DSS commissioner trying to push back a tidal wave of paper
DSS commissioner trying to push back a tidal wave of paper
Wednesday, July 27, 2011
On his BlackBerry, Roderick L. Bremby, the state's new commissioner of social services, keeps photographs he took on visits to field offices to illustrate what his agency is dealing with.
They show rows of file cabinets so full that papers get stored on top, files for long-term care patients that are several inches thick, and boxes of mail returned by the post office as undeliverable.
"This is a conference room that is now used for storage," he said while scrolling through them. "Those are more files. Those aren't trash, but those are files that need to be stored somewhere."
Actually, Bremby wants the department's eligibility workers to see them as something else. "Don't look at that as a file. Don't look at it as paper," he says. "It's a person. It's a family, and they're needing you."
The Department of Social Services serves close to 750,000 people--more than one in five state residents. Its $5.7 billion budget represents more than 28 percent of state spending, and 88 percent of it pays for medical assistance programs. Bremby, who began the job in April, hopes to modernize the department's technology, make its work "client-centric," and change the way the agency communicates with those it serves.
For now, he faces challenges that few would envy.
Caseworkers are overworked, and rely on technology that is outdated and inadequate. The department's staff is down nearly 30 percent since 2001, while demand for its programs has soared.
The department doesn't have the capacity to digitize documents, so nearly everything is done on paper--lots of it. The department processes some 3.7 million pieces of paper a month. And relying on paper documents means that if the caseworker handling your application is out sick, it doesn't get processed that day.
Isabel King, an eligibility services supervisor in the department's Danbury regional office, said earlier this year that some of the workers she supervises stay up at night thinking about the applications they're supposed to process but don't have the time to handle.
"I've never seen so many people do so much with so little," Bremby said during a presentation to state agency commissioners Tuesday, which, like other presentations he gives, included some of his field office photographs.
The phones, meanwhile, get 879,000 calls a month--an average of more than 28,350 a day. The voicemail boxes can't be resized, and in some offices, they fill up at least twice a day.
"I've said it's easier to get cable services here than it is to get access to a caseworker," Bremby said. "You stand in line behind all our other calls, whether they are urgent or whether they're simply looking for directions to get to the office."
And the job could get even more challenging. If state employee unions do not ratify a concession deal in the coming weeks, the department stands to lose 206 positions and cut more than $130 million over two years, including the regional offices in Middletown and Stamford.
"I think that DSS is an agency that has the capacity and the willingness to serve people better. I've seen the commitment, I've heard people say they really want to do more and do it better," Bremby said. "But we really need to accelerate the deployment of the proper tools, technological tools, so that we can serve people better."
The department is on the path to getting there, he said, but added, "I'm just going to be honest, it will take some time."
Taking down a tree with a pocket knife
When Bremby was picked for the job after nearly eight years leading the Kansas Department of Health and Environment, some questioned his lack of direct experience running a Medicaid program. But others have said Bremby has what the department truly needs: experience with technology, implementing systems to better handle government functions.
People who work in social services have heard promises about new technology before. The plan for modernization was discussed as far back as 2005 and initiated in 2008.
But Lucy Nolan, executive director of End Hunger Connecticut, which helps many residents apply for the Supplemental Nutrition Assistance Program--formerly called food stamps--said she thinks Bremby can make progress.
"I do think that people are feeling optimistic that this is the person who might be able to do all the things that people have either tried to do or not been able to do," she said, citing modernization as a key one.
Technology isn't the only need the department has. Employees have said more workers are needed, and people who work in social services have raised concerns about a lack of standardization between offices, saying clients are given different explanations at different offices, told to come in for interviews at some offices when phone interviews are acceptable, or told they need certain documents that aren't actually required when applying for a program.
Bremby said consistency across department offices is important; to do otherwise is not fair to clients. But he said he's reluctant to seek additional staff before the technological changes.
"If we get too many people, our overhead goes up, which doesn't allow us to utilize resources to buy technology, so there's a balance that we have to achieve," he said.
He illustrates the idea with a story: "If I asked you to walk out and, say, 'take down that tree,' and hand you a pocket knife, it's going to take you a while, and you're likely to say 'I need help.' And so if I send 10 more people with pocket knives, what good is that really going to do?"
"But if I say, 'OK, you need help, how about a chainsaw?' Yeah, you can probably take care of that in a fraction of the time, without more people."
Still, Bremby said, improving the technology can't take too long, "because at the end of the day, there are people who are desperately in need of services that can't get that service or access us because we have neither the tools nor sufficient people without the tools to do that work today."
21 months or less
Bremby said Tuesday that he hopes to have the contract for the modernization done this month. Implementing it is expected to take 21 months, although he said that's too long and he hopes it can be done faster.
At the front end will be a document imaging system that allows paperwork to be digitized, eliminating the reliance on paper files that can only be accessed in one place, and improvements to the phone system. After that, the plan includes the development of a call center that can help people calling from anywhere in the state, and a processing center that will handle paperwork that doesn't require face-to-face interactions with clients.
Toward the end of the timeline is a web portal for applications.
Some changes could come sooner, including pilot programs to make the phone system more manageable and a way to access case information from smartphones.
The state will also need to replace the eligibility management system, the core information technology function of the department, which Bremby says was state of the art in 1989.
Beyond that, Bremby wants to change the way work is handled. Rather than leaving each caseworker with an "ungodly" number of cases, workers would be responsible for whatever cases show up on their desk in a given day, with a goal of handling as many as they can. He expects the department to begin reaching out to clients more, including allowing people to sign up for alerts by text message.
He also wants the department to examine its more-than-90 programs to see how their requirements can be better aligned. Sometimes, he said, the requirements for programs conflict, and being eligible for one can cause someone to lose eligibility in another.
"The fact that we may adjust by $50 here or there may mean substantial reductions in staff time and client frustration or lack of eligibility altogether," he said.
Offices also need physical modifications. "The fact that people don't have privacy when they step up in a window to talk about their needs, that's really not the type of organization we want to be," he said.
DSS tends to serve more people when the economy is bad, and Bremby doesn't expect the agency's caseloads to fall dramatically in the next decade. Regardless of the economy, demand will increase under federal health reform, which is expected to add more than 100,000 people to Medicaid in 2014.
"Demand for our services will continue to be fierce," he said, "and so we will have to reconfigure our systems to prepare for this new normal."