Volusia County, Florida has an approximate population of 495,890 residents. FDOH-Volusia serves as the safety net for residents who do not have a medical home and as a leader in the community for public health issues. Florida Department of Health Volusia County consists of four clinical sites; two Dental offices located though out our county and conduct outreach within our community. With the continuous financial constraints that we as a state agency face, it is imperative that all resources are utilized for maximum benefit to the FDOH-Volusia . The team was established to improve the efficiencies in the process to ensure the development that the Family Planning income for all clients receiving family planning services received a financial eligibility to update to the BPL (Base Poverty Level). Family Planning allocations for funding are based on the Base Poverty Level (BPL) of clients served. Through the Plan Do Check Act (PDCA) we analyzed the Family Planning Unknown Income on Family Planning Aggregate Report (FPAR) Report a procedure was developed for Financial Eligibility Staff to review and update Financials for all Family Planning Clients. The team analyzed and stratified current operational processes within the clinics and applied these processes to a productivity model. F/P annual report (FPAR) shown over last 3 years the % of clients having "unknown income" was 69.8, 66.4 and 64.6 % Develop a process to correct percentage in order to be in compliance of less than 5%. Two processes were developed for updating BPL in the Health Management System (HMS).
1) Financial counselors will update the financial information from the clinic schedule. Financial staff will generate a copy of the F/P schedule for the next day. Staff would then verify income information using the "Florida System” when the client arrived for services financial counselors would update any income changes reported by client. 2) All clients must be seen by a financial counselor prior to being seen in the clinic. A financial evaluation would be done on all clients. It was agreed that F-DOH Volusia would test process #1 since the other proposal would be disruptive to clinic flow and not all clinics have a full time financial counselor available every day.
· Meet with financial counselors and discussed the process for implementing new process. F/P Missing income report will be run at least weekly.
· Develop a process for financial counselors to update BPL prior to clients being seen in clinic
· Develop a process that can be replicated to other CHDs
· Pull the clinic schedules the day before the F/P visits. Update financial information based on the data from the Florida system.
· Develop and verify the income information on the Household questionnaire with the information documented in the Florida System.
As we serve as a safety net for health in our community, it is vital to ensure a consistent level of quality of service delivery throughout FDOH-Volusia. The State of Florida has a number of performance standards and processes that require and define accountability as expected by the taxpayers of Florida. Accountability for funds received is a primary function of by the FDOH-Volusia Financial Counselors Our mission is to provide the infrastructure to support Public Health Services by maintaining and providing financial management. Chapter 154 of the Florida Statutes establishes the framework for the delivery of public health services at the county level. This statute outlines a contractual partnership between the state and each county, as well as general service delivery,funding, and reporting requirements. This statute requires the county health department to administer 43 public health programs. Of these 43 programs, 32 have zero or inadequate funding; only 11 have adequate dedicated funding. Programs without adequate funding are supported by Medicaid cost-based reimbursement (CBR) fees and general revenue.
As we serve as a safety net for health in our community, it is vital to ensure a consistent level of quality of service delivery throughout Florida Department of Health Volusia County. The State of Florida has a number of performance standards and processes that require and define such accountability as expected by the taxpayers of Florida. This necessitated a hard look at the financial eligibility process to determine what our core functions are and what our most valid and reliable measures to report and monitor these functions. Valid and reliable information is needed to facilitate the strategic plan process, allowing the most effective and efficient use of our resources to meet community needs. Key financial indicators are identified as the basis for the most productive and efficient ways to obtain the base poverty level for all clients that were in need of Family Planning Services. The mythology for evaluating clinic flow and the need for clients to have a financial determination done with little to no interruption to our clients and staff adjustments were made to schedules and reports were developed to review all clients that were receiving family planning services had their income updated prior to being seen in the clinic. The Financial counselors will update the financial information from the clinic schedule. Financial staff will generate a copy of the F/P schedule for the next day. Staff would then verify income information using the "Florida System” when the client arrived for services financial counselors would update any income changes reported by client. 2) All clients must be seen by a financial counselor prior to being seen in the clinic. A financial evaluation would be done on all clients. It was agreed that F-DOH Volusia would test process #1 since the other proposal would be disruptive to clinic flow and not all clinics have a full time financial counselor available every day. We continue to use the Plan-Do-Check-Act (PDCA) mechanism for process management on the analysis of the Family Planning Unknown Income Report allowing us to monitor and manage our daily operations.
There were numerous meetings with financial counselors to discussed the rollout for implementing new process. F/P Missing income report will be run at least weekly. Develop a process for financial counselors to update BPL prior to clients being seen in clinic. Develop a process that can be replicated to other CHDs Pull the clinic schedules the day before the F/P visits. Update financial information based on the data from the Florida system. Develop and verify the income information on the Household questionnaire with the information documented in the Florida System.
There were also meetings with all four clinic sites this uniform processes were developed and agreed upon by the team and key productivity and operational indicators were established. This process was done to ensure buy in from all staff and allowed them the opportunity to review the new process and afford any miscommunications among clinic sites and staff.
FDOH-Volusia approach to the utilization of this new eligibility process which was a joint effort by staff at all levels it required by-in from providers, nurses, supporting staff, clinic management, finance and accounting and senior management as well as the clients we serve. All FDOH-Volusia levels agreed that this new process would ensure that FDOH-Volusia would meet the state requirements in accordance with the Family Planning Program office in order to secure the state allocations which are approximately $265,000.00 to help support the family planning services for the community. Since the start of the Affordable Care Act in July FDOH- Volusia was forced to cut our Maternity program which resulted in workforce reduction and the reallocation of resources such has reassignment of staff and services, which would meet the needs of the community based on the needs of the clients. It is critical that all state funding is allocated to the program so that there would be no new cuts to our programs. This process and the reports provide valuable information of the financial health of VCHD my maximizing our resources we ensure that VCHD utilizes the taxpayers’ funds to serve our community.
The second quarter January 2014 to September 2014 were just released and Volusia County was at 4.38%, which is under the required 5%. (see below)
Family Planning Unknown Income Report Jan - Sep 2014County #of clients withunknown income total # clients %of clients with unknown incomeVolusia 145 3307 4.38%
The implementation and development of this process must have the by- in from all staff to be successful. It is necessary to ensure that all staff is fully aware of what the measurements and goals of the department are. It is imperative that the eligibility staff have input to the review process and the procedures that they perform so to eliminate discrepancies after the reports are analyzed to see where improvements and decisions need t be made. Another benefit was the development of best practice for the eligibility process at all four clinic sites was the same. As well as any decisions on what changes might need to be made to continue to achieve the percentages for client services in accordance with the state mandated guidelines.
By strategizing and assessing our current processes, we were able to identify and improve the efficiency of of our eligibility process in all clinics. We investigated best practices, implemented and monitored change. Because of our endeavors, we have greatly improved outcomes as well as increased revenue and staff is reassigned to maximize resources. The reallocation of resources has eliminated the possible need for work force reduction.
The development of the Family Planning Eligibility process ensures that FDOH-Volusia receives the family planning allocations from the program office, FDOH-Volusia is able to maximize its limited resources relativity quickly. The reallocation of staff to other clinic sites continues to be cost effective and enables FDOH-Volusia to continue to provide essential health services to all residents. Without the Family Planning funding FDOH-Volusia would not be able to continue providing service to the community. Many of our clients that receive family planning services are teens without these funds many of the teens may become pregnant and there would be an increase in teen pregnancies in Volusia County.
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