Update on Medical Cards nationally

Health Service Executive (HSE)

Primary Care Reimbursement Service (PCRS)

Centralisation of Medical Card Services

September 2010

Introduction

The HSE Primary Care Reimbursement Service (PCRS) has been providing payment services on behalf of the HSE, and formerly all of the Health Boards, to Primary Care Contractors in respect of services that they provide to members of the public under the various community bases Schemes for nearly 40 years. In addition the PCRS now deals with approximately 39% of the national medical card population in relation to medical card applications, reviews and associated work.

In 2008, the Government introduced a new Medical Card Scheme for persons aged 70 years and over. The processing of applications under the new scheme was centralised in the national office at PCRS in Finglas. In addition, from November 2009, approval, review and reimbursement of all claims for services and refunds, under all of the Primary Care Schemes nationally, and overall responsibility for all associated budgets, came under the central governance of PCRS.

While executive responsibility transferred to PCRS in 2009, the transition and streamlining of the Schemes is taking place over a phased period so that the project can be continuously monitored and evaluated in a controlled way, and if required modified to deliver optimal results, for both the client and the HSE.

Background

Prior to January 2009 Local Health Offices provided the public with advice and assistance in relation to applying for medical cards, and the staff in these offices also processed medical card applications in more than 100 locations across the country.

As part of our ongoing programme to provide a more responsive and cost effective service, the HSE is centralising the processing aspect of medical card applications to its facility at the PCRS in North Dublin.

Under the centralisation plan, the HSE’s Local Offices will continue to provide the public with assistance and information locally in relation to medical card eligibility and making an application, and the current status of their application or review.

From the customers perspective this means that at all times s/he will be able to seek advice from his/her Local Health Office.

Local Health Offices have access to the national system to help clients with enquiries about their application or review, and can also deal with queries of a general nature about the medical card scheme.

The development of additional functionality within the new system to assist clients and our HSE colleagues in this area is continuing apace in line with the agreed plan.

At the new national processing centre, medical card processing is characterized by standardised decision making in line with the medical card guidelines. The process is transparent from application receipt through to completion, with customer service accessible through multiple new channels including phone, correspondence, online facilities and SMS text services.

Current Status

The centralisation programme has been introduced on a phased basis.

Phase 1 – Medical Cards for people over 70 years.

23% of all medical cards issued are in respect of people over 70 years of age.

In January 2009 the automatic entitlement for people over 70 to receive a medical card was replaced with a new approach that involves a means assessment. With this new approach, when a person’s eligibility for a medical card comes up for review, their means and therefore eligibility, is assessed in accordance with new higher income levels.

This review process and the administration of new applications for people over 70 are now being carried out at the HSE PCRS facility in North Dublin.

Phase 2 – North West Dublin & Dublin North Central

This phase involved transferring the processing of renewals and applications for medical cards from the North West Dublin and Dublin North Central Local Health Offices to the Central Office at the PCRS. Medical cards issued to people in these areas represent 6% of all medical cards.

Phase 3 – Consolidate and Rollout National

The next phase of the project is to go live and process all new applications in the Central Office from a given date following a consultative process with staff representatives and in line with the recent agreement on pay and reform in the public service. Taking cognisance of the fact that this is a critical change project which must move ahead, there are many benefits accruing in the final phase, e.g. better customer service, full implementation on a given date will provide more clarity to all concerned (Clients, TD’s, Primary Care Contractors, HSE staff etc.), will free up staff for redeployment to key frontline services (e.g. primary care teams) more quickly, and will result in the provision of better CRM services to the client.

Customer Service

To date the new central office has launched a number of new customer focused initiatives to ensure a high standard of customer service:

1)      At the new website – www.medicalcard.ie – any person who has applied through the national central office – currently 39% of all applications nationwide – can now view the status of their medical card application or review online, using a unique reference number which is provided to each applicant immediately on application receipt.

2)      Medical card applicants who give a mobile phone number on their application are provided with SMS acknowledgement and application updates.

3)      All HSE Local Health Offices now have, for the first time, full visibility of the national database of Medical Card clients, including historic records. This allows them to track the current status of applications and reviews being dealt with by the central office and answer queries locally in respect of current clients, new applicants or review clients.

4)      GPs have access to weekly updates of their panel listings, through the PCRS Online Application Suite. Over 75% of GP’s currently use this service.

5)      A new call triage telephone system, which provides customer focused information and call routing, as well as other services to support clients who have enquiries about medical cards or their application or review.

6)      Continued the systems integration with GPs and Pharmacists so that medical cardholders can have their eligibility confirmed at point of service to avoid any delays etc. The number of checks at point of service made by GPs is anticipated to reach 5,000,000 by the end of 2010.

7)      In addition in June 2010, the HSE launched a new online Medical Card application service which guarantees a 15 day turnaround for complete applications. This new facility was developed to enable people, anywhere in the country, to apply online for a medical card, as is the case with many other public services. To date we are receiving approximately 3,000 applications via this new channel each week with more than 50% of these applications made outside normal office hours.

8)      Introduced a new user friendly review process for people over 70 years of age.

The new online Medical Card application is suitable for people who are likely to qualify for a medical card on income grounds. Online assessments are immediate and for applicants who supply all evidence/documentation and are eligible on income grounds, medical card delivery is guaranteed within 15 days of receipt of the completed application pack. Applicants who are over the income limits (i.e. Discretionary Cases) will be informed immediately and may apply to the HSE for assessment in the normal way, if they wish.

The online application works better for the customer because;

1)      Eligible applicants are guaranteed to get a medical card quickly

2)      The online form will help them to submit a correct application

3)      If a person is not eligible on income grounds, completion of an online application will determine this immediately, and we will provide the person with a written assessment of the application within fifteen days.

Many medical card applicants are regular users of the internet. We would appreciate if friends, family members, neighbours and support groups would assist those who may have difficulty in making an online application but would benefit greatly from the convenience of the facility. For those unable to apply online medical card application forms and assistance will continue to be available in Local Health Offices.

This new online application service provides a service for the thousands of people who simply wish to verify their eligibility and the majority of applicants who automatically qualify for a medical card based on their income.

The launch of www.medicalcard.ie is part of the HSE’s ongoing plan to provide a more responsive and cost effective medical card service. Centralising the ‘back office’ processing of medical card applications and reviews in PCRS will save the tax payer €10 million per annum. The PCRS “back office” will ensure a streamlined and fast system of client registration, card production and payment to contractors whilst providing a consistent, fair and equitable service with increased quality controls and increased turnaround times.

The HSE will continue to engage with all user groups including, medical card applicants, GPs, patient advocacy groups, Local Health Office staff and public representatives,  in order to ensure the system is as efficient and user friendly as possible.

PCRS has also issued more than 500,000 letters, handled hundreds of Parliamentary Questions and Public representative enquiries, with the oldest complete application on hand less than four weeks old This implementation of a shared service model has also delivered significant productivity gains for the HSE, demonstrating how the HSE can deliver improved services within the more limited resources available in a way that meets the needs of citizens in a modern society.

The improved service and many benefits which will accrue to the client, the taxpayer and the health service from centralisation may be outweighed in the eyes of some stakeholders who have specific interests and focus on the medical card scheme. However, if everyone pulls together to complete this project and cooperates with the change we can achieve the goal much faster and at less cost to all concerned. Many of the problems encountered to date are the result of non cooperation with the change, or simply are the result of the change itself, as everyone involved becomes familiar with the new ways of working. We will continue to strive to meet the targets to provide a better, faster, fairer and more consistent service to our clients whatever happens.

Backlog

When the processing of medical cards was transferred from the Local Health Offices in North West Dublin & Dublin North Central to the PCRS facility it was discovered that there was a backlog of unprocessed renewals and applications in these offices. While the backlogs from these offices are now dealt with, their existence in the first place reinforces the urgent need for this work to be centralised if the public is to get the service it deserves.

Transition Arrangements

It is very important to reiterate that the centralisation plan relies on local staff remaining available in each Local Health Office to provide local assistance to clients, providing front line services at local level, with back office processing and support.

Local Representatives have been provided with a contact number for both the PCRS facility and for every Local Health Office. The HSE has also put in place a new structured enquiry system for Local Representatives, Staff and members of the public in order to streamline the query process.

Additionally, a new call triage telephone system, which provides customer focused information and call routing, as well as other services to support clients who have enquiries about medical cards or their application or review has also been implemented. Since the introduction of the new call triage system (lo call 1890-25-2919) service in mid June 2010 every call is answered and the system has handled over 77,542 calls. A caller can get information directly from the triage system or can select to be put through to an operator that will handle their enquiry. We are currently taking 573 medical card related calls each day of which over 80% are answered in less than 20 seconds, with an overall average answer time of approx. 13 seconds.

In addition to customer supports such as the website, phone line and text service, the ‘front house’ service for medical cards will remain in the HSE’s Local Health Offices around the country. Here the public will be able to get information on eligibility, advice on how to apply, assistance with making an application etc. Local Health Office’s have access to the central database and the online application tracking resource and so can answer questions and queries from the public quickly and efficiently.

This new initiative, along with the other initiatives put in place as part of the centralisation of Medical Card Application Processing, will provide a number of significant benefits to the public:

  1. Applications for medical cards will be processed in 15 days – down from the current 12 to 16 weeks.
  1. The cost of the Medical Card Scheme will be reduced by more than €10 million a year, which will be made available for frontline services. (39% of medical cards are currently being processed centrally and the centralisation project has realised savings of more than €5 million to date).
  1. All applications will be assessed using a uniform and consistent process, which will ensure appropriate expenditure of taxpayer funding.
  1. Staff in Local Health Offices will have more time and resources to meet pressing front line service need i.e. Primary Care Team support.
  1. Other HSE services, e.g. Paramedic services, Public Health Nursing Departments, Doctor on Call services, Hospitals etc. will also be in a position to determine the eligibility of a client for services by accessing the national online system at the central office in PCRS.

Some Facts and Figures

Significant progress has been made to date in this national project in providing an improved service to the public at less cost to the State. There are So far the centralised office at PCRS has, as at 17 September 2010, in addition to providing all of the new customer focused initiatives set out above:

  • Processed over 204,657 Medical Card applications and reviews
  • Issued 165,407 Medical Cards on foot of these applications
  • Requested 14,309 of those applicants to provide additional required information as their applications were incomplete
  • 8,877 applications are in progress
  • 5,549 of these 204,657 applications were not successful

Moving forward

In the 20 months since the central office started working on this, a significant number of client and staff friendly initiatives have been introduced. As the centralisation process continues more initiatives will be introduced, and the current initiatives will continue to be enhanced as we receive feedback and continue to engage closer with advocacy groups, staff and public representative and primary care contractors to provide improved services to our clients in a more efficient way.

We understand that Medical Cards and GP Visit card are very important for people, particularly for people who depend on a number of different services. They are the gateway to a whole host of services: free GP visits, free medicines, free dental care as well as a number of other services such as all inpatient, outpatient, maternity and infant care services, ophthalmic and aural services. Knowing that they can access these free health services when they need them can relieve considerable stress, particularly for older and vulnerable people. It is hoped that friends, family members, neighbours, support groups would assist those who may have difficulty in making an online application but would benefit greatly from the facility’s convenience.

We are now looking forward to moving ahead with the support of staff and stakeholders to:

  • Finalise centralisation on a given date following a consultative process with staff representatives and in line with the recent agreement on pay and reform in the public service.
  • Redeploy the required resources to the central office
  • Roll out all new available services nationally to realise the benefits set out
  • Establish links with each main local area to ensure consistent approach to MC customer services nationally
  • Finalise and implement a national approach to the application of discretion
  • Finalise and implement a national approach in relation to homeless/sheltered accommodation and other marginalised groups
  • Finalise review of all application and review processes involved in the medical card process  and roll out national changes

When Medical Card centralisation is finalised staff will remain available in every local office to assist clients that require information or assistance completing forms. The central office has also already rolled out, and made available to every local office, systems that allow staff to see the national register and to enquire on the current or historic status of a client and to see the current status of any client application or review made to the central office, and any letters issued to clients etc. These tools currently allow local office staff to help clients with enquiries, and are already being used.  In addition the central office has provided a number of initiatives that allow clients to help themselves; clients (of the central office) can now check the status of their application or review online at any time of the day or night, they can also check that status by sms text message at any time or by calling the lo call triage system during office hours.