DHHS TRIES AGAIN

The overhaul at the Department of Health and Human Services that has a legislative committee so interested is about improving response, increasing skills and reducing bureaucracy. All good ideas, but fair to say few expected the commissioner of the department, Jack Nicholas, to be caught up in the senior-level resignations. The sweeping changes, however, are evidence of how determined Gov. Baldacci is to force the state’s largest agency to run more efficiently.

The specific office under reconstruction within DHHS is MaineCare, the state’s Medicaid services. With the help of Deloitte consultants, the department last summer looked at the office’s strengths and weaknesses and found plenty of the latter.

According to Deputy Commissioner Mike Hall, who is overseeing the reform, the problems pre-date the Medicaid computer disaster and include poor communication, little support for staff, a rigid management that didn’t respond to workers and an absence of training. The workers “get a job, get a desk, a computer screen and are told good luck,” was how he summarized it.

Health care providers had similar complaints about the system, the department discovered. Not only are they reimbursed at a level below their actual costs, to add insult to economic injury, they are too often treated less than respectfully and not helped nearly often enough, Hall concluded. For these and other reasons, the reformers have redrawn the structure of the office to make it more responsive to workers, providers and the public. They also picked up the pace of reform, which may have been what surprised legislators this week. A few on the Health and Human Services Committee said they had learned of the reform only recently, though DHHS can show committee agendas dating back to August with “MaineCare Services Reorganization” scheduled for discussion.

One of the more dramatic results of a new office organization was that senior managers were asked to resign. They can apply for the newly created positions, but the message for some of them is inescapable: You’re part of the problem.

Part of the solution is to recognize that MaineCare is a giant health-insurance firm and should have call centers and provider and technical services as good as the best insurers around. Deloitte has already done an analysis of what’s wrong and Mr. Hall says new practices will be fully in place by spring or summer. That is a good sign for a department struggling for years to become more efficient and effective. If the changes in training and management responsiveness work there, of course, applying them elsewhere in the department might be a good idea.

Mr. Nicholas accepted the job as commissioner in February 2004, and weathered near constant revelations of old and not-so-old foul-ups throughout his career there. Whatever the reason for his departure, he guided the department through some of its toughest times, forcing it to confront its shortcomings. That’s quite an accomplishment.