Management and Performance Review of County Government ...

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Health & Welfare/Library/Veterans Services of Jefferson County EXHIBIT 5-5 HEALTH SERVICES ELIGIBILITY AND CLAIMS AT JEFFERSON COUNTY HEALTH CLINICS, 2000-2004 Unit 1 2000 2001 2002 2003 2004 CIHC PHC CIHC PHC CIHC PHC CIHC PHC CIHC PHC Total # Applications 537 589 692 276 991 372 832 484 1276 643 # Applications Approved 162 226 150 131 189 180 251 340 266 276 # Applications Denied 375 363 542 145 802 192 581 144 1010 367 Applications Pending at year end 20 0 38 0 20 0 36 0 67 0 Interim Reviews 403 119 312 93 329 73 448 125 527 175 Total Claims Processed 9738 8922 5792 4974 4307 Unit 2 2000 2001 2002 2003 2004 CIHC PHC CIHC PHC CIHC PHC CIHC PHC CIHC PHC Total # Applications 867 451 1036 672 902 544 1219 633 1424 565 # Applications Approved 277 451 282 310 252 218 296 267 341 194 # Applications Denied 590 0 754 362 650 326 923 366 1083 210 Applications Pending at year end 21 0 50 18 89 6 127 11 171 5 Interim Reviews 486 506 522 276 501 251 563 99 588 158 Total Claims Processed 6439 7895 6654 6418 6815 NOTES: 1. Applications for are eligibility for CIHC and PHC health programs. 2. Total claims processed are for IHC patient referred outpatient, inpatient, lab, x-ray and prescription services. Page 5-13
Health & Welfare/Library/Veterans Services of Jefferson County The biggest difference between the two units for the welfare division somewhat tracks the health division workload, as Exhibits 5-5 shows. The majority of applications for IHC and PHC, however, are denied due to ineligibility. In addition caseworkers conduct periodic reviews, as required for the CIHC program to verify eligibility. Consistent with Unit 2 serving a larger IHC population, it has more claims processed than for Unit 1. There may be some inaccuracies in the data entered and tracked for the two welfare units. Although difficult to say for this review, HWD may want to review its internal procedures for entering, coding and tracking welfare health eligibility caseload data. In addition, HWD may want to confer with the county MIS department to ensure that the software created to track welfare department workload is correctly capturing data. Accurate data is an important management tool for resource allocation as is the ability to see changing trends. Overarching Issues The county’s Health and Welfare Department has adopted many efficient and cost-effective processes over the years to counter a decrease in staffing and a rising workload. Some of these practices include: ‣ common access to online client tracking systems for both nursing and welfare staff; ‣ the contract with UTMB for outpatient clinic and inpatient services; ‣ cross-training of staff in both units; ‣ extensive written policies and procedures for nurses and caseworkers; ‣ the use of two distinct file colors, white for IHC and orange for PHC, to avoid mixups; ‣ controls to prevent excessive patient use of emergency room visits for routine care; and ‣ controls to prevent patient abuse of prescription medication. Page 5-14
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Management and Performance Review o
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TABLE OF CONTENTS (Cont’d) 7.0 JU
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ACKNOWLEDGEMENTS This review has be
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EXECUTIVE SUMMARY MGT was selected
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Executive Summary To finance these
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Executive Summary from generating e
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Executive Summary assistant chiefs,
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Executive Summary in good working o
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CHAPTER 1.0 INTRODUCTION AND BACKGR
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Introduction and Background 1. Ford
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Introduction and Background EXHIBIT
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Introduction and Background The rev
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Jefferson Peer Average Brazoria EXH
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Introduction and Background Jeffers
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Introduction and Background Jeffers
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Introduction and Background EXHIBIT
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Introduction and Background In Augu
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2.0 JEFFERSON COUNTY EMPLOYEE SURVE
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Jefferson County Employee Survey Re
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3.0 ASSESSMENT OF THE ORGANIZATION
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Assessment of the Organization and
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4.0 ASSESSMENT OF THE FINANCE AND B
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Assessment of the Finance and Busin
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Maintenance, and Fleet Operations o
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CHAPTER 7.0 JUDICIAL AND PUBLIC SAF
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Judicial and Public Safety Function
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8.0 ENTERPRISE OPERATIONS OF JEFFER
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Enterprise Operations of Jefferson
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APPENDIX 1 ECONOMIC DEVELOPMENT INC
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Economic Development Incentives Pol
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APPENDIX 2 FISCAL IMPACT SUMMARY
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Fiscal Impact Summary Recommendatio
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Fiscal Impact Summary Recommendatio
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