Crossing Borders to Improve the Medi-Cal eligibility process: A process improvement collaborative

Background: The Medi-Cal (Medicaid) Eligibility Process Improvement Collaborative (MEPIC) was a structured environment where 13 California county teams learned improvement methodologies and applied new skills to maximize the effectiveness of enrollment and retention processes in Medi-Cal eligibility systems. To do this they transcended eligibility determination of half a century ago to the present.

Methods: Counties were chosen to participate based on improvement goals, ability to track performance measures and leadership capability to support teams and spread learning. Through three learning sessions, monthly collaborative group and individual team phone calls, e-mails, site visits and a web-site, the teams learned and applied the Plan-Do-Study-Act (PDSA) Model of process improvements and assessed whether tests resulted in positive changes. Counties provided baseline data on their eligibility processing and tracked changes in processing time and other factors. Teams provided qualitative feedback about their collaborative experiences.

Results: The teams conducted a total of 130 PDSAs, with 46 adopted strategies that were put into practice. Strategies were spread to units other than the test unit, and to programs other than Medi-Cal. Participation in the collaborative led to a different way of thinking, showed the value of testing on a small scale before implementation and the value of collaboration. Teams were enthusiastic about the tools learned, and there was a new emphasis Client centered services.

Conclusions: The collaborative applied private-sector methodologies to improving public-sector programs and can serve as a model for process improvement to foster better service to our most vulnerable populations.