2017 Provider Satisfaction Improvement Goals

Transcription

1 2017 Provider Satisfaction Improvement Goals

2 Provider Relations Expand Network Health s competitive advantage in the areas of provider relations, satisfaction and loyalty Communicate 2016 Provider Satisfaction survey results to all Network Health constituents Prepare 2017 Provider Satisfaction survey (NEWI and SEWI) Identify metrics/goals for 2017 Provider Satisfaction Improvement Plan Service Category Specific Improvement Plans Finance Utilization and Quality Management Network Care Coordination Pharmacy Call Center Service Staff Provider Relations Create and implement overall 2017 Provider Communication Plan 2

3 2016 vs Overall Satisfaction Would you recommend Network Health Network Health Anthem Arise United Health Humana

4 Summary of Results Overall satisfaction 6% drop from 16 but 7% > benchmark Best results Provider Relations: 96 th percentile; 42% > benchmark Call Center: 96 th percentile; 44% > benchmark Good, but can improve Finance/Claims: 20% dip but 26% > benchmark; 71 st percentile Utilization & Quality Management: 21% dip but 23% > benchmark; 65 th percentile Focus areas Network Care Coordination: 33% dip and 5% < benchmark; 41 st percentile Pharmacy: 42% dip and 4% < below benchmark; 61 st percentile *Percentiles based upon SPH Commercial Book of Business

5 Results by Category Category Composite SPH Benchmark Overall Satisfaction 79.5% 84.2% 80.4% 81.4% 74.5% Finance Issues 50.1% 63.0% 56.5% 61.1% 39.7% Utilization and Quality Management 48.8% 61.9% 56.0% 60.3% 39.7% Network Care Coordination 35.6% 53.5% 52.3% 49.5% 37.3% Pharmacy 27.2% 41.7% 40.3% 37.8% 28.2% Health Plan Call Center Service Staff 68.4% 75.7% 72.9% 79.1% 47.6% Provider Relations 62.7% 62.1% 58.5% 62.7% 44.1%

6 Pharmacy

7 Pharmacy Pharmacy - Composite 27.2% 41.7% 40.3% Consistency of the formulary over time 37.3% 44.5% 39.7% Extent to which formulary reflects current standards of care 31.0% 46.6% 38.2% Variety of branded drugs on the formulary 21.2% 8.3% 36.8% Ease of prescribing your preferred medications within formulary guidelines 21.7% 41.2% 46.2% Availability of comparable drugs to substitute those not included in the formulary 25.0% 38.0% 40.4%

8 2017 Pharmacy Plan Electronic prior authorizations New option allows for more efficient and quicker review on prior authorizations. No more holding on the phone, mailing paperwork and waiting days for a response. Medical drug authorizations As of , all HIX drug authorizations will be handled by CVS. Plan to have CVS handle commercial drug authorizations; epa plans underway for this type of authorization as well. Prescriber outreach Network Health pharmacists are following up directly with prescribers on appeals and authorization requests. Clinical discussions about member care. Network Health pharmacists assisting prescribers on steps and criteria to get drug approved.

9 Pharmacy Plan (cont.) Continued Communications/Newsletters Worked directly with marketing for 2017 newsletter content Initiation of pharmacy newsletters faxed directly to pharmacies Awareness and revision of pharmacy formulary to reduce administrative burden Number of step therapies reduced Quarterly measuring and assessing of prior authorizations with critical review of necessity of such requirements

10 2017 Utilization and Quality Management

11 Utilization and Quality Management Network Health Summary Rate 2016 Network Health Summary Rate 2015 Network Health Summary Rate 2014 Utilization and quality management composite 47.5% 61.90% 63.50% Access to knowledgeable utilization management staff 52.0% 64.7% 61.2% Procedures for obtaining pre-certification/ referral/authorization information Timeliness of obtaining pre-certification/ referral/authorization information The health plan's facilitation/support of appropriate clinical care for patients 48.1% 62.6% 54.3% 47.2% 62.2% 58.9% 44.6% 62.1% 50.8% Access to case/care managers from this health plan 50.4% 63.8% 58.9% Degree to which the plan covers and encourages preventive care and wellness 43.0% 56.0% 51.9%

12 Utilization Management Provider Goals Satisfaction Strategies Access to knowledgable utilization management (UM) staff Procedures for obtaining authorization Timeliness of obtaining authorization Access to case managers Strategy Provider site practice manager meetings Attend provider site meetings to field authorization process questions Pulse articles Access to UM staff and medical directors Authorization procedures Authorization turnaround timeframe results Improved website and provider portals Launch provider portal for authorization requests and determination notifications

13 Quality Will Focus on Improving Satisfaction Scores Goals Degree to which the plan covers and encourages preventive care and wellness The health plan's facilitation/support of appropriate clinical care for patients Strategy Streamline provider education and communication Collaborate with other departments to provide unified messaging Dedicated onsite provider educator to assist with risk adjustment, quality, HEDIS and preventive care training Pulse articles Monthly HEDIS coding tips and articles on relevant wellness and preventive screening topics Quarterly provider spotlights to highlight involvement on Network Health committees and providing expertise in providing high quality, evidence-based care Clinical integration efforts Integrated efforts to encourage members to receive annual wellness visit, receive all recommended preventive screenings and to seek care in appropriate settings Provide monthly gaps in care reports to providers to easily identify which members to contact Frequent collaboration to understand how best to collaborate on quality and wellness interventions to avoid duplication Improved website and provider portals Provide comprehensive messaging, reminders, and easy access to information on preventive care, clinical care guidelines, and quality measures such as HEDIS and Stars

14 2017 Call Center and Finance/Claims

15 Call Center Service Staff Health plan call center service staff - composite 68.4% 75.7% 72.9% Ease of reaching health plan call center staff over the phone 71.2% 78.3% 77.1% Process of obtaining member information 67.6% 76.0% 73.0% Helpfulness of health plan call center staff in Obtaining referrals for patients in your care 61.4% 71.3% 68.8% Overall satisfaction with health plan's call center service 73.3% 77.3% 72.9%

16 Finance Issues Finance issues - composite 50.1% 63.0% 56.5% Consistency of reimbursement fees with your contract rates 40.2% 63.6% 51.0% Accuracy of claims processing 59.2% 67.6% 63.5% Timeliness of claims processing 47.9% 60.3% 57.9% Resolution of claims payment problems or disputes 53.0% 60.6% 63.7%

17 2016 Call Center Staff Goals Goal Increase the composite score from 75.7% to 79% to bring us closer to 2013 score Increase overall satisfaction (77.3%) and ease of reaching staff metric (78.3%) to 80% Increase the process of obtaining member information metric from 76% to 78% Action Increase agent staffing and training on provider calls Improve portal experience for providers to obtain membership information

18 2016 Finance (Claims) Goals Goal Increase accuracy of claims processing to 67% Improve all other measures to 65% Action Implement end-to-end audit process for contract setup through claims Implement NetworX modeler and pricer for improved contract build and testing Increase auto-adjudication of claims Improve front-end intake and back-end handling of provider disputes

19 2017 Provider Relations Goals

20 Provider Relations Provider relations composite 62.7% 62.1% 58.5% Do you have a provider relations representative from this health plan assigned to your practice? 70.3% 49.8% 43.4% Provider relations representative s ability to answer questions and resolve problems 76.6% 73.7% 79.5% Quality of provider orientation process 53.8% 53.9% 47.2% Quality of written communications, policy bulletins and manuals 57.8% 59.0% 48.9%

21 Goal Provider Relations Goals Increase survey metric: provider relations representative s ability to answer questions and resolve problems from 76.6% to 78% Action In 2016, managed care contracting (MCC) had a staffing transition. MCC is working with corporate training to ensure staff has resources needed to address questions or concerns. MCC will be forming a bi-weekly work group comprised of claims, health management, pharmacy and customer service to keep a pulse on the interactions with providers and their respective departments.

22 Provider Relations Goals (cont.) Goal Increase survey metric: quality of provider orientation process from 53.8% to 58% Action Reorientation process occurring today Survey providers to see what is of value to them when working with a payer Work with marketing on new ideas for provider orientation Provide additional training and awareness of the provider portal

23 Provider Relations Goals (cont.) Goal Increase survey metric: quality of written communications, policy bulletins and manuals from 57.8% to 60% Action Creation of a provider manual (available electronically and print) Provider specialty focused communication WebEx and recorded practice manager meetings

24 2017 Marketing (Targeted for all areas)

25 2017 Marketing Goals Goal Achieve overall provider satisfaction of 84.2% Action Develop provider communications strategic brief to include collaboration across departments Develop and execute comprehensive 2017 provider communications plan Work with managed care contracting to communicate the importance of survey completion and impact

26 2017 Marketing Goals (cont.) Goal Increase quality of provider communications satisfaction from 58% to 60% Action Develop standards for more proactive communications with providers Participate in regularly scheduled meetings with SMEs on upcoming changes that need to be communicated to providers and assess the best outlet for communication Send The Pulse from individual contract managers to ensure providers know their contract manager