UTR

Unable to Reach (UTR) Process Optimization

The process for handling nonresponsive members is different with each program at Montefiore's Care Management Organization (CMO). The goal of this Lean Six Sigma Black Belt project was to standardize and optimize the process for handling nonresponsive members.

Objectives

• Solve a multi-objective constrained optimization problem such that the response rate is maximized while the cost is minimized
• Determine the optimal:
  • Number of times to outreach a member before they are labelled as UTR
  • Amount of time between outreach attempts
  • Time frame in which to outreach members
• Determine the time(s) of day which yield the highest response rate(s)
• Determine the appropriate amount of time that a member should remain flagged as UTR before attempting to contact them again (placing them back on the enrollment list)
• Determine the response rate of each outreach method (phone call, mailed letter, home visit)
• Calculate yearly expenditure on mailed outreach attempts (paper, stamps, ink, other printing costs, staff-hours or programs with call centers) vs. response rate to determine whether or not to continue this outreach method

In Scope

The scope includes the UTR processes for the following NCM programs:

• Enrollment
• Baseline
• Health Home
• Intensive Case Management (ICM)
• Complex Case Management (CCM)
• Chronic Care Management programs
  • Diabetes
  • Respiratory
  • Chronic Kidney Disease (CKD)
  • Heart Failure (HF)
• Housing
• Post Discharge
• Managed Long Term Care (MLTC)

Business Case

The first stage of the care management process is enrollment. The outreach step in the enrollment process includes contacting members and documenting their interest in being managed by CMO. A standardized process for handling nonresponsive members will streamline the outreach process.

Constraints

• Some programs (i.e. Health Home) have federal or state regulatory requirements regarding the number of outreach attempts and the length of time between outreaches.
• Data collection via Data Analysis & Research (DA&R) difficult because of resource and staffing constraints

Assumptions

• Cost includes resources, monetary expenses, and staff-hours
• Maximize response

Methodology and deliverables

Lean

• "As-is" workflow(s)
• "To-be" workflow(s)
• Value stream map
• Cause & effect diagram

Six Sigma

• Cost/benefit analysis
• Statistical control charts
• Pareto chart
• ANOVA
• Tukey's test
• Process capability
• Standardized work