WIC BENFITS ISSUANCE THROUGH PODS

The Florida Department of Health in Broward County (DOH-Broward) is one of 67 Public Health Departments under the governance of the integrated Florida Department of Health (DOH). Although DOH-Broward is a state agency, it maintains a very strong partnership with Broward County Government, which is formalized in a core contract. The main administrative campus is in Fort Lauderdale, Florida, with additional facilities in geographically accessible locations.  DOH-Broward is responsible for protecting, promoting, and improving the health of the county's 1.9 million residents and over 10 million annual visitors. 

According to the U.S. Census population estimates for July 2021, Broward County is the 17th most populous in the United States, with over 1.94 million people and 9% of Florida's residents. 34.1% of residents are foreign-born. The population is increasingly diverse with significant growth among minority racial and ethnic groups. Among Broward residents, 63.1% identify as White; 30.2% Black or African American including many who immigrated from Haiti, Jamaica, and other parts of the Caribbean, as well as Central and South America. 31.1 % of the population identifies as Hispanic or Latino. 37.5% of the population speaks a language other than English in the home.

The Special Supplemental Nutrition program for Women Infants and Children (WIC), serves low-income pregnant, post-partum, and breastfeeding women, infants, and children up to age 5 who are at nutritional risk.  The program provides nutritious foods to supplement diets, information on healthy eating, breastfeeding promotion, and support, as well as referrals to healthcare. Broward County has over 58,000 residents potentially eligible for the WIC program. WIC-Broward has approximately 49,000 individuals currently enrolled in the program.    

As a result of the COVID pandemic, we experienced several staffing issues that impacted service delivery such as staff out with COVID or exposure to COVID, staff resignations, and the inability to successfully recruit candidates. Because of this, we were unable to keep-up with the demand of clients with scheduled appointments clients calling the call center with pending certification/enrollment, the inability of staff to reach clients when calling from the appointment list, clients returning the missed call by calling the DOH-Broward call center and an influx of emails received from the call center to WIC Administration staff to add/modify the appointment list queue.

The initiative in which we are applying for a model practice is called the Broward WIC POD (Person of the Day.)  The purpose of this practice is to provide a method in which clients who contact the WIC program are immediately transferred to WIC staff assigned to the Broward WIC POD for service over the phone.  This ensures that clients are served when they contact us versus waiting for a call back from WIC staff.

The Special Supplemental Nutrition program for Women Infants and Children (WIC), serves low-income pregnant, post-partum, and breastfeeding women, infants, and children up to age 5 who are at nutritional risk.  The program provides nutritious foods to supplement diets, information on healthy eating, breastfeeding promotion, and support, as well as referrals to healthcare.  Broward County has over 58,000 residents potentially eligible for the WIC program. WIC-Broward has approximately 49,000 individuals enrolled or 84% of the estimated eligible population enrolled in WIC services.    

In March 2020, the COVID-19 pandemic changed the way WIC does business and provide services to its clients.  At the Federal level, the Federal declaration of Public Health Emergency allowed for certain waivers to be put into effect, removing barriers to WIC services, and allowing for remote services to be provided by WIC programs across the country.  In the state of Florida, more specifically Broward County, this meant services had to be provided over the phone and benefits uploaded electronically by WIC staff or benefits had to be auto generated for one month if certain conditions were met. We also had a web-based education option that triggered an electronic auto-generated issuance of benefits if conditions were met.

 Serving clients over the phone meant more than 1 month of benefits could be issued to clients and client health-related education or referral needs could be addressed in real-time. Contact clients by phone, was the preferred method and was initially done by WIC-Broward staff calling clients from the appointment schedule list and serving clients on their appointment date and time.

In March 2020, 84% of our eligible population was enrolled in WIC and the second low risk nutrition education contact was at 95.6% and second high risk nutrition education contact was at 95.9%.  By March 2021, there was a drop in enrolled clients to 81% and the second low risk contact dropped to 84.7% and the second high risk contact dropped to 85.6%.

As a result of the COVID pandemic, we experienced several staffing issues that impacted service delivery such as staff out with COVID or exposure to COVID, staff resignations, and the inability to successfully recruit candidates. Because of this, we were unable to keep-up with the demand of clients with scheduled appointments clients calling the call center with pending certification/enrollment, the inability of staff to reach clients when calling from the appointment list, clients returning the missed call by calling the DOH-Broward call center and an influx of emails received from the call center to WIC Administration staff to add/modify the appointment list queue.

Additionally, the auto-generated 1 month of benefits helped clients receive benefits but did not address their current health-related needs such as: formula shortages or intolerance issues, food package issues, WIC enrollment, and breastfeeding assistance. These issues all require live consultation to achieve the necessary client-centered interactions and service.

The web-based education option was put into effect prior to COVID but was not effective as less than 1% of clients elected to participate in this option and there was low compliance for meeting criteria to generate benefit issuance.

On February 3, 2022, the DOH WIC-Broward Administration team discussed the potential for creation of a WIC-Broward Person of the Day (POD) to handle calls from the DOH-Broward call center by direct transfer.  No other WIC program in the state has implemented a process such as this and we are unaware of any such programs at the national level.  Without a benchmark, DOH-Broward needed to gather data to assess needs and criteria.  In addition to not being able to reach clients, the number of nutrition education contacts provided by staff dropped by 19% one year after remote services began due to the COVID pandemic and remote services were implemented. The number of nutrition education contacts provided by staff increased by 2% when compared to pre-remote service using the WIC POD process which resulted in a greater number of clients being served by this program. 

The goal of the WIC-Broward POD practice was to improve the success rate of client contacts, measured by second low risk contacts and second high risk contacts, the number of nutrition education services provided by staff, increase WIC enrollment and participation, and improve remote service process efficiency and effectiveness.

The number of nutrition education contacts provided by staff dropped by 19% one year after remote services began due to the COVID pandemic. The number of nutrition education contacts provided by staff increased by 2% when compared to pre-remote service using the WIC POD process.

It was a collaborative effort between WIC Broward Administration, DOH Broward call center managers, and the DOH-Broward Management Information System (MIS) team.  On February 3, 2022, the WIC-Broward Administration team discussed the potential for creation of a WIC-Broward POD creation to handle calls from the DOH-Broward call center by direct transfer. The DOH-Broward call center Manager was contacted to help facilitate the feasibility study. The WIC-Broward Program Coordinator contacted the DOH-Broward Call Center manager to identify the most appropriate day to shadow the call center to identify the most frequent issues and determine feasibility of direct transfer to handle issues.  Monday and Tuesday was identified as the highest call volume days and therefore would give us the greatest amount of data.  The WIC Program Coordinator spent a several days in the call center observing prcesses, gathering data and performing a test run of the WIC-Broward POD from the call center agent desk.  Feedback and the findings were shared with the WIC-Broward Administration team. A list of top client concerns was created from client feedback which led to the creation of the WIC-Broward POD call transfer criteria.  The number of calls served during the observation and information gathering phase provided WIC Administration call demand and how many workers to assign to meet client needs.

DOH-Broward MIS was contacted and helped facilitate retrieval of agent identification (ID) numbers and setting up skills (queues) for routing.  A new skill” was requested to create an extension for WIC-Broward POD nutrition concerns to be transferred and held in queue for a WIC-Broward POD agent. 

The DOH-Broward MIS team also assisted the WIC Program coordinator in setting up the Avaya VOIP software necessary to receive incoming calls transferred from the call center to the Broward WIC POD. Harware adjustments including setting up network switches and the existing Avaya phone options was converted to enter call agent ID numbers and agent ID numbers were requested through an exisitng phone extension.

The initial pilot of the program started with 2 nutrition staff assigned to the WIC-Broward POD to handle the specific identified criteria for the WIC POD.

On March 28, 2022, skills and agent IDs were received by the WIC Program Coordinator.  And on March 29, 2022, a test run was conducted using the WIC-Broward POD by the WIC-Broward Nutrition educators. 138 calls were transferred to the WIC-Broward POD during the test run and 80 calls were answered.  Approximately 40 calls were handled per WIC-Broward POD agent during the test run.  In comparison, staff calling the appointment line list averaged 20 clients served per employee. By April 8, 2022, a schedule was created for 3 WIC-Broward POD staff to be assigned per day to support the high demand.

By May 2022 the following identified transfer criteria was established for the WIC POD:

·         electronic benefits transfer (EBT) personal identification number (PIN) not working

·          Formula change

·         All other food package changes

·         WIC Application Issues logging in

·         Address change

·         Client was called within the past week but is still missing benefits

The WIC-POD data for May 2022:

The total number of calls answered by the WIC-POD in May 2022 was 2,189 calls, with a 19% abandonment rate. Clients hung-up the phone after waiting 11 minutes on average.

An analysis of productivity of nutrition staff, showed that staff using the call list method, maintained that same rate of productivity. However, staff that were not productive according to productivity standards, doubled service production when assigned to work the new WIC-Broward POD process. Feedback from staff working the WIC-Broward POD was that although the workload seemed heavier, clients were more prepared to be served. Clients were able to call at a time that was more convenient for them as opposed to staff calling and catching clients at a bad time or a time when they didn't have the information, they needed for a WIC appointment. We determined that the WIC-Broward POD process had the capacity to do more.

On June 10, 2022, the WIC-Broward Administration team requested from MIS 2 additional skills for WIC-Broward POD clerks and WIC-Broward POD breastfeeding (BF).  Additional agent IDs were requested to add additional agents work support and WIC skills. On July 6, 2022, clerical and BF agent IDs were assigned and WIC site extensions were configured to add and agent login feature.  July 7, 2022, concluded the las day of the email WIC process from call center and on July 8, 2022, we expanded the criteria for the WIC-Broward POD Transfers.

With the addition of the clerical and BF Skills,” the criteria for call transfer were expanded to the following:

To transfer to clerical staff:

·         Missed call from previous day or today

·         Not called due to no recent previous appointment or not called for previous appointment scheduled

·         Uploaded or emailed documents

·         EBT (electronic benefits transfer) card issues such as: needs replacement card or needs card to be mailed

·         Address changes

·         Foster families/children certification

To transfer to breastfeeding staff:

·         All Breastfeeding issues or concerns

To transfer to nutrition staff:

·         Pin number not working

·         Formula change shortages

·         Food package changes

·         WIC app issues logging in

·         Direct Distribution formula issues

·         Missing benefits on card

July 27, 2022, the Senior Public Health Nutrition Supervisor in DOH-Broward WIC administration conducted WIC POD training for additional WIC staff.

August 2, 2022, Expanded Nutrition POD to 11 agents, BF POD to 2 agents, Clerk POD to 8 agents.

August WIC-POD data:

Total calls answered by Nutrition WIC POD = 4,370, with a 14% abandonment rate. Clients hung up the phone after waiting 12 minutes on average.

Total calls answered by Clerical WIC POD = 6,687, with an 8% abandonment rate. Clients hung up the phone after waiting 8 minutes on average.

Total calls answered by BF WIC POD = 571, with a 14% abandonment rate. Clients hung up the phone after waiting 8 minutes on average. 

The performance measures utilized to track the demand is the number of calls transferred and abandonment rates.  This data is obtained from the Avaya system reports.  The measures utilized to track success are the enrollment and low and high-risk nutrition education contacts.  This information is obtained from state WIC office data reports and the FL-WISE WIC data system.  In addition, this data is tracked and reported on in Active Strategy, DOH-Broward's performance management system.

The practice is sustainable with the allowance for remote, over the phone services to clients to continue for a majority or some of WIC services in the future. This would be dependent on WIC regulations.  This method is favorable amongst clients as evidenced by participation rate in WIC-Broward reaching above 90% consistently throughout the implementation of remote services.