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Covering Kids & Families

An RWJF Collection

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Improving Processes and Increasing Efficiency

The Case for States Participating in a Process Improvement Collaborative

State Medicaid and State Children’s Health Insurance Program (SCHIP) agencies provide vital health coverage to low-income populations and other groups, but have limited administrative resources to support enrollment and renewal functions for these programs. Streamlining and enhancing the effectiveness of their administrative procedures and processes can help state programs do more with less and can ease the burden on individuals who apply to these programs by clarifying instructions or allowing phone or Internet applications or renewals. In short, everyone could benefit from improved procedures.

In this brief, researchers look at the experience that some state Medicaid and SCHIP agencies have had in using a process change model developed by the Institute for Healthcare Improvement (IHI), and adapted by the Southern Institute on Children and Families (Southern Institute), to strengthen the way they approach enrollment and retention administrative processes. IHI’s model, known as the Breakthrough Series, has helped numerous health care providers improve quality and efficiency in various ways, including reducing patient waiting times by 50 percent, reducing intensive care unit costs by 25 percent and reducing hospitalizations for patients with congestive heart failure by 50 percent (Institute for Healthcare Improvement, 2003). The Breakthrough Series uses a “process improvement collaborative” or “learning collaborative.” It has not been widely applied to improve purchaser administration.

Researchers explore in this brief whether state governments can use this model to improve Medicaid and SCHIP eligibility and enrollment processes and also whether a process improvement collaborative is a worthwhile investment for states.