MERC Program
Kaizen
Minnesota Department of Health
November 5, 2014
Kaizen Team
Troy Taubenheim, Will Wilson, Gina Danyluk, Jeff Richter, Dawn Ludwig, Deb Mayland-Poyzer, Diane Reger, Kyle Stenstrom, Margo Marko, Ginny Zawistowski,
Mark Schoenbaum, Darwin Flores Trujillo
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Project Objectives
 Improve application speed, ease, and accuracy.
 Improve distinct grantee application data (one grant app
to many teaching programs/sponsoring institutions).
Facility applications are inconsistent from one program to
another.
 Shorten processing time from application to payment and
shorten time lag between training activity and payment.
(Currently, for example, 2013 training & revenue data was
submitted in October 2014 with payout in April 2016.)
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Project Goals
 Develop recommendations and timeframe to transition from
old web app to new grant system by December 1, 2014.
Implement/rollout by mid-August 2015.
 Reduce the number of contacts and training site applications
within a single facility/organization to one per facility.
 Place a higher level of responsibility on clinical training sites
applying for grant funds. Reduce burden placed on teaching
programs/sponsors. (Implement by August 2015)
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Project Goals
 Reduce the lag between the program’s data years for
revenues, expenditures, etc., and its funding/appropriation
year by one year. (Implement by August 2015)
 Shorten the length of time between application and
expenditure reporting by a minimum of two months. Ideally,
application and expenditure reporting would be single,
simultaneous process. (Implement by August 2015)
 Close the gap between application and grant payment by 3
months in the first year and 5 months in the second year.
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Project Goals
 Reduce the number of incorrect training site applications to
less than 5% of the total applications received in the first year
and 3% of the total the second year.
 Reduce time in handoffs between MDH and DHS (for
revenue/IGT data) to 2 weeks in order to meet February 28
distribution of funds.
 Reduce paper (electronic applications, amendments, records,
contracts, etc.).
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Project Scope
In Scope
Out of Scope
 Starting point: Decide what
application year will be
collected on application
(MDH)
Legislative formula or other
legislative changes that would
require federal approval on use of
Medicaid funds. (Administrative
and process improvement
legislative changes can be
considered.) Application must be
through sponsor. Funds must be
sent through sponsor. Additional
reports to DHS to respond to
federal requests.
 Ending point: Potential
funding being returned from
sponsor after grant payment
(GVRs returned).
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Day 1:
Complete a
current state
swim lane
map
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Sample Observations of
Current State
Surprised we have an outcome
Many handoffs
Diane being the constant - might fall apart without her
Actually 3 different years going on simultaneously
Majority of everyone’s time/waste is on application
Change from MA ID to NPI’s added lots of difficulty
MERC uses complicated parts of healthcare system to
achieve education purpose of MERC
 A lot of duplication with application process
Day 2:
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Observations,
ID Waste,
Solutions
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Sample Observations of
Current State
Follow-up or verify or clarify tasks indicate waste
Lots of defects: missing/wrong information from training sites
Errors, defects with expenditure reporting
Contact information/multiple contacts causes problems
Application from training site part has opportunities
Dealing with sites regarding check cashing/follow-up
Manual processes throughout (copies/GVR/inability to
download the app.)
 All copies made throughout (electronic and hard copy)
 1 to many ratio throughout process (application,
dispersement of funds, etc.): sponsors to teaching sites
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Snapshot of Potential Solutions
 Need electronic signatures in new tool
 Tool should require identification of 1 contact for MERC
purposes from both training sites and training programs
 Essential to work with DHS on setting deadlines on UPL
calculation so grant can be completed on time
 All users should have identity &password in new tool
 Tell training sites that all checks will be voided if not cashed by
“xx/xxxx” date;
 Training programs and training sites should be responsible to
keep information current
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Future State Swim Lane Map
Day 3:
Complete an
ideal future
state swim
lane map
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Ideal Catch Up Scenario
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Ideal Catch Up Scenario
Current approach - MDH Proposed transition
uses for allocating SFY
year - MDH uses for
15 funds
allocating SFY 16 funds
Proposed future annual
cycles
MA revenue years used
in formula to distribute
MERC PMAP and
cigarette tax funds
2012
2013 & 2014
combined
2015, etc.
State FY appropriation
2015
October 2014*
2016
October 2015
DHS calculates UPL
November 2014
November 2015
MDH disburses MERC
funds
April 2015
February 2016
2017, etc.
October 2016,
etc.
November 2016,
etc.
February 2017,
etc.
DHS provides Inpatient
FFS IGT
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Process Metrics
Future State
Current State
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Process Metrics
Process Step
Tasks
Waits
Handoffs
Electronic/Physical
File/Store
Electronic/Paper
Decisions
Total Time
Current State
Future State
Number
187
30
Number
84
8
E = 41
P=7
E = 17
P=1
E = 12
H = 14
13
30 months
E = 14
H=0
3
15 months
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Selected Next Steps
 Get firm timeline for IT component of project External
Contingency
 Continued discussion with DHS to realign UPL/IGT calculations
with new MERC schedule External Contingency
 Discussion with program/sponsor stakeholders about FTE
calculation requirements
Day 4:
 Review and clarify definitions(sponsoring, subparts, etc.)
Action
Planning/
 Form a workgroup to address participant education &
Next Steps
communication needs about the MERC Program
 Modify WebGrants so it captures all fields needed by all
participants
 Discuss possible approaches to expenditure reporting for small
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training sites
Parking Lot Issues
 Revisit DHS Managed Care revenue methodology
 Fix consolidated NPI issue in DHS claims data
 No checks to training sites – electronic wire transfer data part
of what is obtained when training sites register
 Contract directly with training sites
 New method of paying sponsoring institutions instead of by
check
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Questions?
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