Presentation is loading. Please wait.

Presentation is loading. Please wait.

Network Adequacy September 12, 2014 HSPRE0005-0614.

Similar presentations


Presentation on theme: "Network Adequacy September 12, 2014 HSPRE0005-0614."— Presentation transcript:

1 Network Adequacy September 12, 2014 HSPRE

2 Network Adequacy Overview Network Growth GEO Access Provider Relations Outreach and Strategies Mystery Shopper Results 2

3 Network Counts As of Sept % of Change CMAP PCPs2,9143,3393, % CMAP Specialists (MDs, APRNs, PAs etc.) 18,30518,72722, % CMAP Specialists (Other-DME, Physical Therapists, Podiatrists etc.) 1,6631, % CMAP Network Totals21,21923,72927, % Attested ProvidersN/A3,2663,503 OPR Providers EnrolledN/A1,8902,408 In-State OPR Providers Confirmed Enrolled * Includes border and out-of-state providers N/A 420 (216 CMAP OPR Enrolled) 24 CMAP Enrolled 3

4 4

5 Provider Relations Outreach Results Dis-enrolled Providers Dis-enrolled Providers Outreached N/A3, Dis-enrolled Providers EnrolledN/A 1,028 (33%) 63 (23%)

6 In State Network: Open and Closed Panels Specialties Number of Providers 2012 Number of Providers As of Sept 2014 Open Panels Percent of Open Panels PCP2,9143,5133, % OB/GYN5061, % Cardiology % General Surgery % Orthopedics % Gastroenterology % Oncology % Urology % Dermatology % Neurology % Otolaryngology (ENT) % Endocrinology % Rheumatology % 6

7 GEO Access Results-Open Panels Adult HUSKY Program-wide: HUSKY Program -wide Open Panels Only HUSKY 15 miles HUSKY 20 miles HUSKY 25 miles PCPs100% OB/GYNs100% Cardiology99.6%100% Dermatology94.5%98.4%100% Endocrinology94.8%99.2%99.7% ENT99.4%100% General Surgery99.8%100% Gastroenterology99.6%100% Oncology97%99.7%100% Orthopedic99.5%100% Rheumatology95.9%97.9%99.1% Urology98.7%99.7%99.9%

8 GEO Access Results-Open Panels Child HUSKY Program-wide: HUSKY Program -wide Open Panels Only HUSKY 15 miles HUSKY 20 miles HUSKY 25 miles Pediatricians100% OB/GYNs (Age 10 to 18)100% Cardiology99.6%100% Dermatology94.5%98.4%100% Endocrinology95.1%99.3%99.7% ENT99.4%100% General Surgery99.8%100% Gastroenterology99.5%100% Oncology96.9%99.7%100% Orthopedic99.5%100% Rheumatology97%99.4%99.8% Urology98.7%99.8%100%

9 GEO Access Results-Open Panels HUSKY Adult by LOB HUSKY Adult by LOB Open Panels HUSKY AHUSKY CHUSKY D Provider Within 15 miles20 miles25 miles15 miles20 miles25 miles15 miles20 miles25 miles PCPs 100% OB/GYNs 100% Cardiology 99.5%100% 99.6%100%99.6%100% Dermatology 94.1%98.4%100%95.3%98.5%100%94.4%98.3%100% Endocrinology 94.6%99.2%99.7%95.2%99.3%99.7%94.9%99.2%99.7% ENT 99.3%100% 99.5%100% 99.5%100% General Surgery 99.8%100% 99.8%100% 99.8%100% Gastroenterology 99.5%100% 99.6%100% 99.6%100% Oncology 96.6%99.7%100%97.4%99.8%100%97.1%99.7%100% Orthopedic 99.4%100% 99.6%100% 99.6%100% Rheumatology 95.4%97.6%99.1%96.4%98.1%99.2%96.2%98%99.2% Urology 98.5%99.7%100%98.8%99.6% %99.8%99.9%

10 GEO Access Results-Open Panels HUSKY Child by LOB HUSKY Child Open Panels HUSKY AHUSKY BHUSKY C HUSKY D Provider Within 15 miles 20 miles 25 miles 15 miles 20 miles 25 miles 15 miles 20 miles 25 miles 15 miles 20 miles 25 miles Pediatricians100% OB/GYNs100% 99.8% 100% Cardiology99.6%100% 99.4%100% Dermatology94.5%98.4%100%93.1%98.4%100%91.8%96.6%100%95.5%97.3%100% Endocrinology95.1%99.3%99.8%93.8%98.8%99.4%95.9%100% 96.4%100% ENT99.4%100% 99.2%100% General Surgery99.8%100% 99.7%100% Gastroenterology99.5%100% 99.3%100% 99.3% 100% Oncology96.9%99.7%100%96.9%99.6%99.9%96.6%100% 99.1%100% Orthopedic99.5%100% 99.2%100% Rheumatology97%99.4%99.8%95.9%98.9%99.5%98.6%100% 98.2%100% Urology98.8%99.8%100%97.8%99.5%99.9%100%

11 Mystery Shopper Study The Mystery Shopper survey included the following areas for investigation:  Appointment availability  Appointment flexibility  Effects of insurance coverage on appointment setting  Courteousness of office personnel Study approach was to target high volume providers (FQHCs, PCMH, Community providers and Clinics). 11

12 Mystery Shopper Study GreatBlue® conducted 500 completed telephone appointment attempts. The split was 70% Primary Care /30% Specialty calls for appointments. The breakdown of appointments:  125 Urgent Care-not an emergency condition-within 48 hours  142 Non Urgent Care (sick) conditions - 48 to 72 hours  133 Routine Preventive Primary Care conditions - 6 weeks  100 Initial Obstetrics and Gynecology/Prenatal conditions- within 1 week to 6 weeks 12

13 Mystery Shopper Survey 13 Type of AppointmentConditionTimeliness Targets Urgent Care (non-emergency) High fever, coughWithin 48 hours Non-Urgent sick visit Sinus infection, sore throat 48 to 72 hours Routine Preventative Primary Care Well child visit, adult physical 6 weeks Pre-natal visitPrenatal OBGYN Routine OBGYN complaint Within 1 Week Initial or well visit6 Weeks

14 Mystery Shopper Results 14 Available appointment times… 2013 Composite2014 Composite Something available33.6%63.8% Nothing available at this time 66.3%36.2%

15 Mystery Shopper Results 15 Told your insurance affected availability of appointment times? 2013 Composite 2014 Composite Yes35.2%14.6% No47.1%68.2% Don’t know/unable to determine 17.7%17.2% Felt unwelcomed/discouraged from setting appointment 2013 Composite 2014 Composite Yes 7.5%7.0% No 92.5%93.0%

16 Mystery Shopper Study 16 Researchers were most likely offered an appointment within 2 weeks of the time of the call regardless of the condition about which they were calling. The largest areas of improvement exist regarding non-urgent appointments. Approximately one-quarter of researchers were unable to receive an appointment for this type of condition until 2-3 weeks from the call.

17 Improving the Oral Health of HUSKY Members

18 18 Participating Dental Practitioners as of August 29, 2014 CountyEndo General Dentists Oral SurgeonsOrtho Pediatric DentistsPerioHygienistsTotals FAIRFIELD, CT HARTFORD, CT LITCHFIELD, CT MIDDLESEX, CT NEW HAVEN, CT NEW LONDON, CT TOLLAND, CT WINDHAM, CT Out of State Totals

19 Participating Dental Service Locations as of August 29,

20 20 Participating Dental Practitioners as of August 29, 2014

21 21 Building Dental Access, Results Contract Standard: one PCD in <=20 miles Results: all Clients have access to one PCD in <= 15 miles at minimum Green = Two Providers in 10 Miles Blue = Two Providers in 15 Miles Yellow = One Provider in 10 Miles

22 Questions/Comments


Download ppt "Network Adequacy September 12, 2014 HSPRE0005-0614."

Similar presentations


Ads by Google