculation of Average Amount of Time Spent per Caseload Size Calculation of Average Amount of Time Spent per Caseload Size Food Assistance Large County Avg ' Large County Avg :_Large County Avg 10 min 10 min 10 min Adams County Denver Count y El Paso County Average Caseload Average Caseload Average Caseload per FTE per FTE per FTE Medium County Avg Medium Courly Avg Medum County Avg (hl Change in • tt min 11 min 11 Min Circumstances • Reported by the Client Alamosa County Eagle County Logan County •" Average Caseload Average Caseload Average Caseload per FTE Per FTE per FTE J Small County Avg Small County Avg Small County Avg _. 10 min 10 min 10 min Baca Canty Cedilla County Grand County Aver7ge Caseload Average Caseload Average Caseload per FTE per FTE per FTE Figure 3.7:Calculation of Average Amount of Time Spent per Caseload Size CO Workload Study Project—6/23/2007 Page 37 Copyright©2007 Deloitte Development LLC.Ali rights reserved. N a) >. a7 c < Q Ofl O LO Q < Q O c h on (N Nr N Z Z Z o v N 0 , E - .,- co,- as cl c c y Z Z Z C") co N N COO OAC O r O O r O ri O 0 0 ad .C.0- s E (n C •4 Q Q V M O LA CO CJ) co s co v Z Z Z co o N co r c) �o co ao o r v u) h: o t U -c — O S 'in CD C'• Z Z ..:c O M CO Oa7 N � -a „_ 'Yj f N. r O 4 N. CD CO 2 0 C. IL - o U j '. ego Z Z m uc°i co Z ...... Z rn i N a ccoo rn v CV r _ Q r S o V :`'i'i' ti 4 Q Q Q N O V I` CO 0) U :i;';:.,., CA r Z Z Z 4 N M O C.- c Co ilk t" O O •- - r O :1 `� co • ' Q Q N- C1 C0 0 4 Co N. CD 0 r V O) M Z Z Z O N o N C'74 . i l.:jj:. C.) -(:r "O 1r: O CO Q .< N CO CO CO N- I C ill':":,' c0 et Z Z Z r N C') CO N c0 v .. a. uYt.; co N O r CO N- Ch co — .i.,',,,,,, O iihll < Q CA Cr) O 0 C� u co r CD C`7 CND r ,� Z Z Q; rn Z Z Z r v _.. C,3 Co CA v t. CC 4 1jiiG7. vti,a co N Z Z Z Co co 0) N. COCO cc) _ a. - O O O O N ch r -p v; .`' titt d a) N D ro �,,` Ch M CID Q 'O c0 N i;: S7 CD CrJ Z• Z c t 0 N co r r Co v N C' ;�! it 7lii t cD ao rn o vrr-e.4 O co Z Z Z f. C) N 4 ..- ems') ee U O N O N CID o 0; V J I�� eJ CV r J O u > O .. u N E c0. cc y U Ln coN O _. -G c to c 8 . '' _ in c d c c c E a) ci cu Q y 7 i 0 O v hi _ a ': y O G. in O y Ca N 715 u ≥ 0 O .c d s to to d io E ≥ c E >`p 4..: -6 g a U ., E $ �-c u,Q 10 .td► v, 3 ≥ v � o ad a) t7 cc 05 y -15 • O 3 0 % am-o U g cn . ≤o 0 , d To ca 2 cc •c . �_ .o a .� o 3 O t z o a)Mr a aQ ai a a N •- a -Ne,c w cao -o:� m:Y « M; O .a' axis U0 U.,- Q oa Qyr, Q Q U Qz 4D c) J 8. a cc F-� to ! tct •= c — EL) u) sm a o i H >Q e.g.3 N O a "r UU Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Average Amount of Time Spent per FTE Workload For the activities that do not have a quantifiable output,but the amount of time spent each day should he similar for every F 1 E, such as Reports Management or Meetings",we utilize an average amount of time spent per Direct FTE. For example,if a staff member attends a meeting, this time does not result in an application or an Electronic Benefit Transfer(EBT) issuance. However,this time (which should be similar for all staff) still needs to be accounted for. The per FTE workload method is based upon the assumption that every participant who administers a program will spend an amount of time on these activities. Each participant may not conduct even' activity every day so we must use the total number of survey participants, rather than the number who selected the activities in this category,in order to get an average amount of time spent in a day. The time spent on each activity for one day,collected through the Detailed Survey,is identified as the average amount of time spent for each activity for each high-level program group. For example, this average is calculated by summing the total amount of time reported for"Reports Management for Food Assistance in a large county and dividing it by the total number of survey participants that selected Food Assistance in large counties.The activities that are included in this classification are approved by Steering Team and are aggregated to reflect the amount of time on average for each FTE, and are listed below with the alphabetic reference to the Activity List Dictionary provided in Appendix E. • u) Reports Management • x) Management Activities • bb)Training • cc) Meetings (e.g. Unit Meetings, Office Meetings,and Conference Calls etc.) _ • dd) Materials Development and Outreach (e.g. Developing County Training Material, Policy Documentation, Community Outreach Sessions etc.) • ee) Non-Activity Specific Reading(e.g. Reviewing Regulations,Policy Manuals,Rules Lookup) • ff) Travel (lob-Related) This calculation is shown in diagram below. CO Workload Study Project-6/23/2007 - Page 39 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study _ Calculation of'Average Amount of Time Spent per FTE Workload Food Assistance �^ Survey MI Survey#2 Survey03 2 min + 3 min + 5 min ••• Large County Aag 2 min Totai#of Survey Participants in 4 Large County t selecting Food Assistance Survsy#M....; Sunray NM ......: Survey 442 1.6 min +}'•. 2.4 min .+ 7 min ....L. n 0 iiTi countystlp• lu)Rennin mana0ombti 3 mn Tetsl#of Sunray PMugpatsins MedluinCounty j solaetiug Food Montane { — Survey Ad Surrey Atli • • Survey MI.....[ 3.75 min +'. 9.5 min + 5 mn §IMI County Atp hi' 1.7min Total#of Surat prllelpsnts h s Sinn County 1 axle nne Food Ass stance 1 i Figure 3.8:Calculation of Average Amount of Time Spent per FTE Workload CO Workload Study Project—6/23/2007 Page 40 Copyright©2007 Deloitte Development LLC. All rights reserved. CO O1 co C D ; N N M (D CON COCO 'u ay .2 c to > q4 : o r r Ni o o w m ti 4 c o s to c ''8 y m CO rn co H CD N p raO ! 0 o r r 0 0 O - _ �3 w O o a. c a i O O r` w ar N LO o m ' n m CD O N.- N YU E ! O Ni N4 O M — — m = '.'a!nt� O 2 a �4 ' !!' M O co N LC) N OM1 A�p r N M N6 N r O C O m U t .- .i_" CN-D CO CO r O N O CO -c O O O r m O O a C m `-\ti ! O N.- r O V V co Ea L' ' O O O r O O O V N rT a E aaHri m u a 0000 II afSal^ p 2 'i n V). n v Cr)O m ta Ln N.: r r r 0 0 0 -o cd iii F ,i�: .941 cd 444iN O N N a O ill K W h O N O in — s' Ud fti N •- O N O r O ;l 113414 ''d ' 1 O CO N CO N- CV CO - ro li O N O N O O ni co u k s. j a ::ip4:•:i;i O O> co Co N O — C �i : r a) m m a O O ! O O r O O O O N a y d L II rr CO N +; G' J 4 N! n N a co co N r00 t to •E (:I O U) V V O r O ' O1 v 3 Q — C 'rats o co a Co 0 o a W+ 0 !„H a, r J CD COCJ V O O L C U vs E . :?i b C` O m v ... _ v N E c � N m C N O al �m mtj m .0 2 70 a m o a- _ 1.5 cp 3 to CCo $ Q) v F > E ≥ jv o--ao' o E O o 2 d ? a` � p x :,, 0 U m d o m a m O m E >.o a _ m cc m m 0 m 0 o CO m .Z a N- .,- E rn rn%= mmmmy � c ,moo.. mO « Lit,• v a c A d al ra N c0 ° rraa c m > M ` m a `.Em 95moo m °i'o F Oo C F x .o 800 v0r OO m and r 0 o Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study — Data Validation: Field Observations The Field Observations provided validation of the responses received from the Detailed Survey.The following table lists examples of activity occurrences and the actual time observed in the Field Observations,a full list of all activities observed in field observations is provided in Appendix O. Activity Occurrences Observed in Field Observations _ Time(in Activity County High-level Program Groups minutes) a)Application Initiation(Al) Huerfano • Medical 32 — a)Application Initiation(Al) Garfield • Medical 15 c)Interactive Interview(II) Eagle • Medical 15 _ c) Interactive Interview(II) Garfield • Medical 47 d) Eligibility Determination and Sedgwick • Not provided 10 _ Benefit Calculation (EDBC) Wrap-up and Authorization f)Eligibility Recertification(RRR) Saguache • Medical 22 gg)Benefit Issuance/EBT Denver • Food Assistance 8 Activities Table 3.5:Activity Occurrences Observed in Field Observations Analysis a) Application Initiation (AI):The Field Observations show 32 minutes and 15 minutes for a Medical _ Al in a medium size county, showing a reasonable range where an average time of all occurrences in all medium counties obtained through the Detailed Survey provided a average time for Application Initiation of a Medical case to be 20 minutes in a medium county. c) Interactive Interview (II):The Field Observations show 15 minutes and 47 minutes for a Medical 11 in a medium size County, showing a reasonable range where an average time of all occurrences in the Detailed Survey provided a average time for Interactive Interview of a Medical case to be 29 minutes in a medium county. d) Eligibility Determination and Benefit Calculation (EDBC) Wrap-up and Authorization: The Field _ Observations show 10 minutes for EDBC in a small county, showing a reasonable variance where an average time of all occurrences in the Detailed Survey provided a average time for EDBC of 20 minutes for Food Assistance, 13 minutes for Medical and 13 minutes for Adult Financial in a small county. f) Eligibility Recertification (RRR):The Field Observations show 22 minutes for RRR in a medium county, showing a reasonable variance where an average time of all occurrences in the Detailed — Survey provided an average time for RRR of 24 minutes for a Medical case in a medium county. gg) Benefit Issuance/EBT Activities:The Field Observations show 8 minutes for EBT Issuance in a — large county, showing a reasonable variance where an average time of all occurrences in the Detailed Survey provided an average time forEBT Issuances of 9 minutes for Food Assistance in a large county. CO Workload Study Project-6/23/2007 Page 42 Copyright©2007 Deloitte Development LLC. All rights reserved. — Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Calculation of Per Instance Cost The survey data provides an average time for each activity and each high-level program group within the scope of the Workload Study.This average time is multiplied by the per minute cost of County Administration,calculated in the preceding step, to give a per instance cost (unit cost) of each Activity.This calculation is shown in diagram below. (al Application '.. Initiation lime per Per Instance X Minute = Per Instance Cost Cost Food Assistance Large Cty Avg Adams Cty Cost Adams Cty Cost 14 min X $0528995 per min = $7.38 per instance (unit cost) Figure 3.9:Calculation of Per Instance Cost Results A table outlining the cost per instance of each activity for each county for each high-level program group is provided in Appendix P. Step 4: Link Activities to Activity Drivers The defined list of activities are linked to the end-to-end business process in three different ways; (1) one or more activities create a process with a tangible output (i.e. completed intake) referred to in Section 2.1 as Defined Processes, (2) amount of time allocated to a group of activities dependent upon number of case programs in an assigned caseload,referred to in Section 2.1 as "Per Caseload Workload, and (3) amount of time allocated to a group of activities per FTE, referred to in Section 2.1 as Per FTE Workload". For each of the three pieces respectively,the cost per instance of an activity is aggregated to provide a cost per process occurrence, cost per case programs in an assigned caseload,and a cost per FTE. The list of all of the defined processes,the caseload dependent activity group, and FTE dependent activity group is outlined in table 2.7. Graphic representations of what activities are included in the defined processes, caseload dependent activity group,and FTE dependent activity group are provided in Appendix F. Data Inputs —• The survey data provides an average time(in minutes) to complete one instance of an Activity for every county Size and high-level program group within the scope of the study. For those activities that do not have finite beginning and end,time allocation is utilized. For those activities that are allocated per case programs assigned to a caseload and allocated per FTE,the Detailed Survey provides the average time spent on the activity for each one day. CO Workload Study Project—6/23/2007 Page 43 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing _ Workload Study The Activity drivers provide the number of occurrences of each defined process that occur in one year, for the data range of April 1,2006 to March 31, 2007. More information about the Activity Drivers is presented in Section 2.2. — Assumptions In addition to the key assumptions referenced above to be applicable to all data inputs,the following _ assumptions are made: • The defined list of activities, agreed upon by the Steering Team,represents the universe of activities and subsequent processes conducted by direct FTEs. — • Using 222 days as our standard number of work days in one year is based upon the standard 1,776 hours per FTE and dividing it by 8 hours per day. Calculations Below is a list of all of the defined processes, the caseload dependent activity group, and FTE dependent activity group, what activities are included in each process / group and the activity driver used. Activities and Activity Drivers for each Defined Process or Activity Group Process Activities Included Activity Driver Intake Process, Failed (a)Application Initiation #of Failed Application after Application Initiation Interviews (Cancel,Withdraw, _ Deny) Intake Process, Failed (a)Application Initiation #of Failed Interactive after Interactive Interview (c) Interactive Interview Interviews (Cancel,Withdraw, Deny) Intake Process (a)Application Initiation #of Intakes-(#of Failed Als+ (c) Interactive Interview #of Failed Ils)_#of (d) Eligibility Determination and Benefit completed Intakes _ Calculation (EDBC)(including wrap-up and authorization) EBT Card Issuances (gg) EBT Activities(i.e. Embossing EBT #of EBT Card Issuances Card) — Periodic Reporting (g) Medical and Food Stamps Periodic #of Periodic Reportings Reporting Required/Conducted (d) Eligibility Determination and Benefit — Calculation(EDBC)(including wrap-up and authorization) Recertification, (f) Eligibility Recertification (RRR) #of RRRs Discontinued Reverification, (d) Eligibility Determination and Benefit Redetermination(RRR) Calculation(EDBC)(including wrap-up Discontinued and authorization) Recertification, (f) Eligibility Recertification (RRR) #of RRRs Completed ._ Reverification, (d)Eligibility Determination and Benefit Redetermination(RRR) Calculation(EDBC)(including wrap-up Completed and authorization) Investigation,Claims (e) Investigation, Claims Research, #of Claims Opened _ Research, Establishment, Establishment, and Recovery and Recovery Inter-County Transfers (hh) Inter-County Transfers (hh) Inter-County Transfers — CO Workload Study Project-6/23/2007 Page 44 _ Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing — Workload Study Process Activities Included Activity Driver Caseload size dependent (h)Change in Circumstances Reported by #of Case Programs/#of Time Allocation the Client direct FTEs= Caseload (i)Client Communications and Information (o)Appeals and Hearings (p) Make a Referral (r)Alerts Management (s)Case Review (v)Administrative Support Activities _ (w)Seeking/Receiving Assistance Per FTE dependent Time (u)Reports Management #of FTEs allocation (x) Management Activities (z)Breaks (bb)Training (cc) Meetings (dd) Materials Development (ee) Non-Activity Specific Reading (ff)Travel Intake of Adult Protective (b)APS-screening #of l&Rs Services(APS)Cases,# (j)APS—Information and Referral of I&Rs Intake of Adult Protective (b)APS-screening #of APS Referrals Services(APS)Cases,# (a)Application Initiation of APS Referrals Intake of Adult Protective (b)APS-screening #of APS Referrals, Not Services(APS)Cases,# (k)APS—Referral Not Requiring Face-to- Requiring Face-to-Face of APS Referrals, Not Face Intervention Intervention Requiring Face-to-Face Intervention APS Case Maintenance (i)APS—Service Provision #of APS Cases (Time allocated to (n)APS—Investigation and Assessment discrete, non-specific (m)APS—Guardianship/Conservator ship/ Activity Drivers) Payee Table 3.6:Activities and Activity Drivers for each Defined Process or Activity Group Detailed information about the source of the Activity Drivers is provided in Appendix Q. Number of Direct FTEs Required for County Administration The total amount of time is calculated by summing all time in one year for the defined processes,per case workload,and per FTE workload to equal total time required for County Administration.The total time is then divided by 1,776 to determine the number of direct FTEs required to complete the total County Administration workload in each County. Each of the below methods is calculated for each county individually using the county size average amount of time for each activity. Defined Process The average time for each activity is summed by defined process (i.e. the average time for an AI plus the average time for an 11 equals the average time for the defined process of"Intake"). The average time per process is then multiplied by the activity driver (the total number of times a process is conducted in one year) for each County to determine to total amount of time required for each defined process under County Administration. CO Workload Study Project—6/23/2007 Page 45 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Per Case Workload The average time for each activity for each case program for each day is multiplied by the total number of case programs for each county to determine the total time per day required under County _ Administration.The total time per day is multiplied by 222 days to equal the total amount of time required per year. Per FTE Workload The average time for each activity for each FTE for each day is multiplied by the reported total number of direct income maintenance FTEs for each county to equal the total time per day required under County Administration.The total time per day is multiplied by 222 days to equal the total amount of time required per year. Results The following table shows the total number of direct FTEs by County for each high-level program — group, including all time dedicated to Defined Processes, Per Case Workload,and Per FTE Workload.Totals may be nominally incorrect due to rounding. Number of Direct ITEs required in each County County FA MED AF I APS Total Adams 50.5 51.9 8.9 4.3 115.7 Alamosa 5.6 5.8 1.1 2.1 14.6 Arapahoe 33.7 32.5 5.0 8.1 79.4 Archuleta 1.7 1.6 0.3 0.4 4.0 Baca 0.8 0.8 0.1 0.8 2.6 Bent 2.0 1.6 0.3 0.3 4.2 Boulder 17.9 17.6 3.2 4.3 43.0 Broomfield 2.7 3.1 0.5 1.1 7.3 --- Chaffee 2.8 3.5 0.7 0.4 7.4 J Cheyenne 0.8 0.7 0.1 0.0 1.7 Clear Creek 1.1 0.9 0.2 0.1 2.2 Conejos 2.5 3.1 0.6 0.4 6.6 Costilla 2.3 1.7 0.4 0.3 4.7 — Crowley 1.4 1.2 0.2 0.0 2.9 Custer 0.4 0.4 0.1 0.1 0.9 Delta 4.8 5.9 1.0 2.5 14.2 J Denver 106.3 86.8 18.7 22.9 234.6 Dolores 0.4 0.3 0.0 0.0 0.7 — Douglas 2.7 3.3 0.5 0.7 7.2 Eagle 2.3 3.7 0.5 0.5 7.0 _ El Paso 47.7 41.2 7.0 7.7 103.6 Elbert 1.3 1.1 0.2 0.1 2.7 CO Workload Study Project—6/23/2007 Page 46 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing _ Workload Study County FA MED 1 AF APS Total Fremont 7.0 8.7 1.5 1.8 19.0 Garfield 4.2 6.5 1.0 1.2 12.9 Gilpin 0.6 0.5 0.1 0.0 1.2 -- Grand 0.6 0.6 0.1 0.0 1.3 Gunnison 1.2 1.1 0.1 0.1 2.6 Hinsdale 0.4 0.4 0.1 0.0 0.8 — Huerfano 2.0 2.2 0.4 0.2 4.7 Jackson 0.3 0.2 0.0 0.0 0.5 — Jefferson 36.7 37.1 6.4 9.4 89.6 Kiowa 0.4 0.4 0.1 0.0 1.0 Kit Carson 1.6 1.6 0.3 0.1 3.6 La Plata 5.1 5.9 1.0 2.4 14.4 Lake 1.6 1.5 0.3 0.1 3.5 — Larimer 29.7 28.0 5.2 10.7 73.6 Las Animas 3.9 4.9 0.9 1.4 11.1 Lincoln 1.2 1.0 0.2 0.2 2.7 — Logan 3.9 4.5 0.8 1.5 10.7 Mesa 24.1 22.3 4.0 5.2 55.7 — Mineral 0.4 0.4 0.1 0.0 0.8 Moffat 2.1 2.6 0.4 0.0 5.1 Montezuma 4.3 5.1 0.8 1.9 12.1 Montrose 4.3 5.6 0.8 1.7 12.4 Morgan 5.4 7.2 1.3 3.4 17.3 Otero 5.5 6.3 1.2 4.1 17.0 Ouray 0.5 0.4 0.1 0.2 1.2 -- Park 1.2 0.9 0.1 0.2 2.5 Phillips 0.8 0.8 0.1 0.2 2.0 Pitkin 0.3 0.3 0.0 0.0 0.6 Prowers 4.3 5.4 0.9 0.9 11.5 Pueblo 40.5 32.8 6.8 3.5 83.6 — Rio Blanco 1.0 1.0 0.2 0.0 2.2 Rio Grande 4.6 4.9 0.9 0.0 10.4 Routt 1.2 1.2 0.2 0.0 2.5 - Saguache 2.3 2.5 0.5 0.3 5.5 San Juan 0.2 0.1 0.0 0.1 0.4 CO Workload Study Project—6/23/2007 Page 47 — Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing _ Workload Study County FA MED AF APS Total San Miguel 0.5 0.5 0.1 0.0 1.1 Sedgwick 0.7 0.6 0.1 0.4 1.7 Summit 0.8 1.0 0.1 0.0 2.0 Teller 2.3 2.6 0.4 0.5 5.8 - Washington 0.6 0.5 0.1 0.5 1.7 Weld 25.9 25.6 4.4 3.7 59.5 - Yuma 1.5 1.5 0.2 0.2 3.5 Total 527.4 506.0 91.8 113.2 1238.4 Table 3.7:Number of Direct FTEs required in each County - Additional Results - The estimated number of supervisory, clerical, and IT staff is provided in Appendix R. The total time spent on auxiliary activities per county is provided in Appendix S. Calculation of Total Cost per Processor Activity Defined Processes - The per instance (unit cost) of each activity, calculated in step 3,is multiplied by the activity drivers to determine the total cost of the defined processes.This calculation is shown in diagram below. Calculation of Total Cost per Defined Process Process Activity Drivers Total Cost Intake Alof Intakes _ Intake Process X Process Food Assistance Adams Cty Cost Adams Cty Adams Cty $7.38 per instance X 43866 (unit coo . cost) - $324,378.32 Figure 3.10:Calculation of Total Cost per Defined Process - Per Case Workload The Detailed Survey provides the amount of time allocated to a group of activities per the amount of - case programs in an assigned caseload. Step 3 provides a per minute cost of each of the activities that are classified as caseload dependent. Data from the Detailed Survey,validated through the Field Observations,is used to calculate the caseload dependent activities to equal one instance of each activity for even'one case program assigned in a caseload for even,one day.The cost per case program of the group of activities is extrapolated for 222 business days in one year's time to equal to CO Workload Study Project-6/23/2007 Page 48 _ Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study the total workload for the total number of case programs for caseload dependent activities.This calculation is shown in diagram below. Calculation of Total Cost per Case Workload (h)Change in Circumstances Reported bythe Client l lime per Average pot Case Sot Cost per Caseload Size per X Pro rams X Business X Min _ Total Cost FTE per day g Days Food Assistance Large County Avg 10 min Adams Cty Adams Cost/Min Adams Cty 8.949 X 222 X $0.526995 _ 1173,16728 Adams Cty _... 60.45 _.. . Figure 3.11:Calculation of Total Cost per Case Workload Per FTE Workload The survey data provides the amount of time allocated for every one FTE. to a group of activities. These activities can be considered administrative in nature and exist for every one direct FTE. Step 3 provides a per minute cost of each of the activities that are classified as per FTE dependent.We — calculated the per FTE activities to equal one instance of each activity for every one FTE for every one day. Utilizing the county provided FTE data, the per FTE number is calculated and subsequently the additional time required for non-case related non-definitive processes such as policy information review.This calculation is shown in diagram below. Calculation of Total Cost per TIE Workload (u)Reports Management ot T me per FTE per day )( Sol FTEs X Business X Cost Per Min = Total Cost Days Food Assistance - Large County Avg Adams Cty Adams Cost/Min Adams Cty 2 min X 148 , X 250 X $052egg5 = $34,62990 Figure 3.12:Calculation of Total Cost per FTE Workload CO Workload Study Project—6/23/2007 Page 49 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Results A table outlining the total cost of each Activity for each county and high-level program group is provided in Appendix T. _ Step 5: Calculate Cost Objects The total cost of county administration is provided by high-level program group for each of the 64 _ counties.The costs are displayed both in total cost for one year and in a per unit cost. This calculation is shown in diagram below. Cost()bjects Cost Objects ABC Model Output — Adams County Activities• * — Medicaid Programs iFood Assistance Counties i1 - Adult Financial 4 Adult Protective Services' — Denver County — Medicaid [ • Costs are displayed by — Park County — Activity,by Program,by Medicaid r`-j County • Costs are provided in Total for One Year.and Delta County r— -- per unit Medicaid Rh • Costs are split out by '=------__--_=_— Resource pools — Gilpin County — f� Medicaid Figure 3.13:Cost Objects Assumptions In addition to the key assumptions referenced above to be applicable to all data inputs, the following assumptions are made: — • The defined activities,defined processes and activity drivers represent the total workload of the direct staff of County Administration. — Calculation of Total Cost All defined processes,plus per case workload and per FTE workload are aggregated within each _ high-level program group to equal the total cost of County Administration. CO Workload Study Project-6/23/2007 Page 50 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Results The results of the ABC Model Cost build-up include both the aggregated cost for County Administration by county, as well as extrapolations out of those numbers and additional cost detail requested as per the REP. The results are outlined in the next section. 3.2 Results of ABC Model 3.2.1 Cost for each In-scope Program and County This section outlines the calculations and report of the cost for each in-scope high-level program group, for each county.This cost does not include the concurrent eligibility programs of Colorado Works (TANF) or Old Age Pension—Financial. Assumptions Please refer to Section 3.1.2,and the five steps of the ABC Model Cost Build-up. Calculation of Total Cost Please refer to Section 3.1.2,and the five steps of the ABC Model Cost Build-up. Results The following table shows cost for each in-scope high-level program group,for each county.The cost for each in-scope high-level program group for each county broken out by resource pools is provided in Appendix U. This calculation of total cost is not the County Administration allocation. It is a cost projection based upon the data we gathered from the Detailed Survey and analyzed _ through our ABC Cost Model.Totals may be nominally incorrect due to rounding. In addition,we have provided the incremental cost to "open the door"in every base county. The incremental cost is calculated for every county where the cost calculated based upon workload is below the"open the door" threshold cost of a base county calculated in Section 3.2.4 of$87,774. The incremental cost is calculated by identifying the difference of every base counties workload based cost and the base county threshold,and adding the incremental cost to meet that threshold. Total Cost for each In-scope Program and County County FA MED AF APS Total Adams $ 2,833,336 $ 2,916,899 $ 383,539 $ 243,496 $ 6,377,270 Alamosa 196,278 205,623 28,798 74,871 505,570 _ Arapahoe 3,515,968 3,385,865 400,099 846,040 8,147,973 Archuleta 35,709 32,869 4,126 7,693 80,396 Baca 58,960 55,656 7,816 55,700 178,133 -' Bent 67,291 52,346 7,367 10,788 137,792 Boulder 2,128,177 2,099,765 288,296 509,457 5,025,694 Broomfield 297,883 348,117 43,121 121,224 810,345 Chaffee 121,276 151,078 21,351 16,107 309,812 Cheyenne 25,301 22,944 3,402 755 52,402 Clear Creek 90,690 73,072 10,559 4,262 178,583 CO Workload Study Project-6/23/2007 Page 51 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study County FA I MED AF APS Total Conejos 51,176 63,112 9,002 7,489 130,779 Costilla 82,675 62,162 10,691 9,506 165,033 Crowley 63,503 52,143 7,732 169 123,547 Custer 8,528 7,131 973 1,863 18,495 — Delta 185,033 224,050 29,143 93,962 532,188 Denver 10,608,052 8.657,152 1,423,082 2,282,368 22,970,654 Dolores 13,932 12,357 1,696 92 28,077 Douglas 308,003 379,054 44,055 78,041 809,153 Eagle 138,275 223.000 24,415 30,247 415,937 El Paso 3,661,574 3,160,330 410,142 588,726 7,820,773 Elbert 50,971 44,792 5,280 5,946 106,989 Fremont 219,543 275,132 35,641 58,039 588,355 --- Garfield 266,651 417,612 46.898 76,898 808,060 Gilpin 44,793 35,935 4,582 326 85,637 Grand 41,918 42.952 4,164 1,144 90,179 Gunnison 94,647 87,315 9,051 9,872 200.884 Hinsdale 268 24.4 36 - 548 Huerfano 74,716 83,405 11,550 8,479 178,150 Jackson 3,842 3,318 422 - 7,583 Jefferson 2,287,139 2.315,139 306.089 583,376 5,491,743 — Kiowa 29,319 28,365 4,131 118 61,933 Kit Carson 75,511 71,108 9,380 4.039 160,039 La Plata _ 243,603 286,414 38,435 114,691 683,143 Lake 47,249 46,794 6,031 4,398 104,472 Larimer 2,177,440 2,046,424 291,350 781,744 5,296,958 — Las Animas 133,482 169,340 23,268 49,828 375,918 Lincoln 50,385 43,105 5,385 9,192 108,067 Logan 155,844 178,744 23,401 59,881 417,870 — Mesa 1,339,080 1,243,002 171,832 290,833 3,044,747 I Mineral 9 9 1 - 19 Moffat 62,153 75,505 9,384 461 147,502 I Montezuma 136,111 161,559 20,216 58,645 376.530 Montrose 317,150 408,280 42,995 120,778 889,202 i — Morgan 213,637 283,370 38,260 134,930 670,197 Otero 151,395 174,191 25,006 112,563 463,154 Ouray 23,675 22,402 3,168 11,260 60,506 Park 62,810 46,181 5,719 12,674 127.385 Phillips 29,550 27,550 3,364 7,998 68,461 CO Workload Study Project-6/23/2007 Page 52 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing — Workload Study County FA MED AF APS Total Pitkin 30,107 36,854 3,994 246 71,200 Prowers 174,361 215,279 28,745 35,953 454,337 Pueblo 1,422,094 1,153,832 181,705 122,664 2,880,295 — Rio Blanco 50,828 50,299 5,890 502 107,519 Rio Grande 118,183 125,114 17,439 485 261,222 Routt 107,800 102,282 10,470 1,276 221,828 — Saguache 74,764 80,883 11,346 8,380 175,372 San Juan 9,005 7,618 1,025 3,582 21,229 _ San Miguel 41,036 36,474 4,463 2,114 84,086 Sedgwick 25,036 22,646 3,456 13,500 64,638 Summit 81,740 99,636 7,423 1,491 190,290 — Teller 142,499 159,218 20,629 31,185 353,530 Washington 72,779 70,145 7,990 65,289 216,204 Weld 1,683,033 1,662,853 220,662 238,227 3,804,775 Yuma 131,419 127,030 16,026 20,894 295,368 Subtotal $36,989,196 $ 34,753,075 $ 4,845,708 $ 8,046,755 $84,634,733 Incremental cost due to threshold cost to"Open the Doors"in a Base County $611,409 Total I $85,246,142 Table 3.8:Total Cost for each In-scope Program and County — 3.2.2 Out-of-Scope costs of Concurrent Eligibility Determination Programs This section outlines the calculations and report of the cost for each out of scope program area that was included in the workload study, for each county.This cost was calculated due the overlap of eligibility activities,but excluded from the County Appropriation Line Item. Assumptions — Please refer to Section 3.1.2,and the five steps of the ABC Model Cost Build-up. Calculation of Out-of-Scope Costs — Please refer to Section 3.1.2, and the five steps of the ABC Model Cost Build-up. Results — The following table shows cost for the out-of-scope concurrent eligibility determination programs, for each county.Totals may be nominally incorrect due to rounding. — Total Cost for Out-of-Scope Program Areas County Colorado Works OAP—Financial Total Adams $ 749,544 $ 90,625 $ 840,168 CO Workload Study Project-6/23/2007 Page 53 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing _ Workload Study County Colorado Works OAP - Financial Total Alamosa 90,541 6,805 97,3461 Arapahoe 900,396 94,538 994,933 Archuleta 12,989 975 13,964 i Baca 19,605 1,847 21,452 Bent 22,286 1,741 24,027 Boulder 543,918 68,120 612,038 l Broomfield 125,525 10,189 135,714 Chaffee 66,944 5,045 71,989 Cheyenne 10,936 804 11,739 Clear Creek 30,999 2;495 33,494 Conejos 27,694 2,127 29,821 Castilla 27,505 2.526 30,031 — Crowley 21,875 1,827 23,702 Custer 2,605 230 2,835 Delta 86,152 6,886 93,038 Denver 2,690,771 336,254 3,027,025 Dolores 5,569 401 5.970 _, ~ Douglas 103,182 10,410 113,591 Eagle 81,502 5,769 87,271 El Paso 920,272 96,911 1,017,183 — Elbert 19,024 1,247 20,272 Fremont 114,832 8,421 123,253 Garfield 150,888 11,081 161,969 I Gilpin 14,763 1,083 15,845 Grand 13.116 984 14,100 _ Gunnison 28,599 2,139 30,738 Hinsdale 122 9 130 Huerfano 36,176 2,729 38,905 ._ Jackson 1,394 100 1,494 Jefferson 655.128 72,325 727,452 Kiowa 12,593 976 13,569 Kit Carson 27,766 2,216 29,982 La Plata 121,490 9,082 130,571 — Lake 18,428 1,425 19,853 Larimer 606,470 68,842 675,312 Las Animas 72,325 5,498 77,823 Lincoln 17,975 1,272 19,247 Logan 76,075 5,529 81,605 _ CO Workload Study Project—6/23/2007 Page 54 Copyright©2007 Deloitte Development LLC. All rights reserved. , Colorado Department of Human Services Department of Health Care Policy and Financing -" Workload Study County Colorado Works OAP-Financial Total Mesa 359,686 40,601 400,288 Mineral 4 0 5 Moffat 30,798 2,217 33,015 — Montezuma 64,193 4,777 68,969 Montrose 125,774 10,159 135,933 Morgan 122,867 9,040 131,907 — Otero 73,080 5,909 78,988 Ouray 9,246 749 9,994 Park 16,816 1,351 18,168 Phillips 10,489 795 11,284 Pitkin 11,580 944 12,524 -- Prowers 96,522 6,792 103,314 Pueblo 361,837 42,934 404,772 Rio Blanco 18,532 1,392 19,924 Rio Grande 55,635 4,121 59,755 Routt 32,590 2,474 35,064 ,_ Saguache 35,131 2,681 37,812 San Juan 3,334 242 3,577 San Miguel 14,124 1,054 15,178 -- Sedgwick 9,879 817 10,696 Summit 21,237 1,754 22,991 Teller 63,091 4,874 67,965 Washington 25,023 1,888 26,911 Weld 441,231 52,139 493,370 Yuma 45,706 3,787 49,492 Total $10,576,381 $1,144,972 $11,721,353 Table 3.9:Total Cost for Out-of-Scope Program Areas 3.2.3 County Administration Line Item Appropriation This section outlines calculations and reports the final projected cost for the County Administration — line item appropriation based upon the findings above,including required FTE, supervisory,and administrative functions. -- Assumptions In addition to the key assumptions referenced above to be applicable to all data inputs, the following assumptions are made: • All costs,including the cost of each direct staff FTE and all overhead costs,including the supervisory and clerical staff and auxiliary administrative staff and time,is included in the — loaded per minute rate calculated in Section 3.1.2. CO Workload Study Project-6/23/2007 Page 55 — Copyright©2007 Deloitte Development LLD.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Calculation The cost for each high-level program group and county will be added up to equal the total cost of County Administration. Results The following table shows cost for County Administration,broken out by resource pools and high- level program group.The cost for each county,broken out by resource pools and high-level program group, is provided in Appendix U.Totals may be nominally incorrect due to rounding. Total Cost for each Resource Pool Resource Pool FA MED AF APS Total Capital Outlay $ 684,122 $ 641,281 $ 91,591 $ 145,384 $ 1,562,378 Contract Expenses 2,367,388 2,102,346 308,814 495,018 5,273,567 Cty/Client Provider Payments 39,150 35,259 4,849 7,063 86,321 Disallowed Cost Recovery (116,976) (123,921) (16,286) (32,587) (289,770) — Labor 26,187,665 24,827,596 3,418,544 5,773,299 60,207,104 Office Space 1,872,980 1,714,720 249,244 401,785 4,238,728 Operating Expenses 4,611,397 4,243,232 609,674 971,075 10,435,378 Personnel Expenses 393,044 394,458 55,660 86,657 929,819 Travel Expenses — 950,427 918,104 123,617 199,060 2,191,208 Total $ 36,989,196 $ 34,753,075 $ 4,845,708 $ 8,046,755 $ 84,634,733 Table 3.10:Total Cost for each Resource Pool — 3.2.4 Base County Cost Calculation This section outlines the data inputs,assumptions, calculations and report of the base cost for a county department of human/social services to"open the door" and conduct business based on the data collected in 2 base counties. Data Inputs The following data inputs are utilized to build the cost that a base county incurs to "open the door": CDHS Accounting Cost data gathered from CDHS accounting. Grand and Jackson Counties Cost data provided by Phil Maes,Director of Grand and Jackson counties. CO Workload Study Project-6/23/2007 Page 56 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Cheyenne County Cost data provided by Cheyenne County. Assumptions In addition to the key assumptions referenced above to be applicable to all data inputs,the following assumptions are made: • The base county costs do not reflect regional or demographic specific qualities. • The cost data provided by the base counties is accurate. • The input data provided by base counties are a complete picture of their cost structure. Calculation Cost Average Average the costs (rent, utilities,salary) that are received from the two base counties. Shared Cost Reversal We reverse any cost sharing between base counties to reflect a county that is completely independent in resources. Results The following table shows the breakdown of costs for a base county to"open the door" for one year.Totals may be nominally incorrect due to rounding. "Open the Doors"Cost in a Base County %of Resource Pool Cost Total Capital Outlay $ 1,265.00 1.4% Labor 21,553.00 24.6% Cost of Office Space 15,869.08 18.1% Operating Expenses 30,186.44 34.4% Travel Expenses 18,901.14 21.5% Total $87,774.66 100% Table 3.11:"Open the Doors"Cost in a Base County 3.3 Cost Analysis 3.3.1 Unit Cost per Process This section outlines calculations and reports the average unit cost for the County Administration for each high-level program group based upon the findings above. -- Calculation The Unit cost for each high-level program group and county is calculated by taking the total cost of county administration and dividing it by the respective number of case programs for each county CO Workload Study Project—6/23/2007 Page 57 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study — size. This cost will reflect a weighted average within each county size reflective of the number of case programs. Results The following table shows the average unit cost for County Administration, broken out by high-level program group and county size. A unit cost for County Administration for each county by high-level -- program group is provided in Appendix V. Unit Cost for each County Size and High-Level Program Group County Size FA MED AF APS Large $373.48 $ 146.64 $ 168.76 $931.98 Medium $250.30 $ 123.33 $ 124.39 $677.51 Small $410.61 $ 145.19 $ 163.09 $ 1,544.89 Table 3.12:Unit Cost for each County Size and high-level program group The following table shows the total number of case programs for County Administration,broken out by high-level program group and county size. Total number of Case programs for each County Size and I ligh-Level Program Group _ County Size FA MED AF APS Large 84,759 195,323 24,158 13,930 Medium 15,110 38,013 4,768 5,080 Small 3,778 9,806 1,078 836 — Table 3.13:Total number of Case programs for each County Size and high-level program group Analysis The table shows that it is about 1.5 times more to administer county administration programs in large and small counties than it is in medium size counties.This could be due to a range of factors, including the volume of failed intakes or the difference in complexity of cases between county demographics, as well as differences in cost of living . Additional interpretation of the business model variances between county sizes is discussed in Section 4.0. 3.3.2 Key Cost Levers This section outlines calculations and reports the cost of key groupings of activities and high-level program groups that outline the cost levers or areas of workload for the County Administration. Cost levers are areas of an end-to--end business process that can be grouped because they are reactive or dependent upon similar drivers that can drive cost up or down. CO Workload Study Project—6123/2007 Page 58 _ Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing -' Workload Study Calculation The total cost for each cost lever is calculated by adding up the processes and activities for each cost lever.The cost levers and the respective processes and activities that are included within each are listed below. Cost Lever Definitions Key Cost Lever Activities/Processes Included Intake Failed Intake after Application Initiation — Failed Intake after Interactive Interview Completed Intake Case Related Activities Change in Circumstances Reported by the Client — Alerts Management Case Review Seeking/Receiving Assistance _ Client Communications and Information Client Communications and Information Administrative Activities(Non-Case Administrative Support Activities Related) Reports Management Breaks Training Meetings Materials Development Non-Activity(Case)Specific Reading (e.g. Read Regs, Policy, and Rules) Eligibility Recertification(RRRs)and Completed Periodic Reporting Periodic Reporting Discontinued Recertification, Reverification, Redetermination (RRR) Completed Recertification, Reverification, Redetermination (RRR) Management Activities Management Activities(e.g. personnel management,counseling,office operations) Claims Investigation, Claims Research, Establishment, and Recovery Other EBT Issuance Inter-County Transfers Appeals and Hearings Make Referrals Travel Intake of Adult Protective Services(APS)Cases,# of l&Rs Intake of Adult Protective Services(APS)Cases,# of APS Referrals Intake of Adult Protective Services (APS)Cases,# of APS Referrals, Not Requiring Face-to-Face Intervention APS Case Maintenance(Time allocated to discrete, non-specific Activity Drivers) Table 3.14:Cost Lever Definitions CO Workload Study Project-6/23/2007 Page 59 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Results The following table shows the total cost for County Administration,broken out by key cost levers and high-level program group.Totals may be nominally incorrect due to rounding.The cost for key cost levers are provided for each county and high-level program group in Appendix\X'. Total Cost for each Cost Lever %of Key Cost Levers FA MED AF APS Total Total Case Related Activities (e.g. Case Review, Change in Circumstances,Alerts) $12,818,385 $10,292,172 $ 1,854,736 $6,592,204 $ 31,557,498 37% Client Communications and Information 6,007,099 7,904,088 762,946 85,689 14,759,821 17% Intake (Both Completed and Failed) 6,264,509 7,098,079 513,884 295,491 14,171,963 17% Eligibility Recertification (RRRs)and Periodic Reporting 4,787,296 4,620,012 341,241 9,748,548 12%Administrative Activities (Non-Case Related) (e.g.Administrative Tasks, Meetings,Training, Reports) 2,883,694 3,331,735 973,114 73,444 7,261,987 9% Claims 2,549,812 1,226 192,297 2,743,335 3% — Management Activities 1,385,216 1,119,605 164,666 33,195 2,702,683 3% Other(e.g.Travel, — Referrals, ICTs,APS specific Activities) 293,185 386,158 42,824 966,732 1,688,899 2% Total $36,989,196 $34,753,075 $4,845,708 $8,046,755 $84,634,733 100% — Table 3.15:Total Cost for each Cost Lever Analysis _ The table shows that one third of resources are expended towards case maintenance activities that are indirectly related to processing of a case.The second highest resource consumer is communications with the client. The case maintenance and client communication together compose — 55%of resource consumption dedicated to management of clients and cases not related to primary case processing. Intake, Eligibility Recertification,and Periodic reporting compose 28%of resource consumption,and the remaining 17% are dedicated to administrative and other activities. _ Interpretation of how to address these cost levers are presented in Section 4.0. CO Workload Study Project-6/23/2007 Page 60 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study 4.0 Overview of Field Observations, Summary Survey, Business Models, and Human Services Modernization The Field Observations and Summary Survey provided insight into county business models, processes and other trends from county human/social services offices across the state.This section includes a summary and overview of the key activities conducted during Field Observations, key findings from the Summary Survey,and ideas regarding modernizing Human Services delivery. Our extensive experience with State-funded, County-administered Human Services has shown us that there is typically a low degree of standardization across Counties'business process. Because counties have an increased level of autonomy and flexibility across the state, they will attempt to customize their business practices to best accommodate their staff,workload and client preferences. Customized practices,evolved over several years often result from specific needs which include,but are not limited to familiar work processes, cultural traditions,workload, office space,client demographics,and organizational structure.Although each county may have many unique solutions, counties of similar size,geography,and demography often face similar challenges. In Section 4.0 we use our findings from Field Observations and the Summary Survey to profile small,medium and _ large counties. Our discussion includes business model,workload,and staffing, and we share some innovative practices that we observed in Colorado counties,as well as additional modernization strategies from human services agencies in other states. In the recent past, county offices experienced a significant transition from a more manual form of data collection and input to a more automated,integrated eligibility model. Changes of this magnitude inevitably create stress and the transition is never easy. In our Field Observations, the counties appeared to continue to struggle with this transition. We will report on what we understood to be the biggest challenges and provide information and documentation regarding these challenges. Finally,we will provide you some potential solution options to assist in a more effective transition to the newly consolidated business model. 4.1 Field Observations 4.1.1 High Level Summary of Results Purpose Field Observations are a key component of the CO Workload Study Project. In addition to the Detailed Survey providing raw data needed to populate the ABC model, the Field Observations allowed us to learn more about the numbers being collected from the Detailed Survey. On a county- by-county basis,we learned how the business model they employed affected their Detailed Survey results. By analyzing the business model in each county,we were able to gain a better understanding of each county's Detailed Survey results. For example,a county that conducts Al separately from the interview will likely have different survey results than a county that performs both functions in one sitting. By comparing specific activity times from the Detailed Survey to the Field Observation rime- in-motion study,we were able to validate survey data and conduct our due diligence by investigating CO Workload Study Project-6/23/2007 Page 61 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study unusual results. Ultimately,information gathered during Field Observations brought the survey data to life,and helped us understand the challenges counties face on a daily basis. Field Observations also allowed us to have candid discussions with county stakeholders from every level of the agency hierarchy. In doing so,we learned about what aspects of the job made county employees lives easier and more difficult and counties noted aspects of their organization they were particularly proud of,and also explained the most significant challenges they face. As noted earlier,Field Observation counties were determined by the Steering Team. Selected counties represented all eight Department of Local Affairs (DOLA) regions,and small, medium,and "•• large counties. Fifteen counties were selected for Field Observations consisting of five Large, seven Medium and three Small. Additionally,two Base counties were selected to illustrate what is required to "open the doors" and deliver services in a Base county.The picture below shows all Field .•. Observation counties. li,Field Observation Counties iingLogan _ Phillips 11010 kb gan 1Lma � Yihshinglmpahoe — Krt _ ouglasCarson 111 lir:liallill1)4P- Gunnison Crossley V lIl Bern ._ Dolores San Juanilb Rio Grande Montezuma dal Baca Ine Base In Small M Medium ❑ Large Figure 4.1:Field Observation Counties Components ^ Field Observation components were designed to support the ABC model,and allow us to understand the factors influencing how counties deliver services. Also,Field Observations provided a forum for counties to describe their strengths and challenges. The main components of Field ,_ CO Workload Study Project-6/23/2007 Page 62 Copyright©2007 Deloitte Development LLC. All rights reserved. "' Colorado Department of Human Services Department of Health Care Policy and Financing — Workload Study Observations include 1) County Director Interview 2) Office Tour 3) Supervisor Interview 4) Time- In-Motion Study. Below,we have provided a description of each activity and benefits of each activity. Field Observation Components Activity in Field Observation Description of Activity Benefit of Activity County Director • Brief interview/discussion with the • Understanding the agency's strategic Interview County Director and any designates vision deemed appropriate (maximum 6-8 • Learning priorities of agency county participants to keep the executives discussion as focused and interactive • Hearing agency strengths and as possible) challenges from the director's • Discussion includes county business perspective model (i.e. high level organizational structure, understanding of roles/responsibilities by key positions, subcontracting staff(if any), attrition rate, hiring/retention practices, etc) Office Tour • Tour of Reception, Mailroom, Intake, • Viewing office layout and setup Ongoing • Determining the linkages between • Tour Guide explains the key different business units processes of each area of work • Understanding county business • Gain important information regarding model at a high level the key steps taken in each process by program Supervisor • Talk about the activities conducted in • Hearing agency strengths and Interview their units/areas of work challenges from a mid-management • Discuss type and volume of work perspective related to the activities and programs • Learning how workload is being outlined in the Detailed Survey managed"on the floor." • Ask specific questions regarding • Comparing and contrasting mid- these activities and the amount of time management priorities to executive needed to complete many of them priorities Time-In-Motion • Sit with a staff person and validate • Validating results of the Detailed Study information recorded in the Detailed Survey Survey • Understanding typical work habits • Ask additional questions, and collect • Learning how work is executed "on any other information that may prove the floor" useful to the Workload Study Project Table 4.1:Field Observation Components CO Workload Study Project-6/23/2007 Page 63 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study — 4.1.2 Business Model Findings Business Model Continuum _ To standardize our descriptions and analysis of county business models our team developed a Business Model Continuum.Two key data inputs that shape business models were noted and ultimately are the key inputs to the model: — 1) Program Area—Program Area refers to the human services programs a staff person works in. A worker can perform work in all program areas,a subset of program areas,or in one program — area. 2) Work Function—Work Function refers to the specific kinds of work a staff person performs. This includes functions such as Clerical, Intake, Ongoing/Case Maintenance, Fiscal, etc. Using these two key criteria,we subsequently identified three separate categories of business model. The categories are Generalist, Hybrid and Specialist. Our business model findings during Field — Observations were, indeed, comparable to trends from other County Human Services Agencies. The general trend in US Human Services shows counties moving from a more specialist model to a more generalist model, either in terms of work function or program area to accommodate a more — consolidated business model. From what we have seen, this transition typically begins 6-12 months after implementation and is undertaken to accommodate the integration of program information and data collection. During our Field Observations we visited counties that fell into three categories. Further,we noted specific model trends across small, medium and large counties related to organizational structure and we found that the size of the county was the biggest determinant in the type of business model that they employed. CO Workload Study Project—6/23/2007 Page 64 Copyright©2007 Deloitte Development LLC. All rights reserved. — Colorado Department of Human Services Department of Health Care Policy and Financing — Workload Study Business Model Continuum More Generalized More Specialized Generalist , Hybri tliiatiE i°kie+g ;, • Staff con work in • ' vMiar ' '$tatspes7a14Cke,' $ ( ° ° r ° most/allIncome 9i;b8etofW ii:$414 sR9 ' ' " ; ° iv ., Maintenance Program O a !PC v '� ,e, �r s a i b}v 11 Areas • Staff speaahze ii #rib pk Boll i +M) , § "2.47 !s'� , , • Staff have lessdistind 'sulkseto P ,pyseas 70,`v,, �t yr I roles : T. , - '..r' ,,, , N r ,.: r. responsibilities olesand and • 'S3iFf ktit'�dtii i33ittttoc ', tv�}, , r43r,� �.. — typically do multiple .,51•irat srii p _ '` ,� .°; �pF Work Functions ° is, (Intake, Ongoing, , l' — Clerical) •.. t ft's '#tnut1pleunxe12t ' • Organizational } �.: ,,l t , �, .v, Structure is flatter in t E �}� <.z . smaller counties(duties • aX# i41.aa'stateqiiiii atli 10' „,.. overlap administrative ° } V — and executive boundaries) ilis �x Smaller Size of County Larger Figure 4.2:Business Model Continuum Small Counties Business Model Continuum Small Counties shared many similarities in terms of strengths and challenges and also employed similar business models.The Hybrid (Functional Generalists/Program Specialist) Business Model was found in the larger of small field observation counties,and in the smaller of small counties, the Generalist Business Model was employed. In small count es, eligibility techn clans often carry a broad caseload that covers multiple program areas.Typically, the small counties we visited employed one director with three to seven eligibility workers,plus accounting,investigat ons and front desk staff. Child welfare and child care workers (programs out of th s study's scope) were generally housed in the same local on as these employees.The larger small counties also employed one or more supervisors in addition to the director. Detail The biggest influence on small counties'business models was resource constraints. Small counties indicated they do not have the option of specialization,often because of a small resource pool. Also, throughout the state it was noted that smaller counties tended to rely more heavily on paper-driven CO Workload Study Project—6/23/2007 Page 65 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study processes (Paper Queuing, Al Forms, SPA-1,and Statement of Facts) rather than directly inputting information into CBMS. Likely due to their size,small counties did not conduct a major business process redesign when the state migrated from a manual to automated environment with CBMS, because of their lack of resources and small number of affected staff Instead, individual staff persons made changes to the _ way they processed work,rather than having a structured and regimented implementation of new business processes. For example, the eligibility tech in one small county told us that she now divides her work week between interview and data processing days.We found this type of schedule to be common across all county sizes. However,workers in a Generalist model are responsible for both -' intake and ongoing duties. Small counties were generally not trending towards paperless processes such as imaging,and _ conducting true Interactive Interview. However, some county workers we talked to indicated that they use the online 11 function if a case is new or relatively simple.This trend was seen across all counties, where individual workers would conduct paperless II, even if it wasn't mandated by the _ department. Although small counties may eventually move towards conducting CBMS activities such as Al and II without the aid of paper forms, they do not currently have the human or monetary capital to support more advanced paperless solutions such as the implementation of an imaging solution. Investigations and fraud were areas handled uniquely by small counties. Though some small counties have a dedicated fraud investigator, they indicated they would like to have additional resources to be — more aggressive in preventing and identifying fraud on the front end of the process. Positive trends noted in the small counties include a high staff retention rate and depth of program knowledge. Employees in small county offices generally have multiple years of experience with a valuable historical perspective. Although small counties tend to have smaller workloads than larger counties, and most small counties did not identify workload as a key concern, some counties still struggle to meet workload requirements. They indicated that they simply do not have adequate resources to pay overtime needed to reduce backlog or to hire new employees to take over the cases that are not being worked on. One person in a small county indicated that,"in a small town,when you get a good job you hold on to it...and this is a good job," but in general,pay is low in small rural counties.To make up for a lack of resources,small Counties rely on one another for support and have a strong communication network. Medium Counties Business Model Continuum In Field Observations,we found that Medium Counties typically employ a Hybrid type of business model. However,depending on the county,they use one of two derivations of the Hybrid Model; (Functional Generalists/Program Specialist) as well as (Functional Specialists/Program Generalists). Medium sized county offices are increasingly specialized (compared to small counties)in an attempt to better manage caseload. Counties we visited gave Al responsibilities to front desk workers (ranged from two to about five employees),while creating separate units for ongoing work. For example,one county split its business model in the following way: AI Unit (five FTE), FS Combo Unit—All _ CO Workload Study Project—6/23/2007 Page 66 _ Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Programs (three FTE + Supervisor),TANF Unit (six FTE + supervisor),Adult Programs Unit (five FTE),and the APS Unit(one employee). Another had two supervisors, a lead-worker and eight technicians specialized by program. Detail Like small counties, medium-sized counties used multiple paper-driven processes (Paper Queuing,Al Forms, SPA-1, and Statement of Facts).Although some counties seem to be trending towards paperless processing,document imaging, and true Interactive Interview, manual processes are still the norm. One unique means of workload distribution observed in a medium county is a shared or"banked" caseload model. All cases are assigned to a generic worker and staff organize their shared workload on a daily basis.They gather stacks of Als,Ils, Periodic Reports and complete as many as they can in a given day.This model was found in a county where staff was co-located and could communicate easily with one another. Although a shared workload risks diffusing accountability,management _ indicated that there were alternative supervisory measures in place to mitigate such risks.Aside from the potential accountability risks, this model appeared to be an effective method of operation for the county. Although we only observed one county in Colorado using the "banked caseload" model, this is a strategy more commonly being deployed across the nation as an effective means of dealing with staff shortages in an integrated eligibility social service organization. Staffing was prominent discussion topic in medium counties and many explained that they had staffing shifts following the CBMS implementation.Though staff left for a variety of reasons,the most common reason for leaving was a frustration level with learning a new automated system. Workers had significantly more control over eligibility decisions prior to CBMS,and experienced frustration with having to rely on a computer system to make the decision for them.In addition,due more to location than size,West Slope counties are experiencing difficulty retaining staff due to a highly competitive labor market.A booming economy has made it difficult for some counties to compete for workers who often leave for less complex jobs that, according to county management, can pay upwards of$10-12 more per hour than is paid by the county. Consequently,a significant amount of resources are expended on hiring and training new employees who often leave after a short period of employment. Large Counties Business Model Continuum The larger counties are the most specialized of the three county groupings and they use both a Specialist Model and Hybrid Model (Functional Generalists/Program Specialists). One director _ indicated that he believes specialization is truly the only way large counties can manage their workloads. Due to the high volume of caseload per worker and turnover,he indicated that it would he nearly impossible to train workers for the wide variety of program combinations and other case complexities a generalist would need to know. Consequently,large counties employ workers in specialist areas allowing their workers to become proficient in their assigned area of expertise. All of the large counties we visited separated intake from ongoing activities. In fact,several counties had AI-only units,moving clients on to program-specific II workers to process their applications and _. determine eligibility. Some counties specialized even further. For instance, they separated RRR from general Case Management in their Ongoing units. CO Workload Study Project-6/23/2007 Page 67 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing _ Workload Study Detail Large counties generally use paper-driven processes (Paper Al Forms, SPA-1, Statement of Facts), and they consider moving toward paperless imaging and true Interactive Interview a priority. — Consequently,the only Field Observation county performing true Interactive Interview is a large county. One large county we visited was in the process of implementing a document imaging system, and others plan to or are considering implementing a paper imaging solution. One other trend seen _ in large counties as a means of mitigating funding issues and caps on the number of Human Services FTEs,is the use of contract labor. This includes contracting out entire functions such as fraud and investigations,as well as employment programs. Some of the largest counties have several hundred contracted positions and multi-year contracts worth tens of millions of dollars. — Large counties have created various custom,paper and automated systems in addition to using CBMS. For example,one large county created a sophisticated online scheduling system while another — uses at least three scheduling systems, two of which are paper-based. Except for the one county that uses true Interactive Interview, large counties (and nearly all counties) use paper forms to collect information when performing Al, II,RRR and other functions. Consequently, applications are being processed in two steps: collecting information on hand written forms and entering the data into the CBMS at a later date and time. Staff retention was more often mentioned as an issue in large counties. Larger,more urban economies provide more diverse employment options, creating a more competitive labor market compared to smaller counties. Accordingly,large counties expend significant resources hiring and training new employees. One large county that experienced major problems with staff turnover recently reclassified positions to increase salaries,which has proven to significantly improve staff retention taking the vacancy rate from 17% to 6% in one year.Not all counties have the resources to increase staff salaries, and counties expressed a desire to explore alternative options to reducing — turnover rates. County Director/Supervisor Interview Findings County Director Interviews focused on discussing business models,workload and staffing issues,and unique circumstances. During the interviews, certain trends became apparent. One topic that occupied a large part of each interview was workload management. All of the large counties we — visited noted challenges, but the degree and nature of those challenges were different. Some counties indicated that they were overwhelmed with their current workload,while others suggested that their workload was large but manageable. Based on what counties told us,and based on the other information sources at our disposal including caseload size, FTE count, and fiscal information,we developed a barometer by which to measure the degree of challenge counties were facing.The two key factors influencing the degree of challenge are — 1) Local Tax Revenue and 2) County Caseload Size. Local Tax Revenue is a factor because Counties' whose state allocation does not cover all costs have a means to cover their remaining annual operating costs from an alternative funding stream. Caseload is the other factor influencing the degree of challenge,because each case corresponds to a discrete workload that must be assumed by the county. In Figure 4.3—County Director Interview Findings 2x2,there are four quadrants representing the various degrees of challenge. The bottom right quadrant has the highest level of _ challenge, the top right quadrant has the second highest level of challenge, the bottom left quadrant has the third highest degree of challenge and the top left quadrant has the fourth highest degree of challenge. CO Workload Study Project—6/23/2007 Page 68 Copyright©2007 Deloitte Development LLC. All rights reserved. '— Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study County Director Interview Findings—2 x 2 4th highest challenges 2"highest challenges (Example: Ouray) (Example: Denver) - r 3rd highest challenges Highest challenges re (Example: Lincoln) (Example: El Paso) G County Caseload Size Figure 4.3:County Director Interview Findings—2 x 2 County Director/Supervisor Interview Findings (Continued) As noted above,paper-based processes dominated the county offices we visited.Various reasons were given for this approach to doing business. Several interviewees noted that they consider CBMS unreliable; therefore they need the paper documentation to keep a record of a client's information. Others stated that they feel using the system to process applications in real-time is less interactive — with the client and would require the client to wait too long. However,workers in the county using true II indicated that they did not feel that either of these complaints was valid.Though sometimes true II can be a lengthy process (especially for very complex cases),they noted that clients are generally pleased because they know immediately for which programs they are eligible along with the benefit(s) they are to receive. Interactive II provides continuity by allowing EDBC,Wrap-Up and Authorization and shifting the case from Intake to Ongoing mode in one process. Across Small, Medium and Large Counties there were three primary topics that dominated the County Director and Supervisor interviews. Although all three topics were discussed in all counties, the focus of the conversation tended to vary depending on county size and location. CO Workload Study Project—6/23/2007 Page 69 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing _ Workload Study Challenges Disjointed Communication _ Communication was a primary discussion topic during County Director and Supervisor interviews in small counties. They cited a disconnection between Counties,Policy (CDHS/HCPF),and CBMS. In summary: • Policy is too complicated. • Policy is too voluminous. — • Policy implementation time is unrealistic. • Lack of synchronization between policy implementation and systems' readiness results in confusion. Of note, small counties identified instances where changes were described differently by these different groups prior to being released to CBMS.This sentiment was also shared by medium and large counties. Additionally,counties identified that they often have difficulty obtaining information — from their counterparts at the state.Therefore, small counties often band together to discuss high priority issues relating to Policy or CBMS. Small counties shared information through both formal channels such as regional meetings, and also informal communication such as phone calls to — neighboring counties.This has proven to be an effective method of information sharing. Although communication was also discussed during medium and large county interviews,it was most prominent in small counties. — Heavy Workload Workload was identified as a high priority item in all counties,regardless of size,though was perhaps more prevalent in medium and large counties. Counties cited growing caseloads, CBMS defects, and changing regulations as the primary contributing factors to their workload issues. One small county noted that they hired temporary workers to assist them through the CBMS transition, and have extended the contract of those employees to continue to manage the county's workload. — Counties also expressed concern about workload distribution. Multiple counties we visited were reorganizing their employees'program responsibilities and the purpose of these efforts was to distribute the workload more equitably. Consequently,we sat with a number of workers who were not necessarily new to the office,but were learning new programs. In addition, some small counties we visited are experiencing backlog issues because they do not have the resources it takes to — compensate existing workers for the hours required to process all of those backlogged cases. Counties also expressed concern about unfunded mandates.This situation occurs when the state or — federal government institutes new requirements without providing adequate funding to implement the change. CO Workload Study Project-6/23/2007 Page 70 _ Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study CBMS Functionality Concerns CBMS was in (almost) all instances a primary discussion topic in medium and large counties. Counties suggested that the functionality needs improvement and commonly cited Case Assignment, EDBC and Client Correspondence as areas that frequently experience problems. Counties also expressed concern regarding the significant changes to the system that occur on an ongoing basis. Though solving one problem, "code fixes" often cause a previously functioning part of the system to break down when released into production.This often triggers the need for"workarounds" and creates additional workload. Counties explained that using paper-based processes provides backup documentation in the event that CBMS malfunctions. User error was also cited as a problem in several counties. Interestingly many relatively new employees noted that after they navigated the considerable CBMS learning curve,they actually liked the system. However, some counties noted that they are losing employees (both long and short term) due to frustration with the system. Areas of Strength Small County Strengths Small counties'strength lies in customer interaction. Due to the"small town" culture in many of these counties, staff is able to develop strong relationships with their clients. For example,in Ouray County, time is dedicated to counseling clients and addressing their more personal and unique needs. Deep program knowledge is also a common strength in small county offices,and employees in these offices (including directors) wear many"hats." Medium County Strengths Though generally more specialized than small counties,the medium sized counties we visited all made efforts to provide one worker per client. In Fremont County,their office is divided into units that are specialized by case and program complexity. Consequently, even clients with the most complex cases are assigned to one worker.This builds consistency and reliability into the client experience. Fremont is also particularly aggressive at addressing backlog. When the state provides pending case reports on Monday, affected workers are expected to provide an update on the status of those cases by Thursday of the same week. In Cheyenne,clients are seen immediately by one of the three staff members or the director.Therefore, appointments are generally not necessary. Large County Strengths The most significant differences in business models were noted in large counties. Each county we visited developed its unique business model in an attempt to best serve their clients. Adams showed us their innovative custom IT solutions as a key area of strength. Documents are filed using an imaging program,and employees felt comfortable using this process.Their custom scheduling program provides a paperless, easy to use system of managing appointments for workers in all _ program and functional areas. Finally,Adams uses the Q-Matic queuing system to provide clients an assigned number at the "Start-here" desk. Simple document drop-offs and inquiries can generally be handled at the "Start-here"desk,and if the client is coming in for an Al, Intake or RRR appointment they are assigned a number. Once a client's number is called they are directed to a specifically numbered workstation to meet with the appropriate worker. Another large county with a key area of strength is Mesa County who prides itself on minimal client wait times,vowing that no client should wait more than 15 minutes before being seen by a worker. CO Workload Study Project-6/23/2007 Page 71 '- Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing _ Workload Study 4.2 Key Findings from Summary Survey 4.2.1 High Level Analysis of Summary Survey Results — Response Rate • 1727 Responses/3107 Statewide County Human Services Employees —Response Rate of 56% Level of Experience This question asked staff to rate themselves on their level of knowledge and ability to do their job. Most staff responded with a rating of"Very Good"which is the second highest rating. Staff offered comments on their self-ratings, and some of those comments are listed below. 1) Very Good (56%)— • "While I still have a lot to learn about Human/Social Services Program regulations, — and CBMS,my overall management experience, and ability to do my job is higher than my peers, some of whom also don't have substantial knowledge of program regulations and CBMS." — • "If I were to have marked excellent, I would not have any more to learn." • "I am a fast learner and willing to accept new responsibilities to further my career." • "I work well on my own,meet deadlines, know what needs to be done and can fill in for employees that are absent." 2) Excellent (29%) — • "I always give 100%plus. I am a team player." • "I have years of constant changes and historical perspective." • "I have learned program areas and job responsibilities, as well as IT issues,and hold a managerial position." _ • "I had 13 years of social work experience before I got here and I have a Masters degree in social work. • I have worked three different programs,performed data entry,intake and on-going caseload work. I also am very proud of my knowledge of CBMS." 3) Fair (13°/x)— • "I'm new to this position and still learning my role." CO Workload Study Project-6/23/2007 Page 72 Copyright©2007 Deloitte Development LLC. All rights reserved. — Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study • "I feel I am doing better than my peers that started at the same time as me and I have been told this as well. But, I feel 1 got thrown into this job without any real direction or support. Not to mention the rules and guidelines change so frequently." • "I do very well in the things that I do repetitively, but still need help in some areas where it might not he done every day." • "I am new to the job." 4) Need Help (2°/n)— a. "I've was promoted to a new position 3 months ago and still have quite a bit to learn" b. "I'm very confident in my knowledge to perform my job duties and T work very hard along with all my peers.The work load is too much and very overwhelming. CBMS doesn't work properly despite what anybody says." c. "I have never worked in Human Services before and everything is new and always changing." d. "I am still in training and feel I have a lot to learn." e. "1 need some serious,on the job training as an IMT." Summary Survey Results-Level of Experience Based on your experience level listed above and comparing yourself with your peers,how would you rate your level of knowledge and your ability to do your job? Excellent . ._ ,... 504... 29% Very Good . . _.,: .._n,,.a .. . ,.._-.,,..:w. 952 56%_.. Fair tat 218 _.. 13% Need Help 38_.. 2% Total 1712 100% Figure 4.4:Summary Survey Results-Level of Experience Factors Making Your Job Easier — The majority of staff indicated that their Co-Workers were the main factor making their job easier. This was followed by Supervisors/Management and Work Hours/Schedule. Some specific comments related to each response are listed below. 1) Co-Workers (74%)— • "Our department is very team oriented. Everyone works together to provide the best services to clients." • "My co workers are exceptional trainers,and had I not worked with them I would not _ know as much as I do." CO Workload Study Project-6/23/2007 Page 73 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing ` Workload Study • "Mv co-workers are always there when I have a question or when problems arise with a case." • "You can always count on co-workers for support to help you get through a problem." 2) Supervisors/ Management (51%) _ • "I have supportive supervisors and management team within our internal organization." • "I appreciate the fact that my supervisor is able and willing to assist me with any complications that may occur on a drop of a dime." • "A good working relationship with my supervisor and agency managers as well as the flexibility/space given to me has made it easier to do my job." • "Management works with us to make sure we have the tools available to do our job." 3) Work Hours/Schedule (32%) • "I enjoy the schedule flexibility." • "Having a flexible schedule is a good thing." • "I have a flexible schedule and see this as a nice benefit" _ • "I enjoy having flex time because of my limited energy." 4) Technology (29%) • "The computer programs that are available to us make research more efficient." • ":Most of all,having the ability to use fax and e-mail make my job much faster and easier." • "I like all the manuals and procedures being online." • "Computers make it easier to do repeated calculations,and store date for quick retrieval. Setting my own schedule allows me to worry less about my family as I work around their — schedules/days off." 5) Working with the Public (18%) • "I enjoy working with people" • "Working w/public is always interesting." • "I love to work with the public." _ CO Workload Study Project-6/23/2007 Page 74 _ Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study • "1 get enjoyment from working with the public." 6) Other (16%) • "I like having the ability to Partner internally and externally." • "I enjoy the level of professionalism in my job." • "My work ethic and dependability makes my job easier." • "Good training always helps and makes things easier." 7) Workload (10%) • "My workload is manageable and my co-workers are team players." • "Workload is more evenly distributed in my office." • "We have smaller caseloads that are more manageable." • "The workload is light compared to what I'm used to." Summary Survey Results-Factors Making Your Job Easier in your experience,what factors have made your job easier to do?Why? Co-Workers .:.... ...... . P.. _ .._ .».. 1270 74% Supervisors/Management ' S77 51% Technology .._.... 500 29%__. . Work Hours/Schedule ""-' ' 550 32% Working with the Public assilis 304 18% �.. Workload Eat_.. _.. 164 10% Other,please specify _... _. .. View Responses 272 16% Figure 4.5:Summary Survey Results-Factors Making Your Job Easier CO Workload Study Project—6/23/2007 Page 75 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Factors Making Your Job Harder 1. Workload (53%) • "Workload is by far the greatest obstacle in completing my work." • "A workload that is not manageable creates a poor work product." _ • "At times the amount of work required is more then 40 hours/week" • "There is not enough time in day to do all the work." 2. Technology (46%) • "CBMS is still not up to acceptable standards." • "In the IT area we need more advanced and up to date computer systems that work more efficiently and faster in order to serve our clients." • "CBMS constant changes do not help to get ahead." — • "Although CBMS is supposed to be a system that relieves and makes one's job easier there are a lot of kinks in the system and procedures that are much more complicated than they have to be." 3. Supervisors/Management (25`Y%) _ • "Supervisors don't communicate very well." • "My supervisor delegates her work to the online staff." • "The supervision/management has been changing and we currently have a supervisor who doesn't know much about our field." _ • "There is a lack of leadership and management for cohesiveness within." 4. Other(23%) • "State and Federal Policies and inadequate funding make the job more difficult." — • "CBMS makes the job more difficult." • "Changes in policy and procedures." • "Lack of training." _ CO Workload Study Project-6/23/2007 Page 76 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study 5. Working with the Public(13%) • "Clients turn paperwork/verifications in late or incomplete." • "Sometimes the public can be very difficult." • "Working with the public can often be very challenging." • "Working with the public is sometimes hard." 6. Co-Workers (12°/)) • "Some co-workers are a distraction." • "I have some co-workers that are very,very incompetent." • "Some co-workers are difficult to work with." • "Negativity in our work environment from a few co-workers makes it harder to experience change and accept new ideas." 7. Work Hours/Schedule (7%) • "You can only do what you can in 8 hours." • "It is hard to ask for time off with the work schedule." Summary Survey Results-Factors Making Your Job Harder In your experience,what factors havkade your job harder to do?Why? Co-Workers _„;..-..._ 198 12% Supervisors/Management 413 25% Technology 757 46% • Work Hours/Schedule 117 • 7% Working with the Public y,;,.„... ... 223 13% • Workload .._ ..,_rrrrry 875 53% Other,please specify 389 23% —. View Responses Figure 4.6;Summary Survey Results-Factors Making Your Job Harder Work Function The results of this question correlate very strongly to the Field Observations and Detailed Survey. These other data collection methods showed that the three largest work functions conducted by county Administration staff are Ongoing/Case Maintenance,Application Initiation,and Intake. These are the three main components associated with maintaining existing cases and opening new cases.It makes sense that Ongoing/Case Maintenance is a bit higher than Intake/AI.Since there are CO Workload Study Project—6/23/2007 Page 77 Copyright O 2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study — more tasks associated with Ongoing/Case Maintenance,it is expected that more survey respondents would select this option. Summary Survey Results-Work Function Please place a checkmark next to any(and all)of the job functions that you conduct. a)Front Desk/Reception 371 22% b)A0plication ".., 745 44% Initiation e)Intake ::: ..� , a vim, 756 44% d)Case Maintenance/Ongaing 676 52% e)Fraud Prevention 300 13% and Enforcement f)Eligibility Supervisor +YflYifid0 141 8% g)Eligibility Manager 95 5% _. h)Fiscal Operations 9WIYW-- 129 8 ij CMS Supportmikaaritmits 266 16% D APS 135 8% _ Other,please specify {....:.:; .,,......r YYi 608 36% View tesperses Figure 4.7:Summary Survey Results-Work Function Business Model Continuum The answers to the first Business Model Continuum question again correlate strongly with Field Observations.The majority of staff indicated that they are specialized by Program Area.Large and medium Counties using either a Hybrid Model (Program Specialist/Functional Generalist) or a Specialist Model (Program Specialist/Functional Specialist)would have fallen in the majority indicating Specialist by Program Area(44%),and small counties using the Hybrid (Program Generalist/Functional Specialist) or Generalists (Program Generalist/Functional Generalist)would have fallen in the second category Generalists by Program Area(36%). — The majority of respondents also identified that,in their office,are Generalists by Function(45%) versus Specialist by Function (39%).This too correlates strongly to Field Observations which show _.. that the majority of Small to Medium counties is Generalists by Function.Generally,Large Counties are the only category that is Specialist by Function (39%). CO Workload Study Project—6/23/2007 Page 78 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Summary Survey Results-Business Model Continuum Are the Eligibility(Technician)staff in your office: ik Specialists by Program Area (Example:One unit does Food Stamps 739 44% Only,One unit does TANF,FS,Medicaid, etc.) Generalists by Program Area 599 36% (Example:Staff work on all programs) Not Applicable i== 219 13% Other,please specify: 287 17% ..� Vie?,Response_ Are the Eligibility(Technician)staff in your office: Specialists by function (Example:Intake Only Units,Ongoing 650 39% Only Units) Generalists by Function (Example:Eligibility 751 45% staff do Intake and Ongoing functions) Not Applicable IMMO 236 14% Other,please specify ® 130 8% View Responses Figure 4.8:Summary Survey Results-Business Model Continuum _ CO Workload Study Project—6/23/2007 Page 79 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study AI—Paper/Paperless The majority(33%) of staff(excluding"N/A"and "Other") stated that AI is first done on a paper form before being entered into CBMS.A smaller group(20%) indicated that Al was being entered ._ into CBMS in real-time.The large number of staff who answered"N/A"or"Other"were ancillary/indirect staff who did not know the answer.These answers match what we saw in Field Observations,where most counties were completing some kind of paper form before completing the Application Initiation(AI) process in CBMS. Summary Survey Results-AI—Paper/Paperless • When you are conducting Application Initiation(AI),are you: Writing information on a paper form while • you are conducting ..... the interview with the 541 33% client and entering information into CBMS at a later time. Entering information into CBMS while you are conducting the • 335 20% interview with the client. • Not Applicable 711 43% Other,please specify 256 16% View Responses Figure 4.9:Summary Survey Results-AI—Paper/Paperless 11—Paper/Paperless The majority(40%) of staff(excluding"N/A"and"Other") stated that II is first done on a paper form before being entered into CBMS.A smaller group (22%)indicated that AI was being entered into CBMS in real-time.The large number of staff who answered"N/A"or"Other"were ancillary/indirect staff who did not know the answer.These answers match what we saw in Field Observations,where most counties were completing some kind of paper form before completing the Interactive Interview (II)process in CBMS. Summary Survey Results-II—Paper/Paperless When you are conducting Interactive Interview(II), are you: Writing information on a paper form while you are conducting the interview with the allENIMMUMME 656 40% client and entering information into CBMS at a later time. Entering information into CBMS while you • are conducting the ® 361 • a22% interview with the • client. Not Applicable 654 40% Other,please specify . 198 View Responses Figure 4.10:Summary Survey Results-11—Paper/Paperless -- CO Workload Study Project—6/23/2007 Page 80 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study AI—Clerical or Eligibility Staff 49%of staff indicated Application Initiation (AI) as an eligibility function,and 400/0 indicated it as a clerical function.This is comparable to what we saw in Field Observations,where many small and medium counties had workers doing their own AIs,and larger medium and large counties had other clerical or support staff completing Al. Summary Survey Results-AI—Clerical or Eligibility Staff • Is Application Initiation(AI)done in your office by the: Front Desk (Clerical/Administrative • 654 40% Support)staff. Eligibility(Technician) ammimmaims 305 49% y staff. Not Applicable =ID 213 13% Other,please specify 281 17% View Responses Figure 4.11:Summary Survey Results-Al—Clerical or Eligibility Staff Scheduling—Electronic or Paper 44%of staff indicated that they used electronic scheduling,and 42%of staff indicated that they use paper scheduling.This,again,is very comparable to what we saw in Field Observations,with about half of counties (generally medium to large) using electronic scheduling and half of counties (generally small to medium) using paper scheduling. ... Summary Survey Results-Scheduling—Electronic or Paper What type of scheduling system do you use in your office to sdiedule client interviews? Pacer Scheduling System • (Wall Calendar, u,„ww.. • 693 42% • Appointment Book, • • 3 etc.)oin Electronic Scheduling • System .,. ..,.,.ud..: 733 44% (MicrosoftOutlook, ScheduleView,etc.) Not Applicable 282 17% Other,please specify: --- -- 220 • 13'+6 View Responses` Figure 4.12:Summary Survey Results-Scheduling—Electronic or Paper ammo CO Workload Study Project—6/23/2007 Page 81 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing _ Workload Study 4.3 Our Interpretation of Field Observations and Summary Survey Results _ One key trend from the Detailed Survey is that processing times in smaller counties are higher than larger counties (see Table 1.5). We believe this fact is due to certain choices that counties are making, and also extenuating circumstance, and we do not view this as a structural or business model _ problem.The fact that smaller counties tend to be more Generalist and larger counties tend to be more Specialist, is not the cause for the disparity in processing time. Instead the differences come as a result of counties'varying priorities and constraints. In Field Observations,we found that, although smaller counties are aware of performance and efficiency metrics, their primary focus is attending to clients'unique needs and fostering personal interaction. Smaller counties'lower per-capita workload allows them to focus more on client — interaction rather than constantly streamlining processes. Smaller counties do not have as large of a workload and dedicate more concentrated attention to clients' unique needs,which explains the higher activity times. Smaller counties could benefit by adopting some of the positive aspects seen in _ larger counties and creating calculated process efficiencies,without completely overhauling the way they operate. Specifically,we believe that smaller counties could benefit from improved Change Management, Communications and Training which tend to be more accessible in larger counties. Consequently, smaller counties would be able to maintain their generalist customer-centric model, and in parallel improve efficiency. We found much different challenges in larger counties. Although, larger counties are committed to providing quality customer service, they are much more aware of metrics and process efficiency than smaller counties and hence focus on maximizing these elements.The higher per-capita workload in larger counties necessitates a certain degree of specialization and requires that processes are continually improved. Although specialization offers clear benefits to larger counties,other benefits can be realized by centralizing more routine tasks. Since workers generally have large caseloads,they spend an inordinate amount of time on ad-hoc case-related functions. As reflected in Table 3.15, _ 37%of a staff person's workload is spent on Case Related Activities such as case reviews and changes in client circumstances. Couple that with 17%of workload resulting from Client Communications and Information such as phone calls and noticing, and 55% (37%+17%) of a worker's time is spent on ad-hoc case activities.This may be a contributing factor to backlog and — overdue processing of RRRs, Claims and Intakes. By creating a unit of centralized staff to handle aspects of client communication and ad-hoc case maintenance,workload can be re-balanced and eligibility staff can be freed up to focus on more core responsibilities such as Intake and RRR, — providing a significant opportunity to reduce backlog and provide more personal client service. Another way of re-distributing workload that would benefit larger counties includes providing alternative methods of client access to benefit information and ability for clients to self-serve for _ things such as minor case updates,viewing benefits and submitting applications. This too would significantly reduce workers'ad-hoc case related workload. Once larger counties are able to reduce their workload to a more manageable level,they will be able to adopt a more customer-centric focus as seen in smaller counties. In section 4.4 we describe specific solution options to build upon existing strengths and improve areas of need, and describe our recommended timeline for implementation of the solution options. CO Workload Study Project—6/23/2007 Page 82 — Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study 4.4 Trends in Human Services Modernization 4.4.1 Overview In this section,the team identified selected modernization strategies that effectively align with some of the challenges identified above. As these solution options are considered, and as various options .— are implemented,the state and counties move closer to aligning itself with its vision of integrated service delivery.We have divided this section into three key areas of modernization considerations: 1) Technology 2) Process and 3) People. Each solution option describe therein provides an assessment of the impact the changes will make to county offices and describes their benefits. Technology Within the Counties, technology is used to process cases, run reports,monitor operations,document compliance, store information,communicate with others within the organization,and to communicate with others outside of the organization.The systems in place throughout the counties are inextricably linked to an employee's ability to perform his or her job. Technology is a key enabler in streamlining and improving business operations and customer service. By implementing innovative technologies while maximizing the effective use of existing technologies, significant improvements are still possible. Operations/Service Delivery Operations/Service Delivery refers to the daily tasks and activities associated with the administration of social benefits to disenfranchised citizens. It is the cohesive collection of responsibilities that are primarily performed by county staff and administrators to provide clients, and their community '— partners,with consistent,accurate,and appropriate access to human services benefits and support. Service delivery is measured by a county's ability to provide clients with timely access to information as well as benefits in a manner that is respectful of cultural and lifestyle differences. People Staff/Customer Care is a multifaceted concept. In a county,Staff/Customer Care includes providing adequate attention, support,guidance and information to staff balance with timely, accurate and compassionate delivery of benefits to those most vulnerable.This delivery depends,in part,on an understanding of the complex issues that trigger`people issues' and high yield ways to effectively reduce the stress and frustration often found in human services CO Workload Study Project—6/23/2007 Page 83 "" Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Core Components of Human Services Modernization • • • Figure 4.13:Core Components of Human Services Modernization CO Workload Study Project—6/23/2007 Page 84 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Technology Web-Enabled Access 1) Provider Access - Provider Information Update -Client Participation, Tracking, Compliance 2) Community Partners Access -Assisted Screening -Assisted Application -Outreach 3) Client Access -View Case Information -Update Case Information -Online Application CBMS Enhancements 4) Increased Automation of CBMS 5) Improvements to Existing CBMS Sub-Systems 6) Additional CBMS Subsystems Operations/Service Delivery Communication/Change 7) Project Management Management 8) Help Desk(IT Service Management) 9) Change Management(Tracking Change Requests, Bug Fixes, Release Notes) 10) Strategic Communications, and Training Governance 11) IT Program Management Office 12) Policy Program Management Office 13) Subcommittee Structure involving both Executive Groups People Business Model 14) Role Re-Definition 15) Business Model Re-Design Customer Service Center 16)Centralized Statewide Customer Service Center for General Questions/Inquiries How did we define this list of Solution Options? Throughout the Detailed Survey, Field Observations,and Summary Survey,County Staff identified key areas for modernization.The information from county stakeholders during Field Observations and the results of the Summary Survey had strong correlations expressed by County Stakeholders. Figure 4.13—Areas for Improvement reflects the general feedback of County Staff related to areas of change or improvement: CO Workload Study Project—6/23/2007 Page 85 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study —' Summary Survey Result-Areas for Improvement If you were able to choose,what areas that you'd like to see expanded,improved upon,or changed. 36. -- Please salad only three areas that you'd like to see changed. Change Management and Training -Providing CSMS and _. Policy information in a 936 59% concise,usable format -Help Desk -Eliminating duplicative processes Reducing Paper/Document Imaging -Imaging case 619 39% documentation -Creating E-Files for cases Client Web-Access -Internet access to client eligibility information 338 21% -Internet access to benefit information -Internet client self- screening Electronic Scheduling -Integrated electronic scheduling for client appointments 211 13% -Automated noticing for client appointments Reduce Vacancies and Reduce Caseload Size -Hire more staff and _ , ., • re-distribute workload 1261 79% -Less cases per worker More Office Space -More space for 653 41% r desks and client contact Figure 4.14:Summary Survey Result-Areas for Improvement As noted,Workload and Change Management and Training were identified by the majority of County Stakeholders. Reducing Paper/Imaging and More Office Space also had very strong response rates. CO Workload Study Project—6/23/2007 Page 86 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study 4.4.2 Technology Options In this section we will discuss some innovative technology being used by other states to modernize service delivery and provide some options for Colorado to enhance existing technology and implement new technology to meet the State and Counties' unique needs. By improving existing technologies and developing new technologies, the State and Counties' can increase outreach, — encourage self-service, and de-centralize workload.The Technology Solution Options that we will be discussing are as follows: 1) Web Enabled Access 2) Integrated Eligibility Enhancements 3) Change Center Web-Enabled Access _ High-Level Summary What is it? Web Enabled Access includes three main components for different stakeholder groups. Provider Access makes allows providers to self-serve and make their own provider updates, as well as track and monitor client participation and compliance. Community Partner Access allows community groups who interface with Human Services to screen and refer clients, as well as complete portions of the application process. Finally,client access allows clients to self-serve by looking up their benefit information and updating case information much like an online banking system. Who is it relevant to? State and Counties Why it is relevant? Although an initiative such as Web-Enabled Access would have to be sponsored at the state level,the benefits would apply to both the Sate and Counties. Detailed Description Client Access Web-Enabled Access makes ease-of-use priority,intentionally making use of white space, customizing references to "Suzy's income" rather than "Person l's income", using simple language (4th grade level),and use of familiar icons and pictures. Clients can complete eligibility screening within 15 minutes and can apply for benefits within 30 to 45 minutes. Optional account creation allows user to save and complete the application at a later time. Pages and questions are intelligently scheduled based on programs requested and demographics. Progress bar and intelligent left navigation menu provide status of the user's progress through the application or screening process. Pages provide flexibility to leave questions unanswered while a "completeness check" strongly encourages users to submit completed applications. Filing date applications are permitted,wherein the user submits a minimum amount data to get their request for benefits.The minimum data requirements for this include: Program Requests, First Name,Last Name, County and Street Address. Clients can electronically sign and submit their application in real time to their local agency. The submission process provides clients with an application number for reference and a printable version of the application after submission. CO Workload Study Project-6/23/2007 Page 87 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Provider Access Providers are offered similar benefits as clients with Web-Enabled Access.They can apply to be providers and manage their provider information once they are registered as providers. Applicability to Colorado The use of web-based solutions for Human/Social Services have been used by many states as a way to encourage self-service,yield cost savings and reduce workload. Based on the results of the ABC — Model, 17% of the cost associated with County Administration was attributed to the Intake Process (including Al, II,and EDBC,Wrap-Up and Authorization). An additional 17% of the cost of County Administration was attributed to Client Communication (including phone calls regarding case — specifics and answering general eligibility questions.) Value Potential Analysis The table below is used to analyze where value is being added by each solution option. Furthermore, it describes the individual value potential for both the State and the County. Some of these options: 1) Add value at the county-level and state-level, and some of the solutions 2) Add value only at a county-level. The Impact analysis will indicate which of these three scenarios is true for each solution option. Not Some Moderate High Very High — Applicable Potential Potential Potential Potential O O • Value Proposition #3 #2 Reduced #1 Streamlined Workload/ #4 _. Stakeholder Optimized Business Increased Improved Client Group Staffing Model Processes Productivity Service Comments County • • • Clients and Providers will have easier access to services • Less"busy work" for eligibility staff • Less"real"work for eligibility staff. _ CO Workload Study Project-6/23/2007 Page 88 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Value Proposition #3 #2 Reduced #1 Streamlined Workload/ #4 Stakeholder Optimized Business Increased Improved Client Group Staffing Model Processes Productivity Service Comments State O O O . • By lessening the workload burden on counties,web- access can also create efficiencies for shared state and county processes. • In implementing a web-solution, the state will greatly improve their client service to the counties. Table 4.2 High-Level Impact Analysis This table describes the impact of implementing the described solution option on a process-by- process basis.The X-Axis contains the Value Proposition Criteria (Optimized Staffing Model, Streamlined Business Processes,Reduced Workload/Increased Productivity,Improved Client Service) and the Y-Axis contains Work Functions.The Impact analysis will give the potential impact that the solution option will have on each specific Work Function. By looking at all processes and potential impact for each Work Function, one can derive the Cost-Benefit of implementing such a solution. Value Proposition #3 #1 #2 Reduced Optimized Streamlined Workload/ #4 Staffing Business Increased Improved Process Model Processes Productivity Client Service Comments (ntake Intak • • QI • fewer Eligibility Staff e l handle (Intake Complete, fewer intake cases. Failed Al,Failed II) • Creates a parallel intake self-service process. • Workers will handle fewer face-to-face intakes. • Enables clients to self-serve will give them more control over their case, resolve transportation issues and expand access. CO Workload Study Project-6/23/2007 Page 89 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing _ Workload Study Value #3 Proposition #1 #2 Reduced Optimized Streamlined Workload/ #4 Staffing Business Increased Improved Process Model Processes Productivity Client Service Comments Case Related O al • Clients will be able to make Activities(Case ad-hoc case updates. Review, Seeking • Workers will receive less and Receiving single case update calls from — Assistance, clients. Processing Client Change in Circumstances, — Alerts) Client • • a • Clients will have on-demand Communication and inquiry access. — Information(Making • Clients will be able to and Returning validate notices that they Phone Calls,Ad- receive. Hoc -- Communication, Manual Noticing) Non-Case Related O O O O • Web-Enabled Access is not Administrative applicable to this Work Activities Function. (Administrative — Tasks, Meetings, Breaks,Training, Reports Management, Policy — Review) RRRs and Periodic • Web-Enabled Access is not — Reporting O O O O applicable to this Work Function. Claims O O O O • Web-Enabled Access is not applicable to this Work Function. Management O O O O • applicable Access is not Activities(Personnel a licable to this Work Management, Function. Counseling,Office — Operations) CO Workload Study Project-6/23/2007 Page 90 _ Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Value #3 Proposition #1 #2 Reduced Optimized Streamlined Workload/ #4 Staffing Business Increased Improved Process Model Processes Productivity Client Service Comments Other(Travel, O O O O • Web-Enabled Access is not Referrals,Appeals applicable to this Work and Hearings, Inter- Function.. County Transfers, APS-specific, EBT Card Embossing) Table 4.3 Other State Im lementations State Brief Description Benefit to Colorado Pennsylvania COMPASS is a Web-Enabled solution The COMPASS solution would provide clients COMPASS/ first implemented in Pennsylvania and and providers the option of on-demand self- Massachusetts IE&R then for the Commonwealth of service and has high potential to re-distribute Massachusetts. It includes tools workload,while improving customer service. include a common intake application, Web-access would also address some of the a disability assessment tool, a self- geographical challenges that counties face. In screening tool, a catalog of services, Field Observations, many counties expressed that an application inbox, and a resource their clients have difficulty obtaining transportation locator and are referred to as the to county offices.Web-Enabled access would Intake, Eligibility and Referral (IE&R) provide another way of applying for benefits or system. The online application is a making changes to a case.Additionally,workers single,online data collection form for can minimize the necessary interactions with registered providers as well as providers. Providers will be able to apply(to residents of Massachusetts. register as a provider)online, and will also be Wisconsin ACCESS Wisconsin ACCESS is another Web- able to make online updates to their provider Enabled application that allows clients information.Wisconsin ACCESS offers similar to see if they are eligible(screening), benefits as COMPASS and IE&R, and all three check benefits, apply for benefits and solutions have user-friendliness and intuitive report changes. navigation as core benefits. CO Workload Study Project—6/23/2007 Page 91 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing _ Workload Study Integrated Eligibility Enhancements High-Level Summary What is it? There are many technologies including Appointment Scheduling, Case Assignment and Electronic Case File (File Imaging)that can be implemented to improve the way core eligibility functions are conducted.Who is it relevant to? State and Counties Why it is relevant? By augmenting and integrating core technologies,the State and Counties will benefit through increased efficiencies, reduced workload and lower errors. Detailed Description Integrated Eligibility Upgrades and Improvements Our recommendations for core technologies are based on reports from State and County — stakeholders and our knowledge of the Integrated Eligibility systems. Electronic Scheduling and Noticing can he integrated and eliminate many manual scheduling and noticing workloads. Case Assignment would allow for better tracking,assignment and distribution of cases. Finally, Imaging — would allow the State and Counties to move towards a truly paperless system by being able to image all case documentation and view case documents online.All of these solution options offer a different set of benefits. Rather than looking for a one "fix all" solution,the State and Counties — should view Human Services Modernization as a holistic shift in thinking what can be accomplished through multiple means. Applicability to Colorado All the technologies described above address a different need for Colorado. Electronic Scheduling will eliminate much of the administrative work that technicians are currently doing.According to the ABC Model, 9% of the cost associated with County Administration is associated with Administrative Activities such as noticing and scheduling for client appointments. By automating these processes and eliminating duplicate and disjointed business practices, there is substantial opportunity for time and cost savings. Case assignment is another activity that is currently unwieldy in Colorado. It is not easy or intuitive to assign, manage or move individual cases or whole caseloads.This is another source of inefficiency and unnecessary administrative tasks. Finally, the creation of Electronic Case Files is a third means of reducing the time and cost of administrative tasks. By imaging case files you improve accessibility to client information by centralizing this information and putting it online. Although this task requires a significant time and resource commitment to implement,it can yield significant benefits. Once implemented,all client case information is available on-demand,without having to locate a paper case file. —' Value Potential Analysis The table below is used to analyze where value is being added by each solution option. Furthermore, — it describes the individual value potential for both the State and the County. Some of these options: 1) Add value at the county-level and state-level,and some of the solutions 2) Add value only at a county-level. The Impact analysis will indicate which of these three scenarios is true for each solution _ option. CO Workload Study Project-6/23/2007 Page 92 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Not Some Moderate High Very High Applicable Potential Potential Potential Potential O 0 • Value Proposition #3 #1 #2 Reduced #4 Optimized Streamlined Workload/ Improved Stakeholder Staffing Business Increased Client Group Model Processes Productivity Service Comments County O • • • Improving and further augmenting Integrated Eligibility functions will allow counties to make holistic business improvements. State O • O • • Imgeg and furtaer augmenting Integrated Eligibility functions would demonstrate a high level of commitment by the state, help quell discontent in the counties, and minimize county push-back. Table 4.4 I Iigh-Level Impact Analysis This table describes the impact of implementing the described solution option on a process-by- process basis.The 3i-Axis contains the Value Proposition Criteria (Optimized Staffing Model, Streamlined Business Processes,Reduced Workload/Increased Productivity,Improved Client Service) and the Y-Axis contains Work Functions.The impact analysis will provide the potential impact that the solution option will have on each specific Work Function. By looking at all processes and potential impact for each Work Function, one can derive the Cost-Benefit of implementing such a solution. CO Workload Study Project—6/23/2007 Page 93 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Value #3 NT #t #2 Reduced #4 Optimized Streamlined Workload/ Improved Staffing Business Increased Client ProcessModel Processes Productivity Service Comments Intake • Electronic Scheduling Module will (Intake Complete, automatically close cases when Failed AI, Failed II) clients miss their interview, eliminate manual scheduling, _... integrate scheduling all client interviews and hence eliminate the need for disparate methods of scheduling. • Case Assignment will allow for automated and equitable distribution of new cases. • Imaging will allow all case — information to be put online once the case is authorized. Case Related O C • • Case Assignment will allow for Activities(Case the seamless movements of Review, Seeking caseloads and caseload re- and Receiving balancing — Assistance, Processing Client Change in Circumstances, — Alerts) Client • • Electronic Scheduling will Communication and automate many aspects of Information (Making noticing. and Returning Phone Calls,Ad- Hoc — Communication, Manual Noticing) Non-Case Related O O • Imaging will eliminate the risk of Administrative lost paper case folders and Activities provide more controls over the (Administrative access to case information. Tasks, Meetings, • Imaging will save administrative — Breaks,Training, time associated with locating a Reports paper case folder. Management, Policy Review) RRRs and Periodic O O O O • Integrated Eligibility Reporting Enhancements are not applicable to this Work Function. • CO Workload Study Project—6/23/2007 Page 94 Copyright©2007 Deloitte Development LLC. All rights reserved. — Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Value #3 NN Proposition #� #2 Reduced #4 Optimized Streamlined Workload/ Improved Staffing Business Increased Client Process Model Processes Productivity Service Comments Claims O O O O • Integrated Eligibility Enhancements are not applicable to this Work Function. Management O O • Case Assignment will allowfor Activities(Personnel caseload re-balancing and re- Management, distribution of work. Counseling, Office Operations) Other(Travel, O O O O • Integrated Eligibility Referrals,Appeals Enhancements are not applicable and Hearings, Inter- to this Work Function. County Transfers, APS-specific, EBT Card Embossing) Table 4.5 Other State Im,lementations State Brief Description Benefit to Colorado California The Appointment Scheduling module for Colorado would greatly benefit from the Electronic Scheduling the CaIWIN system is an integrated increased EDBC and Client Correspondence scheduling module that not only provides automation associated with Appointment all users a means of scheduling and Scheduling. Every time an appointment is managing all client appointments, but it scheduled a pre-populated appointment letter is also enhances existing functionalities printed (either online or in batch).This reduces such as EDBC and Client the administrative work associated of Correspondence. generating a manual appointment letter. EDBC will also be impacted by the implementation of Appointment Scheduling. Once an appointment is scheduled,the system tracks appointment status and takes action accordingly. If a client misses their Intake/RRR appointment,the system will automatically close the case, and send a notice. This eliminates the need for workers to manually Cancel/Withdraw/Deny these cases and create the discontinuance notice. California The Case Assignment module for the Case Assignment would reduce administrative Case Assignment CalWIN system allows counties to workload and error associated with the customize the way they managed their management and assignment of cases. It would cases.This included assigning caseload allow users to maintain more control of case access rights based on profile, and caseload movement or automate case automated or manual case assignment, assignment and balancing based on county caseload balancing, and transfer of any preference. one case or caseload within the county. CO Workload Study Project-6/23/2007 Page 95 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Wisconsin The ECF solution allows for creation of Case Workers Electronic Case File an electronic case file which is stored • Create an electronic case file that (ECF) either in an online database or on a could be easily accessed and shared _ County's intranet. Every active/inactive among workers while still maintaining case would have its own file containing a the confidentiality and privacy of client "scanned"version of Statement of Facts, info Verifications and any other paper forms • Clean-up and update case files to _ associated with a case. The solution ensure they contain appropriate and provides easy and broad access to client current information case information. • Standardize case file content across locations State and County Management • Improve the Food Stamp error rate by ensuring all required documents can be easily found — • Improve payment accuracy for all programs of Public Assistance • Ease in sharing information across offices for QC and case transfers — Clients (Recipients) • Improve customer service by making the documents easily available and shared among workers administering — different programs Customer Contact Center High-Level Summary What is it? Customer service center for answering questions, providing case — information, and doing limited eligibility tasks. Who is it relevant to? State and County Why ft is relevant? A Customer Contact Center can be used to reduce workload for counties and reduce costs for the state. Detailed Description The development and implementation of a Customer Contact Center could be considered as a means to alleviate routine district office staff work and offer an alternative avenue to serve clients -most notably by giving clients a choice in how they interact with a Human Services agency. Depending on its structure and function, a Customer Contact Center could also provide expanded hours of access by using automated information message and ideally Interactive Voice Recognition (IVR) telephony system and could enable clients to help themselves by accessing information from self-service menus. The staff of the Customer Contact Center could support the County/State eligibility staff by helping to address questions and perform routine case actions. It will be important to empower Customer -' Contact Center staff to deliver better service by giving them the right tools,processes,and information to help the client every time. The establishment of a Customer Contact Center can CO Workload Study Project—6/23/2007 Page 96 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study alleviate significant administrative workload such as case inquiry,client initiated case changes, and requests for information. Key benefits include the following, • Reducing foot traffic in waiting rooms,volume of telephone calls disrupting eligibility technicians,voicemail, and return phone calls. • Providing a safe alternative for clients who cannot arrange for convenient transportation to their county office. • Providing services to clients that do not speak English. • Reporting case change information will be easier and timely for working clients. • Providing assurance to clients, through tracking confirmation,that their information was received. • Enabling a client to reach a"live"person —eliminating the need to leave voice messages and wait for returned calls. • Planning for fewer interruptions in work flow for eligibility workers which will result in increased accuracy. • Increasing clients'willingness to report changes because there is a simpler process in place. Applicability to Colorado Based on results from the ABC Model, 17%of the Counties' County Administration costs are expended on Client Communications and Information,which includes making,receiving and returning phone calls.This cost rivals the amount of cost associated with core functions such as Intake (17%) and constitutes 5% cost more than RRR (12%).By implementing a Customer Contact Center, the State/Counties could significantly re-balance the workload in counties and allow staff to focus more of their energy on core functions,rather than ad-hoc communications. Value Potential Analysis The table below is used to analyze where value is being added by each solution option. Furthermore, it describes the individual value potential for both the State and the County. Some of these options: 1) Add value at the county-level and state-level,and some of the solutions 2) Add value only at a county-level. The Impact analysis will indicate which of these three scenarios is true for each solution option. CO Workload Study Project-6/23/2007 Page 97 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Not Some Moderate High Very High Applicable Potential Potential Potential Potential 0N.N Value Proposition #3 #1 #2 Reduced #4 Optimized Streamlined Workload/ Improved Stakeholder Staffing Business Increased Client Group Model Processes Productivity Service Comments County • • • Less ad-hoc phone calls, — answering questions, providing information. • More focus on core functions — such as Intake and Ongoing. State O O • State provides centralized customer service for the Counties. Table 4.6 High-Level Impact Analysis This table describes the impact of implementing the described solution option on a process-by- process basis. The X-Axis contains the Value Proposition Criteria (Optimized Staffing Model, Streamlined Business Processes,Reduced Workload/Increased Productivity,Improved Client — Service) and the Y-Axis contains Work Functions.The Harvey Balls will give the potential impact that the solution option will have on each specific Work Function. By looking at all processes and potential impact for each Work Function,one can derive the Cost-Benefit of implementing such a — solution. Value Proposition #3 #1 #2 Reduced #4 Optimized Streamlined Workload/ Improved Staffing Business Increased Client Process Model Processes Productivity Service Comments Intake O O O O • Clients will be better informed — (Intake Complete, when they come in for Intake. Failed AI, Failed II) CO Workload Study Project—6/23/2007 Page 98 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing — Workload Study — Value #3 Proposition #1 #2 Reduced #4 Optimized Streamlined Workload/ Improved Staffing Business Increased Client Process N Model Processes Productivity Service Comments Case Related O O 4 QI • Center will be able to perform Activities(Case some of the routine case Review, Seeking updates, reviews for eligibility and Receiving staff. Assistance, • Clients will be able to report Processing Client changes without waiting for their Change in worker. Circumstances, Alerts) — Client • • • • • Clients will have 24-hour access Communication and to information. Information(Making • Clients will not have to depend and Returning on notices and sporadic contact — Phone Calls,Ad- with their worker. Hoc Communication, Manual Noticing) Non-Case Related O a cip O • Clients can call the Center to Administrative inquire on Policy Information. Activities (Administrative Tasks, Meetings, Breaks,Training, Reports Management, Policy Review) RRRs and Periodic O O O O • Center will likely have little to no — Reporting impact on this Work Function. Claims O O O O • Center will likely have little to no impact on this Work Function. Management O O O • iCentermpact will likely have little to no Activities Personnel impact on this Work Function. Management, Counseling,Office Operations) Other(Travel, O O O O • Center will likely have little to no Referrals,Appeals impact on this Work Function. and Hearings, Inter- - County Transfers, APS-specific, EBT Card Embossing) '-- Table 4.7 CO Workload Study Project-6/23/2007 Page 99 — Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study — Other State Im elementations State Brief Description Benefit to Colorado Pennsylvania,West Customer Contact Centers were States have recognized over the years the Virginia, Florida implemented in Pennsylvania,West importance of effective stakeholder Customer Contact Virginia and Florida as a means of communications throughout the lifecycle of a Center centralizing certain customer service system implementation. In implementing a — functions and offloading some more routine Customer Contact Center the State will and time consuming tasks from their eligibility staff. It was also used as a • Build effective communications communication hub for policy and systems networks so information is information. disseminated accurately, effectively, clearly and to the right audiences — • Work with advocacy groups to let them know of high priority regulatory and system changes. — • Establishment of advisory committees to provide a forum for discussion, negotiation,guidance — and change. 4.4.3 Operations/Service Delivery Options Communication/Change Management — High-Level Summary What is it? Improve the way change items are being managed at the CBMS Project-Level as well as in the Counties Who is it relevant to? State and Counties Why it is relevant? By vetting change communications at the state and county level,confusion, mistakes and lack of productivity can be minimized. Detailed Description The State and Counties can develop a comprehensive framework for dealing with maintenance and operations of the CBMS system. This is done through the use of tools,templates, and methodologies used for managing and communicating change,including but not limited to,help desk plans, communications templates,work plans, and change request databases. In turn, key staff learn how to summarize and communicate system changes,resolve and/or escalate system problems,and — continually improve processes using efficient standardized methods. By more effectively managing and communicating change,workload and confusion can be significantly reduced for the majority of staff. By communicating change in a clear,concise manner,you lessen the burden of indirect activities such as reading Release Notes and Training Documentation,and hence, staff are able to focus on serving their clients. CO Workload Study Project-6/23/2007 Page 100 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Applicability to Colorado In the Summary Survey, staff overwhelmingly indicated Change Management/Training as an area of potential improvement (59%). In Field Observations it was brought to our attention,that rather than receiving tailored, concise communications about system and regulation changes, staff receive hundreds of pages of documentation that is not easily filterable and required a significant amount of time to sort through.With this just being one example,it is clear that there is a connection between the way change is being managed at the state and county level and the large workload that staff are facing(73% of staff indicated workload as the number one thing they would like to see changed). Staff are overwhelmed with growing caseloads,constant change,and an unclear support structure. Value Proposition Analysis The table below uses "Impact analysis" to describes the potential for either the State or County to implement the respective solution option. Some of these options: 1) Add value at the county-level and state-level, and some of the solutions 2) Add value only at a county-level.The Impact analysis will indicate which of these three scenarios is true for each solution option. Not Some Moderate High Very High Applicable Potential Potential Potential Potential 0 O c • Value Proposition #3 #1 #2 Reduced #4 Optimized Streamlined Workload/ Improved Stakeholder Staffing Business Increased Client Group Model Processes Productivity Service Comments County O • • • ge Management program program will reduce angst felt by county staff about constant change • Communication of change will be clearer and have"one voice" State O • O • • Improved communication and relations with the counties • Better methods for divulging information Table 4.8 High-Level Impact Analysis This table describes the impact of implementing the described solution option on a process-by- - process basis. The X-Axis contains the Value Proposition Criteria (Optimized Staffing Model, Streamlined Business Processes,Reduced Workload/Increased Productivity,Improved Client Service) and the Y-Axis contains Work Functions.The Impact analysis will give the potential impact CO Workload Study Project-6/23/2007 Page 101 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study — that the solution option will have on each specific Work Function. By looking at all processes and potential impact for each Work Function,one can derive the Cost-Benefit of implementing such a solution. — value #3 Proposition — #� #2 Reduced #4 Optimized Streamlined Workload/ Improved Staffing Business Increased Client Process Model Processes Productivity Service Comments Intake • • Change Management and (Intake Complete, Communications will have a Failed Al, Failed II) deep-impact on overall workload, productivity and client service across all functions. Case Related • • • Change Management and Activities(Case Communications will have a Review, Seeking deep-impact on overall workload, and Receiving productivity and client service — Assistance, across all functions. Processing Client Change in Circumstances, — Alerts) Client O • • • Change Management and Communication and Communications will have a — Information(Making deep-impact on overall workload, and Returning productivity and client service Phone Calls,Ad- across all functions. Hoc Communication, Manual Noticing) Non-Case Related O • • • Change Management and Administrative Communications will have a Activities deep-impact on overall workload, (Administrative productivity and client service — Tasks, Meetings, across all functions. Breaks, Training, Reports Management, Policy — Review) Repo and Periodic • • • Change Management and Reporting Communications will have a deep-impact on overall workload, productivity and client service across all functions. CO Workload Study Project-6/23/2007 Page 102 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Value #3 NN Proposition #1 #2 Reduced #4 Optimized Streamlined Workload/ Improved NN Staffing Business Increased Client Process Model Processes Productivity Service Comments Claims O • • • Change Management and Communications will have a deep-impact on overall workload, productivity and client service across all functions. Management • • • Change Management and Activities(Personnel Communications will have a Management, deep-impact on overall workload, Counseling, Office productivity and client service Operations) across all functions. Other(Travel, O • • • Change Management and Referrals,Appeals Communications will have a and Hearings, Inter- deep-impact on overall workload, County Transfers, productivity and client service APS-specific, EBT across all functions. Card Embossing) Table 4.9 Other State Implementations State Brief Description Benefit to Colorado California Tulare County(California)learned from A county Change Management Process counties earlier in the CaIWIN offers many significant benefits: implementation cycle that one of the largest areas of impediment pre- • Provide county staff with timely implementation, during implementation and information before significant post-implementation involved the system/policy changes. management and distribution of • Standardize messaging format so it information being received from Policy is easily and quickly understood. entities(State and Federal)and from the • Minimize confusion with system CaIWIN Project Team. Hundreds of emails releases and policy changes occur. and policy memos would be sent to • Reduce user error due to counties on a monthly basis and it was misinformation about system and virtually impossible to manage and policies. communicate relevant information without a structured methodology. Deloitte Consulting worked with the county to devise a standardized method for digesting,tracking, communicating and storing information called the Tulare County Change Management process. CO Workload Study Project-6/23/2007 Page 103 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing _ Workload Study Oversight and Quality Assurance — I ligh-Level Summan- What is it? IT Oversight and Quality Assurance, Program Management, Subcommittee Structure Who is it relevant to? State and Counties Why it is relevant? Establishing Executive Oversight, Subcommittee Structure for Human Services Policy and IT, and Quality Assurance Detailed Description In order to increase the likelihood of success of change initiatives such as Web-Enabled Access and Integrated Eligibility enhancements, there must be a group of knowledgeable executives and managers to oversee these changes.This can be done through the establishment of subcommittees, creating protocol for decision making,and establishing standardized timelines for task completion. Things such as IT Oversight, Quality Assurance and Program Management can foster accountability and ensure that that all change initiatives undertaken by Human Services stakeholders are executed in a way that mitigates risk and increases the likelihood of success. The core of realizing all these solution options is having strong executive team overseeing the various change initiatives. As new ideas are conceived and eventually constructed, they must be scrutinized.Therefore there must be a structure in place for State and County stakeholders to provide guidance as the various initiatives are being rolled out. Applicability to Colorado The concept of Oversight and Quality Assurance dovetails well with the concept of Change Management and Communications. By establishing an Oversight and Quality Assurance group(s),the State and Counties will provide a decision-making body for key changes.This body can then guide the implementation of something like a Change Management Plan, or Web-Enabled Access.This group would take ownership of any and all change initiatives and guide these initiatives to — completion. Value Potential Analysis The table below is used to analyze where value is being added by each solution option. Furthermore, it describes the individual value potential for both the State and the County. Some of these options: 1)Add value at the county-level and state-level, and some of the solutions 2) Add value only at a county-level.The Impact analysis will indicate which of these three scenarios is true for each solution option. Not Some Moderate High Very High — Applicable Potential Potential Potential Potential O O • CO Workload Study Project-6/23/2007 Page 104 _ Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Value Proposition #3 #1 #2 Reduced #4 Optimized Streamlined Workload/ Improved Stakeholder Staffing Business Increased Client Group Model Processes Productivity Service Comments CountyCID CID CID • Improved IT Governance will have a widespread and significant positive impact on all aspects of County Operations State • • • • • Improved crucial Governance is crucial in gaining solidarity for all State stakeholders including DHS, HCPF and CBMS. Table 4.10 High-Level Impact Analysis This table describes the impact of implementing the described solution option on a process-by- process basis.The X-Axis contains the Value Proposition Criteria (Optimized Staffing Model, Streamlined Business Processes,Reduced Workload/Increased Productivity,Improved Client Service) and the Y-Axis contains Work Functions.The Impact analysis will give the potential impact that the solution option will have on each specific Work Function. By looking at all processes and potential impact for each Work Function,one can derive the Cost-Benefit of implementing such a solution. Value Proposition #3 ._. #1 #2 Reduced #4 Optimized Streamlined Workload/ Improved Staffing Business Increased Client Process Model Processes Productivity Service Comments Intake • IT Governance will have a deep- (Intake Complete, cup impact on overall workload, Failed Al, Failed II) productivity and client service across all functions. Case ies Related O • • IT pact on Governance will have a deep- Activities(Case impact on overall workload, Review, Seeking productivity and client service and Receiving across all functions. Assistance, Processing Client Change in Circumstances, Alerts) CO Workload Study Project—6/23/2007 Page 105 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Value #3 Proposition Reduced #4 #1 #2 _ Optimized Streamlined Workload/ Improved Staffing Business Increased Client Process Model Processes Productivity Service Comments Client • IT Governance will have a deep- Communication and • impact on overall workload, Information (Making productivity and client service and Returning across all functions. Phone Calls,Ad- Hoc Communication, Manual Noticing) Non-Case Related O CII• • IT Governance will have a deep- Administrative impact on overall workload, Activities productivity and client service (Administrative across all functions. Tasks, Meetings, Breaks,Training, Reports Management,Policy Review) RRRs and Periodic O • • IT Governance will have a deep- _ Repoepo rting Ell impact on overall workload, productivity and client service across all functions. _ Claims O • • IT Governance will have adeep- impact on overall workload, productivity and client service across all functions. Management • • IT Governance impact o n will have a deep- Activities(Personnel m act on overall workload, Management, productivity and client service Counseling, Office across all functions. Operations) Other(Travel, O • • IT Governance will have adeep- Referrals,Appeals impact on overall workload, and Hearings, Inter- productivity and client service County Transfers, across all functions. APS-specific, EBT Card Embossing) Table 4.11 • CO Workload Study Project—6/23/2007 Page 106 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Other State Implementations ' State Brief Description Benefit to Colorado Florida Deloitte Consulting developed a Project Establishing a strong executive oversight for Management Office for State of Florida Human Services IT systems the following Human Services IT systems. The PMO benefits can be realized: developed protocols for communication and decision making with respect to their • A"big picture"view regarding the IT systems. future of existing IT systems • A centralized decision-making body for IT issues • Ability to foster unity between disconnected parts of the agency 4.4.4 People Options Business Model Modernization High-Level Summary What is it? A comprehensive assessment and re-engineering of core business processes to maximize efficiency. Who is it relevant to? Counties Why it is relevant? Business Model Modernization allows counties to reduce duplication, leverage technology _. and standardize their business practices. Applicability to Colorado During Field Observations,there were certain inefficiencies/duplications that counties were performing. For instance, the majority of counties were duplicating work by using paper forms to complete key functions such as AI,II,and RRR before actually entering information into CBMS. By conducting a comprehensive business model transformation and standardizing business practices, counties can close efficiency gaps,lower processing times, and improved customer service. Detailed Description A comprehensive business model review and re-engineering involves some key steps. Phase 1 —Strategy First, a human services agency must take inventory of all current or "As-Is"business practices. Secondly, the agency must develop a vision statement,as a guiding principle for formulation of new or"To-Be" business practices. Third,workgroups must be established with subject matter experts from throughout the agency. Fourth, a series of workshops must be conducted and process-flows must be produced from these workshops mapping the agency's new processes (See below for a Phase 1 timeline for a Business Model Transformation Project). CO Workload Study Project—6/23/2007 Page 107 Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study Phase 2—Implementation Once the changes to the agency business model have been determined, they must be implemented. This requires strategic communication,training,executive sponsorship and cooperation of the entire _ agency. An organizational change of this scale requires buy-in from every level of the agency, including executives,middle management, and line staff.Depending on the number of dedicated resources and the preferred timeline, implementation can proceed in implementing in either a "big- bang" or"staggered rollout."A big-bang approach would involve all county business units — implementing the new business model at the same time. A staggered approach would involve implementing the business model in a more gradual manner. For instance,you could transform the county unit by unit, or office by office over a prescribed timeline, until the entire county has moved to the new business model.The total implementation time can range from 6 months in a big-bang approach to one-year or more for a staggered rollout. Value Potential Analysis The table below is used to analyze where value is being added by each solution option. Furthermore, it describes the individual value potential for both the State and the County. Some of these options: — I) Add value at the county-level and state-level, and some of the solutions 2) Add value only at a county-level.The Impact analysis will indicate which of these three scenarios is true for each solution option. Not .Same Moderate High Very Fligh Applicable Potential Potential Potential Potential • Value Proposition #3 #1 #2 Reduced #4 Optimized Streamlined Workload/ Improved -- Stakeholder N.N Staffing Business Increased Client Group Model Processes Productivity Service Comments County • • • • • Counties can yi significant value across all four dimensions by pursuing business model transformation. — • Business model transformation is something that should accompany the transition from a manual to automated environment. State O O O O • Business model transformation is a county-specific solution and does not pertain directly to the state Table 4.12 CO Workload Study Project-6/23/2007 Page 108 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study High-Level Impact Analysis This table describes the impact of implementing the described solution option on a process-bv- process basis.The X-Axis contains the Value Proposition Criteria (Optimized Staffing Model, Streamlined Business Processes,Reduced Workload/increased Productivity,Improved Client Service)and the'i'-Axis contains Work Functions.The Impact analysis will give the potential impact that the solution option will have on each specific Work Function. By looking at all processes and potential impact for each Work Function, one can derive the Cost-Benefit of implementing such a solution. Value #3 Proposition #1 #2 Reduced #4 Optimized Streamlined Workload/ Improved Staffing Business Increased Client Process Model Processes Productivity Service Comments ,— Intake • • • • Transforming business model will (I ntake Complete, allow for a more efficient and Failed AI, Failed II) effective Intake process. Case Related Seeking and Receiving Activities (CaseCil Assistance(Chains of Command, Review,Seeking County Help Desk)will be and Receiving transformed. Assistance, • No impact on Case Review, Processing Client Client Change in Circumstances, Change in Alerts Circumstances, Alerts) Client O O O O • Business Model Transformation Communication and is not applicable to this Work Information(Making Function. and Returning Phone Calls,Ad- Hoc Communication, Manual Noticing) Non Case Related C • Policy Review, Reports Administrative Management, and Training will Activities be transformed. (Administrative • Breaks, Meetings and Tasks, Meetings, Administrative Tasks will likely Breaks, Training, remain unchanged. Reports Management, Policy Review) RRRs and Periodic • • • • RRR and Periodic Reporting Reporting processes will be transformed. CO Workload Study Project—6/23/2007 Page 109 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study — Value #3 Proposition #1 #2 Reduced #4 Optimized Streamlined Workload/ Improved Staffing Business Increased Client Process Model Processes Productivity Service Comments Claims • • • • • Claims processing will be transformed. Management • Business Model Transformation Activities(Personnel is not applicable to this will likely Management, have little to no impact on this Counseling, Office Work Function. Operations) Other ef (Travel, • ty and f Hearings,, Inter- Referrals,Appeals County Transfers, Benefit —. and Hearings, Inter- Issuance Operations will be County Transfers, transformed. APS-specific, • Referrals,APS-specific will Benefit Issuance remain unchanged. — Activities) Table 4.13 Other State Im lementations State Brief Description Benefit to Colorado California The BEST project involved the strategy Colorado Counties could benefit from Business development of a Customer-Centric optimizing their business models, however Environment Human Services Model in Solano optimization will mean different things to System County. The agency is looking to create different counties. The opportunity and ability to Transformation a business model that is make impactful changes is greater in Large and (BEST) 1) Conducive to an automated Medium-sized counties.The relatively large environment. scale of their workload and hence large scale of — 2) Conducive to high-quality complexity and challenges provides the customer service. opportunity for improvement.A business model transformation allows counties to take inventory of their current business model, identify areas — of strength, and identify areas of challenges. The agency can then devise a new business model which allows them to leverage their strengths, mitigate their weaknesses, — streamline business process and move towards improved customer service. CO Workload Study Project-6/23/2007 Page 110 _ Copyright©2007 Deloitte Development LLC.All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study 4.4.5 Summary and Conclusions Short/Medium/Long Term Recommendations Short-Term Web-Enabled Access—Phase 1 In the immediate term we recommend that the State pursue a Web-Enabled solution as a first step towards Human Services Modernization. By implementing such a system,the state can quickly relieve excessive County workload by providing clients with an alternative channel for information and screening. Once development of Web-Enabled Access commences, it is important to engage in external marketing to encourage client acceptance of the initiative.As clients begin to take advantage of the web portal,counties should see a decrease in benefit inquiries and case questions and have more time for core eligibility functions. In Phase 1 Provider and Screening Modules for some programs and the Catalog of Information for all programs can be implemented. Change Management and Training Strategy Development of a comprehensive Change Management and Training Strategy is another opportunity for modernization that we recommend commencing in the short term.The State and Counties should formulate a plan for improving key components such as Communication, Management and Training for IT and Policy changes at a State and County level.We recommend the creation of a Change Management and Training workgroup with a diverse mix of stakeholders including representatives from IT,Policy, and Training from Counties of all sizes,as well as state subject matter experts.This workgroup should meet regularly to develop a strategic vision and begin to create a standard suite of tools, templates,and methodologies. Oversight and Quality Assurance Advisory Committee—Phase 1 In parallel with the first two modernization opportunities,we recommend that the State and Counties collaborate to form an Oversight and Quality Assurance Advisory Committee. This group should include State and County executives who can begin to formulate a long-term Human Services strategy for Colorado.The strategy should include visioning and prioritization of change initiatives for the medium and long term. Medium Term Web-Enabled Access—Phase 2 Provider, Screening,and Catalog modules can be developed for all programs. An Application Inbox module can be developed for some programs. As more functionality is developed and external marketing continues, more clients will take advantage of the web portal and continue to reduce the workload of eligibility staff. Oversight and Quality Assurance Advisory Committee—Phase 2 The O&QA Advisory Committee should start finalizing their long term strategic plan and incorporating cost metrics into the plan.The O&QA Team can use their level of projected funding along with impact of proposed changes to determine timelines for each future change initiative. Customer Contact Center—Phase 1 In the medium term we recommend that the State begin implementation of a Customer Contact Center. We believe that this is a critical second step in re-balancing county workloads. By providing a centralized information hub for clients,the amount of case-related workload done by county eligibility staff will be reduced even further. The first phase of the Customer Contact Center CO Workload Study Project-6/23/2007 Page 111 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study implementation will require set up of the Customer Contact Center including hiring of employees, deployment of telephony technology,and providing training and familiarization for the Counties and clients on how to leverage the services offered by the Center. Again,internal and external marketing _ is critical in maximizing utilization of the Customer Contact Center. Phase 1 should also include a pilot of the Customer Contact Center where services are made available to a subset of counties to test processes and determine how the center can be further refined. I,ong-1-erm Web Enabled Access—Phase 3 _ Application Submission and Eligibility Determination modules are developed and the portal is complete. Clients now have the ability to access program information, check benefits,make case changes, and apply for benefits.The State now has a fully functioning web-enabled customer service channel. At this point the State and Counties should be able to quantify the impact of Web-Enabled —' Access has made on county workload as the O&QA committee finalizes their long-term strategic plan. Customer Contact Center—Phase 2 The completion of the Customer Contact Center implementation includes making any adjustments or fine tuning to operations that were learned in Phase 1,and completing rollout. Again, external _ marketing remains a vital step in encouraging client use of the Center. Oversight and Quality Assurance Advisory Committee—Phase 3 Beginning approximately one year after the strategic plan is adopted, the O&QA Advisory Committee can show how their initiatives have yielded cost savings for the State and County,while improving operations and customer sen-ice. The new ABC funding model can be applied and used as a means of quantifying savings and showing these improvements. _ CO Workload Study Project—6/23/2007 Page 112 Copyright©2007 Deloitte Development LLC. All rights reserved. Colorado Department of Human Services Department of Health Care Policy and Financing Workload Study 5.0 Appendix Appendix A: List of Steering Team Members Appendix B: List of Field Observations counties Appendix C: Opportunities for county participation Appendix D: CFMS and CEDS account codes by cost categories Appendix E: Activity List Dictionary Appendix F: Graphic representations of Defined Processes,Per Caseload Workload, and Per FTE Workload Appendix G: List of the in-scope programs Appendix H: Survey Activity Workbook&Detailed Survey screen shots Appendix 1: County Participation Guide Appendix.): Summary Survey Appendix K: List of county size classifications Appendix L: OMB A-76 Attachment C for Productive Hours Appendix M: CFMS and CEDS exclusions Appendix N: Cost per minute of each county Appendix O: Field Observations time data Appendix P: Cost per instance of an activity for each county and high-level program group Appendix Q: Activity Driver Source Information Appendix R: Estimated number of Supervisors, Clerical, and IT staff Appendix 5:Total time spent on Auxiliary Activities per county — Appendix T:Total cost of each activity for each county and high-level program group Appendix U:Total cost of each resource pool for each county and high-level program group Appendix V: Unit cost for County Administration for each county and high-level program group Appendix W:Total cost for key cost levers for each county and high-level program group CO Workload Study Project-6/23/2007 Page 113 Copyright©2007 Deloitte Development LLC.All rights reserved. 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