Theme 5: Improve Specific State Business Processes

The following goals were established to improve specific State business processes through consolidation of functions, adoption of technology, optimization of existing resources, and improved coordination.

5A. Coordinate Health-Workforce Services policy

Details

The Department of Workforce Services (DWS) has responsibility to provide eligibility services for major medical programs, but the Department of Health (DOH) develops policy for eligibility. The process to coordinate medical policy and procedures between DOH and DWS is labor intensive, duplicative, and inefficient.

The two departments should implement an interagency initiative to better coordinate policy. An independent consultant may help to facilitate with design, data collection, benchmarking, and analyzing best practices, specifically in Medicaid finance and eligibility policy and administration.

Initial cost savings could accrue through the identification of duplication, disconnects, costs, cycle times, errors, rework, and customer value. Longer-term benefits include improved eligibility determination, further reducing costs, and improving timeliness and accuracy of determining eligibility for medical programs."

Target Outcomes

The Department of Health and the Department of Workforce Services have worked closely to design the best process for developing and implementing policy. The departments have implemented a joint policy checklist, streamlined meetings, and improved communication. HB 174 (2011) requires these agencies (and the Department of Human Services) to study the need to consolidate or privatize eligibility determination. This study will help decide if additional changes are required.

Status

The Department of Health (DOH) and the Department of Workforce Services (DWS) have worked closely to design the best process for developing and implementing policy. The departments have implemented a joint policy checklist, streamlined meetings, and improved communication. HB 174 (2011) requires these agencies (and the Department of Human Services) to study the need to consolidate or privatize eligibility determination. This study will help determine whether additional changes are required.

Some of the accomplishments the departments have achieved or are pursuing are listed below:

The departments adopted a joint checklist in November 2010.

In March 2011, the managers were excused from the medical policy coordination meeting to reduce their time in meetings and to ensure that discussion focused solely on policy issues, not other interagency business.

As needed, a DOH staff member has started attending key DWS meetings, such as strategic policy development meeting regarding all DWS administered programs. As needed, a DWS staff member has started attending DOH meetings such as eligibility policy training.

More troubleshooting and problem solving is occurring outside meetings as staff members are more likely to pick up the phone to address issues rather than wait for a meeting.

Staff members from both departments are able to job shadow their counterparts to better understand what happens in the other department.

In order to strengthen and improve training, the departments have agreed to the involvement of a DOH policy specialist in the development and implementation of training for DWS eligibility staff. Quarterly meetings of DOH and DWS deputy directors ensure that potential problems are addressed before they become significant issues.

The Medical Improvement Team has been meeting every other month to discuss audit/edit results with the goal of improving the accuracy rate of eligibility determinations. The departments have agreed that the definition of quality for eligibility determination is “Right Program, Right Plan.”

The departments agree that greater collaboration and an inclusive approach are needed to synchronize DOH and DWS reviews, which includes:

  • Better coordinating the federally required Medical Eligibility Quality Control (MEQC) and Payment Error Rate Measurement (PERM) reviews with the DWS audit process.
  • Assisting with the identification of and development of the MEQC projects.
  • Developing a different method of communicating trends and accuracy rates.
  • Developing a regular and consistent package of reports and outcomes that would help DWS identify areas where deficiencies are occurring in eligibility determinations.
  • Working on identified trends and issues together.

Revisions to the Operating Agreement have been agreed to by both departments. The final agreement is currently going through the approval/signature process.

DOH and DWS have developed a joint process to conduct the HB 174 study. DWS has completed a study with three student groups. The departments will expand on the student reports by getting more data from states on costs, quality, and timeliness. The departments will also see if an independent consultant could be brought on in order to summarize the various efforts and provide an outside perspective. This implementation will begin once the HB174 recommendations have been determined.

Target Completion Date

June 30, 2012

5B. Consolidate the Department of Technology Services Printing Services with the Division of Purchasing and General Services

Details

The Department of Technology Services print shop currently prints checks, notices for the Department of Workforce Services, and Medical I.D. Cards using approximately 12 full-time equivalent state employees and two Xerox 2K135Docuprint MICR printers. These two printers are approximately eight years old and near the end of their useful lives.

All other State printing services are part of the Division of Purchasing and General Services, which has privatized print services through a private contract. Without modifications to their current processes, the private vendor has the equipment and capacity to absorb all of the printing currently located at the Department of Technology Services’ print shop with the exception of the checks.

Target Outcomes

1. Efficiency from the elimination of duplicate services.

2. Privatization of operations.

Status

After analyzing the Optimization Commission’s recommendation to consolidate DTS Print Services with the Division of Purchasing and General Services, we have concluded that the consolidation should not move forward at this time because existing contracts would prevent any cost savings from occurring under consolidation. We plan to revisit the issue in approximately three years, after State Printing has moved to a permanent shared location with State Mail.

Target Completion Date

Complete

5C. Consolidate the Division of Public Utilities (DPU) into the Public Services Commission (PSC)

Details

DPU makes recommendations to the PSC regarding rate setting, applications, hearings and other issues affecting quality of service. DPU also investigates consumer complaints and monitors utility operations to ensure compliance with PSC rules, regulations and orders. DPU is currently organized under the Department of Commerce, which is primarily a licensing agency.

Target Outcomes

The key goal of the Department of Commerce is to ensure the legislature is informed on this issue and potential modification, which would require statutory changes. Under the current statutes, the Department maintains capable leadership and policies to ensure that both the Division of Public Utilities and the Office of Consumer Services perform their functions capably and independent of each other.

Status

A review of the recommendation has determined that the existing function is well run. No further action pending policy review.

Target Completion Date

No further pending policy review.

5D. Dissolve the Utah Medical Education Council (UMEC)

Details

The UMEC was established through a federal Centers for Medicare and Medicaid Services (CMS) pilot project to distribute funds to hospitals participating in graduate medical residency programs. The pilot program ended on June 30, 2010, when CMS began distributing funds directly to hospitals.

The UMEC is also responsible for healthcare workforce planning. This responsibility could be transferred to the Departments of Health and Workforce Services.

Target Outcomes

Completed

Status

After the program was evaluated during the 2011 General Session, it was decided that the state would continue funding the UMEC program. Yearly monitoring will be conducted by the Governor's Office of Planning and Budget and the legislature.

Target Completion Date

5E. Eliminate the Recovery Assistance Program

Details

Currently, medical professionals with access to controlled substances (e.g. doctors and pharmacists) who commit unlawful or unprofessional acts have the option of being placed on probation or participating in the Utah Recovery Assistance Program. The program is operated by the Department of Commerce and is funded through dedicated credits.

Medical professionals pay a premium in licensing fees to support the program, in which approximately 150 professionals currently participate.

Target Outcomes

Status

Review of recommendation determined that the existing function is well run. No further action pending Policy review on potential statutory review. The Department is continuing to operate the program pursuant to current statute. The Department can provide data if an elected policymaker decides to pursue this statutory change.

Target Completion Date

5F. Outsource Medicaid Program Integrity review

Details

The Department of Health's Program Integrity Unit reviews payments from Medicaid to medical providers for fraud, waste, and abuse of the Medicaid system.

Outsourcing this review function could result in increased recoveries, which totaled $3.9 million last year. Outsourcing should occur after increased efforts to audit, requiring software improvements.

The Program Integrity budget is $2,275,000, of which $265,000 for eight FTEs is for Investigations, Collection, and Enforcement.

Target Outcomes

1. Outsource medical review and recovery process within the Program Integrity Unit.

2. Increase recoveries of fraud, waste, and abuse from medical providers.

3. Obtain a software tool (mentioned in the Optimization Report) to better detect fraud, waste, and abuse.

Status

The medical reviews and software tool RFP was issued on November 15, 2010. Only one potential contractor bid on the RFP; however, the Department notified DTS on January 26, 2011 that the single bid proposal received was rejected for not meeting minimum established criteria identified in the RFP. Taking into consideration the time and expense of the RFP process and the single bid received, the Department decided to not pursue another RFP and to leave the Program Integrity unit intact. Therefore, the goal of outsourcing the medical reviews and recoveries function has not been and will not be fully achieved. However, the Department of Health made every effort to ensure the success of this RFP process. In the opinion of the Department of Health, the goals from the Optimization Reports are still being achieved, though in different ways.

Regular Program Integrity recoveries during Fiscal Year 2011 to date have increased more than 48% as compared to the same period in Fiscal Year 2010 because of increased supervision, new performance measures, and new standards and procedures. Recoveries are expected to increase again starting in June 2011, when full access to the software tool is realized. Recoveries should increase yet again in fall 2011 when the new federally mandated recovery audit contracts are signed and operating on a contingency fee basis. These recovery audit contracts to outsource some reviews and recoveries for fraud, waste, and abuse are required by federal regulations to be in place by a date yet to be specified by the federal government in a final rule to be issued in summer 2011.

On February 21, 2011, the Department signed a joint operating agreement with AdvanceMed Corporation and Utah Medicare/Medicaid Data Analysis Center for free access to a federally approved fraud, waste, and abuse software tool for a period of five years. After the five-year period, the Department hopes to have a replacement for the current MMIS system featuring an integrated fraud, waste and abuse software tool. The Department gained access to the software tool on June 1, 2011. This software tool usually costs more than $200,000 per year for a license. For the five year period, this five year access can be viewed as adding $1 million of value at no additional cost to the State of Utah.

Target Completion Date

Complete

5G. Expedite the full implementation of an employee service call center

Details

The Department of Human Resource Management launched the Employee Self Service Gateway on July 1, 2008, as a browser-based tool that allows State employees to access human resource related information. The Gateway is a web-based solution to State employees’ human resource services needs.

The Employee Self Service Gateway could be supplemented by an employee service call center that would increase transaction consistency, reduce staff levels within agencies, and decrease the cost of providing human resource services.

Target Outcomes

1. Increase operational efficiencies by increasing access to online Human Resource (HR) services for new hires, employees, and managers.

2. Consolidate rural HR staff.

3. Implement consistent HR practices statewide.

4. Provide telephone coverage on Fridays to assist the public in accessing services.

Status

Training of Service Center staff has begun. On August 1, 2011, the Service Center team will begin processing payroll for selected agencies for which DHRM currently processes payroll. Remaining agencies for which DHRM currently processes payroll will be brought online on August 15, 2011.

Payroll processing will begin before the complete launch of the center on September 19, 2011, to ensure all systems and processes function properly prior to the launch date. Development and testing of key system components (knowledge base, case management, and on-boarding) continue and will be completed prior to the launch date.

Target Completion Date

September 19, 2011

5H. Extend Human Service Program License to two years

Details

The Office of Licensing within the Department of Human Services currently issues provider licenses for a 12-month period. To better enable licensure staff to cope with increased workload due to staff reductions, these licenses could be extended from 12 to 24 months for any licensee with a record of satisfactory inspections and no violations.

A change in statute is required to implement.

Target Outcomes

1. Savings to private human services providers from reduced paperwork.

2. Small productivity gain to state licensing staff to help contend with rising caseloads and budget cuts already imposed.

Status

Requires legislation. Stakeholders have been consulted, and a sponsor has been identified for the 2012 legislative session.

Target Completion Date

July 1, 2012

5I. Automate Human Services licensor inspection and monitoring

Details

Caseloads in the Department of Human Services Office of Licensing are more than double the nationally recommended averages. Technology exists that enables a licensor to have all forms, regulations, and inspection checklists available on a handheld device that interfaces with a desktop computer. This technology would help reduce the time to complete licensing inspections and monitoring.

A Request for Proposal will provide an estimate of cost to implement.

Target Outcomes

Productivity gain to state licensing staff to help contend with rising caseloads and budget cuts already imposed.

Status

Complete

Target Completion Date

Complete

5J. Create an online document generation system for Child Support Applications in the Office of Recovery Services (ORS)

Details

Investigate and issue a Request for Proposal for the creation of an online data/document entry system that will allow ORS clients, employers, insurers, and agents to enter required data online.

Internally, ORS currently generates in excess of 90,000 documents, all requiring physical input by clients, employers, insurers, and ORS agents. Externally, ORS clients submit more than 3,500 child support applications monthly, each requiring data inputs that exceed three hours per employee.

An online process would eliminate time delays and allow an ORS system and agent to immediately review and assess data upon third-party entry, thus reducing timelines for case review.

A Request for Proposal will provide an estimate of cost to implement.

Target Outcomes

Enable agents to better handle larger caseloads imposed by budget reductions.

Status

Business analysis is complete. Waiting for programmers to begin coding (they must finish the Doc Gen project first).

Target Completion Date

December 31, 2011.

5K. Transition Office of Recovery Services database to a web-based platform

Details

Move the Office of Recovery Services database from the current mainframe system to a web-based modular blade server platform, which has a lower cost.

The transition would require a one-time investment of approximately $1 million.

Target Outcomes

1. Potential cost savings to the Department of Technology Services from reduced mainframe use.

2. Potential cost savings to the Office of Recovery Services from reduced mainframe use.

Status

The Office of Recovery Services and the Department of Technology Services have determined the potential net cost savings of moving just the database would not be as high as originally anticipated. In fact, further studies have shown that the savings likely would be negligible. The focus has shifted toward the eventual movement of the entire system off the mainframe to avoid increased costs that will come in three to five years as remaining users migrate off the mainframe. Other states with similar interests were recently surveyed and responses compiled. More research will be done in the coming year for consideration in the FY2014 budget cycle.

Target Completion Date

5L. Work with local governments to identify costs and benefits of consolidating public safety dispatch offices

Details

Several consolidated dispatch offices exist throughout the state. In some cases, the Department of Public Safety contracts with local government and in other cases, local government contracts with Public Safety.

Those cities, towns, and counties that have their own dispatch offices may experience savings through consolidation of efforts with another local entity or the Department of Public Safety.

Target Outcomes

Identification of potential opportunities for savings through the consolidation of dispatch offices.

Status

Reviewing

Target Completion Date

5M. Implement Motor Vehicle Registration alternatives

Details

The Utah Tax Commission sends out 2.1 million motor vehicle packets annually to remind Utahns to register their vehicles. Replacing these mailings with alternatives such as an email or a telephone call could result in significant printing and postage savings.

The current PIN security system presents significant barriers to Utah vehicle owners. Changing the required registration information to a self-assigned PIN or a driver’s license number, license plate number, and the month and year of title would present fewer barriers to successful online registration, thus improving customer service.

Also, instituting a two-year car registration cycle could result in cost reduction.

Initiatives like these, coupled with an incentive to register online or a disincentive to register in person, could increasingly move people away from costly visits to brick-and-mortar Division of Motor Vehicle offices.

Target Outcomes

Optimize registration process while effectively collecting revenues and regulating motor vehicle registrations.

Status

Citizens can now renew their vehicle registration online if they have misplaced their assigned personal ID # (PIN), by providing other vehicle-specific information. Additionally, citizens can now submit an online change of address for their vehicle registrations. A new renewal notice option will be available in the next few months for those wanting to receive an e-mail reminder instead of being mailed a paper notice. As this option is selected, it will reduce the number of packets that will need to be mailed. Those citizens that do not want to share their email addresses (or those who do not have access to a personal email account) will continue to get reminders in the mail since without some form of notice, registration compliance and related fees would likely decline.

Utah has two very popular online renewal options that have one of the highest utilization rates in the nation. These online applications are now handling more than 50% of the renewal traffic. Since these transactions are no longer being performed in offices, the online applications have allowed the agency to avoid building more offices and hiring more staff to handle ever increasing numbers of motor vehicle transactions. Promotion of the online renewal alternatives will be ongoing.

Target Completion Date

Items 1 and 2 are completed. Item 3 will be available in July 2011.

5N. Implement a Shelf Management Program at liquor and wine stores operated by the Department of Alcoholic Beverage Control

Details

Inconsistent merchandising from store to store creates customer confusion and lost potential profits. Shelf Management software could assist in the strategic placement of products to maximize up-selling opportunities.

Target Outcomes

The Department of Alcoholic Beverage Control hopes to have all liquor stores on some form of Shelf Management by spring 2012. Shelf Management programs in a retail setting typically generate from .5% to 3% increase in sales. The state anticipates results similar to those in retail businesses.

Status

Currently being implemented. The Department of Alcoholic Beverage Control (DABC) hopes to have all liquor stores on some form of Shelf Management by spring 2012. Schematic shelf sets should start showing results soon.

Target Completion Date

Outcomes

For the third quarter of the calendar year there was an increase of $162,396.43 (7.23%) in sales dollars and a 20,310 (1.46%) increase in unit sales over the same period in 2010. These increases take into account that two of our outlets were closed during this same time period in 2011.

5O. Enhance liquor and wine store profits

Details

To enhance profits generated from the sale of alcoholic beverages, the Department of Alcoholic Beverage Control should eliminate consecutive special price adjustments, limit these adjustments to four periods per year for any specific item, and, as a convenience to customers, provide gift cards for state liquor store purchases.

Profits generated through the sale of alcohol are transferred to the Minimum School Lunch Program, the Parents Empowered program, and the General Fund.

Target Outcomes

Promotional products are to be spaced evenly throughout the year, not only to save money, but also to prevent the “clumping” of promotional periods.

Status

The program has been working well, and the investment buy program has been generating same dollar savings each month with additional sales increases of more than 2%. This is an ongoing program that has now become part of Department of Alcoholic Beverage Control policy. The Investment Buy Program generated $409,815 in savings in May 2011 ($12,960 more than the Department saved in May 2010). Profits generated through the sale of alcohol are transferred to the Minimum School Lunch Program, the Parents Empowered program, and the General Fund.

Target Completion Date

Complete. This is an ongoing program that has now become part of DABC policy.

Outcomes

Program has been working well and the investment buy program has been generating same dollar savings each month with additional sales increases of over 2%.

5P. Evaluate the use of Park Rangers in State parks

Details

Utah State Park Rangers are certified Peace Officer Standards and Training Officers, with salaries and benefits commensurate with other State law enforcement officers. Preliminary analysis suggests that Park Rangers' enforcement duties are minimal, and less costly labor could replace some functions. The State Parks Division should review duties for possible savings.

Target Outcomes

Streamline law enforcement where practical and feasible to minimize costs while maintaining appropriate levels of public service and safety.

Status

The Department of Natural Resources plans to evaluate Parks Law Enforcement by identifying geographic areas of required law enforcement activity, organizing law enforcement activity into specialized clusters to minimize costs, decommissioning law enforcement where practical and feasible, and engaging legislature in policy review through task force.

Target Completion Date

November 30, 2011.

Outcomes

Review of operational efficiencies resulted in the decommissioning of 14 law enforcement officers.

5Q. Study State Parks Privatization

Details

Wait for the Legislative Auditor General's report on State Parks Privatization before making operational changes to Utah State Parks.

Target Outcomes

Status

The Department of Natural Resources plans to review the currently privatized “This Is The Place Heritage Park.” DNR will then discuss the feasibility of transferring park operations to local governments. The agency will then work with the private sector to determine the level of interest in running the state operation.

Target Completion Date

November 30, 2011.

5R. Evaluate road conditions classifications

Details

Evaluate the classification of roads to determine the appropriate time to plow (e.g. 24-hour dry policy or a specified amount of snow accumulation).

Target Outcomes

Better utilization of limited road maintenance resources could result in a better overall condition of the state highway system. The gain will not be without pain, since vehicles currently use these routes all year. In some cases the detour around the seasonally closed road will be many miles.

Status

In consultation with the Department of Transportation, the Governor’s Office reviewed these routes and decided that it would continue providing these valuable public services. The state has no plans to close these routes.

Target Completion Date

Could be implemented by November 1, 2011.

5S. Reassess snow removal methods of "seasonal roads"

Details

Using snow blowers to clear roads is more costly than waiting for snow to melt to a level where a plow could be used. Keeping seasonal roads closed until they can be accessed by a snow plow could yield savings.

Target Outcomes

Better utilization of limited road maintenance resources could result in a better overall condition of the state highway system.

Status

In consultation with the Department of Transportation, the Governor’s Office reviewed these routes and decided that the state would continue providing these valuable public services. The state has no plans to close these routes. The outstanding snowpack this year delayed the opening of nearly all seasonally closed roads by 30 days or more. Even with the late opening, the level of effort and resource expenditure was similar to a standard snowfall year, and fortunately, many Utah citizens understood the conditions that caused the lateness of the openings of these important routes.

Target Completion Date

This year the snowpack will likely result in late openings of seasonally closed roads. However, implementation for future years could be in effect by November 1, 2011.

5T. Require counties to cover the full cost of property tax audits

Details

According to State statute, the Tax Commission conducts personal property audits for the counties at a 30% cost rate. This partial reimbursement approach should be examined for sustainability.

Target Outcomes

Cost recovery for services provided.

Status

A legislative change is required to facilitate a billing rate change. SB 276 was not adopted during the past legislative session. The Tax Commission will seek legislative sponsorship and approval of this initiative if it is to move forward.

Target Completion Date

Legislative approval of a rate change is required to implement this recommendation.