Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary THE 2003 MARYLAND MEDICAID MANAGED CARE CUSTOMER SATISFACTION SURVEY Executive Summary Prepared for: Prepared by: Date: September 2003 Job Number:

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 2 Background n As part of the federally required quality assurance plan, the Maryland Department of Health and Mental Hygiene (DHMH) conducts annual surveys to measure adult and child enrollee satisfaction with the services provided by the managed care organizations (MCOs) participating in the HealthChoice Program, Medicaid’s managed care program. n For calendar years 1998 and 1999, DHMH conducted satisfaction surveys using the Consumer Assessment of Health Plans (CAHPS ® ) survey instruments designed for the Medicaid managed care population. n DHMH contracted with WB&A Market Research (WB&A), a National Committee for Quality Assurance (NCQA) certified vendor, to conduct satisfaction surveys for the calendar years 2000, 2001, and 2002 using the CAHPS ® Medicaid Satisfaction Survey for their HealthChoice adult and child enrollees to determine their ratings of and experiences with the medical care they receive. n In 2003, NCQA adopted the 3.0H version of the CAHPS ® Medicaid Satisfaction Survey. As a result, some of the survey results from 2001 and 2002, when the 2.0H version was administered, are not trendable with the 3.0H version. Methodology n The CAHPS ® 3.0H surveys are a set of standardized surveys that assess patient satisfaction with their experience of receiving care from their MCOs. The surveys contain question sets covering such topics as enrollment and coverage, access to and utilization of health care, communication and interaction with providers, interaction with health plan administration, self- perceived health status and respondent demographics. n The CAHPS ® 3.0H surveys were administered according to the protocol outlined by NCQA, which utilizes two mailings and up to 15 follow-up Computer-Assisted Telephone Interviewing (CATI) calls during a two month period. n Separate surveys were conducted for adults and children. The child surveys were conducted by proxy, that is, the parent/guardian who knows the most about the sampled child’s health care was asked the questions. Under the direction of the DHMH, the survey for child members incorporated the measurement set to assess the experiences of care for special needs children with chronic conditions.

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 3 Executive Summary (cont’d) Methodology (cont’d) n The following six MCOs participated in this survey:  AMERIGROUP Community Care (AMERIGROUP)  Helix Family Choice, Inc.  Jai Medical Systems, Inc. (Jai)  Maryland Physicians Care  Priority Partners  United Healthcare. n DHMH provided a list of eligible Medicaid members. To qualify, members had to be continuously enrolled in the same MCO for five of the last six months. Adult members were classified as those 18 years of age and older, while child members were defined as those 12 years of age and younger. WB&A was responsible for pulling a random sample of eligible members from each MCO for participation in this survey, according to NCQA protocol. n Out of 9,720 adult and 16,775 child surveys mailed, a total of 2,771 adult and 6,740 child surveys were completed for the 2003 study. n Additional information regarding the survey methodology can be found in the Detailed Findings Report. n For the purpose of this report, certain terms are used to define the segments interviewed. The term “child members” refers to the general population of randomly selected child members prior to oversampling for children with diagnoses indicative of a probable chronic condition. The term “CSHCN” refers to child members surveyed that met the criteria for Children with Special Health Care Needs, and the term “non-CSHCN” refers to child members surveyed that did not meet these criteria.

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 4 Executive Summary (cont’d) Overall Ratings n Within the CAHPS ® 3.0H survey, there are four global rating questions that reflect overall satisfaction:  Rating of personal doctor or nurse  Rating of specialist  Rating of all health care  Rating of health plan. n Specifically, members were asked to rate each of these global rating questions using a “0 to 10” scale, where a “0” means the worst possible and a “10” means the best possible. n The results in this section are reported as average ratings. n Please see pages 7 through 10 for specific individual MCO ratings. Personal Doctor or Nurse n Across each of the MCOs, members still appear to be most satisfied with their personal doctor or nurse. In fact, the survey shows for 2003 that on a scale of 0 to 10, members across all MCOs rated their personal doctor or nurse between 8.3 and 9.2. This remains relatively consistent with what was seen in the previous survey results. What follows are the results from the 2003 survey.  Average ratings among adult members ranged from a low of 8.3 to a high of 8.8. The Maryland HealthChoice overall average among adult members was 8.5.  For child members, average ratings for their child’s personal doctor or nurse ranged between 8.7 and 9.1. The Maryland HealthChoice overall average among child members was 8.8.  Furthermore, average ratings across the MCOs among CSHCN members ranged between 8.8 and  On the other hand, average ratings among non-CSHCN members ranged between 8.8 and 9.0 across each of the MCOs surveyed 1. 1 The Maryland HealthChoice overall average was not calculated for CSHCN and non-CSHCN members because these segments were defined by the way in which respondents answered the measurement set of questions regarding special health care needs.

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 5 Executive Summary (cont’d) Overall Ratings (cont’d) All Health Care n The survey shows for 2003 that on a scale of 0 to 10, members across all MCOs rated the health care they received between 8.0 and 8.9. This remains relatively consistent with the previous survey results. What follows are the results from the 2003 survey.  Among adult members, average ratings for the health care they received were between 8.0 and 8.4. The Maryland HealthChoice overall average among adult members was 8.2.  For child members, average ratings for the health care their child received were between 8.7 and 8.8. The Maryland HealthChoice overall average among child members was 8.8.  Among CSHCN members, average ratings for the health care their child received ranged from a low of 8.6 to a high of  Furthermore, non-CSHCN members rated the health care their child received between 8.7 and Specialist n The survey shows for 2003 that on a scale of 0 to 10, members across all MCOs rated their specialist between and 8.8, remaining relatively similar to the survey results from 2001 and What follows are the results from the 2003 survey.  Among adult members, average ratings for their specialist ranged from a low of 8.1 to a high of 8.5. The Maryland HealthChoice overall average among adult members was 8.4.  For child members, average ratings for their child’s specialist ranged from a low of to a high of 8.7. The Maryland HealthChoice overall average among child members was 8.5.  Among CSHCN members, average ratings for their child’s specialist ranged between and  Furthermore, non-CSHCN members rated their child’s specialist between 8.0 and Caution should be taken when evaluating this data. Due to the small base (n=<35) there is a high level of sampling error around this data. 2 The Maryland HealthChoice overall average was not calculated for CSHCN and non-CSHCN members because these segments were defined by the way in which respondents answered the measurement set of questions regarding special health care needs.

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 6 Executive Summary (cont’d) Overall Ratings (cont’d) Health Plan n The survey shows for 2003 that on a scale of 0 to 10, members across all MCOs rated their health plan between 8.0 and 8.7, which remains relatively consistent with the 2001 and 2002 survey results. What follows are the survey results from  Among adult members, average ratings for their health plan ranged from a low of 8.0 to a high of 8.2. The Maryland HealthChoice overall average among adult members was 8.0.  For child members, average ratings for their child’s health plan ranged between 8.3 and 8.7. The Maryland HealthChoice overall average among child members was 8.6.  Among CSHCN members, average ratings for their child’s health plan ranged between 8.0 and  Furthermore, among non-CSHCN members, average ratings for their child’s health plan ranged between 8.4 and The Maryland HealthChoice overall average was not calculated for CSHCN and non-CSHCN members because these segments were defined by the way in which respondents answered the measurement set of questions regarding special health care needs.

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 7 Executive Summary (cont’d) AMERIGROUP Helix Family Choice Jai Maryland Physicians Care Priority Partners United Healthcare Adult Members Mean/Average Rating Personal Doctor/Nurse Specialist All Health Care Health Plan HealthChoice Overall Average AMERIGROUP Helix Family Choice Jai Maryland Physicians Care Priority Partners United Healthcare HealthChoice Overall Average Note: The HealthChoice Overall Average was calculated from the ratings of all 6 Medicaid MCOs operating in Maryland and was weighted by plan enrollment

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 8 Executive Summary (cont’d) AMERIGROUP Helix Family Choice Jai Maryland Physicians Care Priority Partners United Healthcare Child Members Mean/Average Rating Personal Doctor/Nurse Specialist All Health Care Health Plan HealthChoice Overall Average AMERIGROUP Helix Family Choice Jai Maryland Physicians Care Priority Partners United Healthcare HealthChoice Overall Average Notes: The HealthChoice Overall Average was calculated from the ratings of all 6 Medicaid MCOs operating in Maryland and was weighted by plan enrollment. *Caution should be taken when evaluating this data. Due to the small base (n=<35) there is a high level of sampling error around this data

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 9 Health Plan AMERIGROUP Helix Family Choice Jai Maryland Physicians Care Priority Partners United Healthcare Executive Summary (cont’d) AMERIGROUP Helix Family Choice Jai Maryland Physicians Care Priority Partners United Healthcare CSHCN Members Mean/Average Rating Personal Doctor/Nurse Specialist All Health Care Notes: The HealthChoice Overall Average was not calculated for CSHCN and non-CSHCN members because these segments were defined by the way in which respondents answered the measurement set of questions regarding special health care needs. *Caution should be taken when evaluating this data. Due to the small base (n=<35) there is a high level of sampling error around this data

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 10 Executive Summary (cont’d) Non-CSHCN Members Mean/Average Rating Health Plan AMERIGROUP Helix Family Choice Jai Maryland Physicians Care Priority Partners United Healthcare AMERIGROUP Helix Family Choice Jai Maryland Physicians Care Priority Partners United Healthcare Personal Doctor/Nurse Specialist All Health Care Notes: The HealthChoice Overall Average was not calculated for CSHCN and non-CSHCN members because these segments were defined by the way in which respondents answered the measurement set of questions regarding special health care needs. *Caution should be taken when evaluating this data. Due to the small base (n=<35) there is a high level of sampling error around this data.

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 11 Executive Summary (cont’d) Composite Scores n Composite scores are groupings of several questions that measure similar aspects of health care or health plan services and have the same response options. The following key areas are composites of several questions:  Getting Needed Care is a composite score of four questions regarding whether it was a big problem, a small problem or not a problem to find a personal doctor or nurse, to see a specialist, to get necessary care, and to get care approved by the health plan without delays.  Getting Care Quickly is a composite score of four questions regarding whether members always, usually, sometimes or never received help over the phone, got an appointment for health care, got an appointment for an illness, injury or condition, and were taken to the exam room within 15 minutes of their appointment time.  How Well Doctors Communicate is a composite score of four questions regarding whether providers always, usually, sometimes or never listened carefully to members, explained things in a way they could understand, showed respect for what they had to say, and spent enough time with them.  Courteous and Helpful Office Staff is a composite score of two questions regarding whether medical office staff always, usually, sometimes or never were helpful to members and treated them with courtesy and respect.  Customer Service is a composite score of two questions regarding whether it was a big problem, a small problem or not a problem to get information they needed in written materials from their health plan or on the Internet and to get help from customer service. n It is important to note that, in 2003, two of the questions within the composite measures for Getting Needed Care and Getting Care Quickly are not trendable with the previous survey results. Changes to these questions are substantial enough to significantly impact composite results. Therefore, these composite scores for 2003 are not compared to the composite scores in 2001 and n Overall, in 2003, the survey results suggest that each of the MCOs surveyed performed adequately among all members on the following composite measures: Getting Needed Care, Courteous and Helpful Office Staff, Customer Service, and How Well Doctors Communicate. n On the other hand, the survey results suggest that each of the MCOs surveyed did not perform well among all members on the composite Getting Care Quickly in 2003.

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 12 Executive Summary (cont’d) Composite Scores (cont’d) Getting Needed Care n Overall, the survey shows for 2003 that members across all MCOs gave the highest ratings to this composite area. What follows are the results from the 2003 survey.  The percentage of adult members who reported having no problems getting needed care ranged from 63% to 74%. The Maryland HealthChoice overall average for the percentage of adult members who had no problems getting needed care was 69%.  For child members, the percentage who indicated that they had no problems getting needed care for their child ranged from 71% to 80%. The Maryland HealthChoice overall average for the percentage of child members who had no problems getting needed care for their child was 77%.  Among CSHCN members, the percentage who reported having no problems getting needed care for their child ranged from 67% to 79% 1.  Furthermore, the percentage of non-CSHCN members reporting that they had no problems getting needed care for their child ranged from 75% to 89% 1. Courteous and Helpful Office Staff n Overall, the survey shows for 2003 that the scores for this composite area remained relatively consistent with the 2001 and 2002 survey results among members across all MCOs. What follows are the results from the 2003 survey.  The percentage of adult members who said that the office staff were always courteous and helpful ranged from 66% to 70%. The Maryland HealthChoice overall average for the percentage of adult members who said that the office staff were always courteous and helpful was 68%.  For child members, the percentage who indicated that the office staff were always courteous and helpful ranged from 69% to 77%. The Maryland HealthChoice overall average for the percentage of child members who said that the office staff were always courteous and helpful was 75%.  Among CSHCN members, the percentage who said that the office staff were always courteous and helpful ranged from 71% to 78% 1.  Furthermore, the percentage of non-CSHCN members reporting that the office staff were always courteous and helpful ranged from 69% to 78% 1. 1 The Maryland HealthChoice overall average was not calculated for CSHCN and non-CSHCN members because these segments were defined by the way in which respondents answered the measurement set of questions regarding special health care needs.

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 13 Executive Summary (cont’d) Composite Scores (cont’d) Customer Service n In general, the survey shows for 2003 that members across all MCOs rated this composite area similarly to what was seen in the previous survey results. What follows are the results from the 2003 survey.  The percentage of adult members who reported having no problems with their plan’s customer service ranged from 65% to 77%. The Maryland HealthChoice overall average for the percentage of adult members who had no problems with their MCO’s customer service was 71%.  For child members, the percentage who indicated that they had no problems with their child’s plan’s customer service ranged from 69% to 80%. The Maryland HealthChoice overall average for the percentage of child members who had no problems with their child’s MCO’s customer service was 75%.  Among CSHCN members, the percentage who reported having no problems with their child’s plan’s customer service ranged from 62% to 77% 1.  Furthermore, the percentage of non-CSHCN members reporting that they had no problems with their child’s plan’s customer service ranged from 75% to 87% 1,2. How Well Doctors Communicate n Overall, the survey shows for 2003 that the scores for this composite area remained relatively consistent with the 2001 and 2002 survey results among members across all MCOs. What follows are the results from the 2003 survey.  The percentage of adult members who said that their doctors always communicated well ranged from 61% to 71%. The Maryland HealthChoice overall average for the percentage of adult members who said that their doctors always communicated well was 63%.  For child members, the percentage who indicated that their child’s doctors always communicated well ranged from 72% to 81%. The Maryland HealthChoice overall average for the percentage of child members who said that their child’s doctors always communicated well was 73%.  Among CSHCN members, the percentage who said that their child’s doctors always communicated well ranged from 72% to 76% 1.  Furthermore, the percentage of non-CSHCN members reporting that their child’s doctors always communicated well ranged from 71% to 83% 1. 1 The Maryland HealthChoice overall average was not calculated for CSHCN and non-CSHCN members because these segments were defined by the way in which respondents answered the measurement set of questions regarding special health care needs. 2 Caution should be taken when evaluating this data. Due to the small base (n=<35) there is a high level of sampling error around this data.

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 14 Executive Summary (cont’d) Composite Scores (cont’d) Getting Care Quickly n In general, the survey shows for 2003 that members across all MCOs gave the lowest ratings to this composite area. What follows are the results from the 2003 survey.  The percentage of adult members who said that they always got care quickly ranged from 45% to 56%. The Maryland HealthChoice overall average for the percentage of adult members who said that they always got care quickly was 48%.  For child members, the percentage who indicated that their child always got care quickly ranged from 53% to 59%. The Maryland HealthChoice overall average for the percentage of child members who said that their child always got care quickly was 57%.  Among CSHCN members, the percentage who said that their child always got care quickly ranged from 52% to 58% 1.  Furthermore, the percentage of non-CSHCN members reporting that their child always got care quickly ranged from 55% to 61% 1. 1 The Maryland HealthChoice overall average was not calculated for CSHCN and non-CSHCN members because these segments were defined by the way in which respondents answered the measurement set of questions regarding special health care needs. 2 Caution should be taken when evaluating this data. Due to the small base (n=<35) there is a high level of sampling error around this data.

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 15 Executive Summary (cont’d) AMERIGROUP Helix Family Choice Jai Maryland Physicians Care Priority Partners United Healthcare Adult Members Percent rated “Always” or “Not a Problem” Getting Needed Care 1 Getting Care Quickly 1 How Well Doctors Communicate Courteous & Helpful Office Staff Customer Service HealthChoice Overall Average AMERIGROUP Helix Family Choice Jai Maryland Physicians Care Priority Partners United Healthcare HealthChoice Overall Average Notes: The HealthChoice Overall Average was calculated from the ratings of all 6 Medicaid MCOs operating in Maryland and was weighted by plan enrollment. 1 The composite scores for Getting Needed Care and Getting Care Quickly in 2003 are not trendable with the 2001 and 2002 composite scores. The changes made to two of the questions within each composite in 2003 were substantial enough to significantly impact the composite results.

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 16 Courteous & Helpful Office Staff AMERIGROUP Helix Family Choice Jai Maryland Physicians Care Priority Partners United Healthcare HealthChoice Overall Average Getting Care Quickly 1 Executive Summary (cont’d) AMERIGROUP Helix Family Choice Jai Maryland Physicians Care Priority Partners United Healthcare Child Members Percent rated “Always” or “Not a Problem” Getting Needed Care 1 How Well Doctors Communicate Customer Service HealthChoice Overall Average Notes: The HealthChoice Overall Average was calculated from the ratings of all 6 Medicaid MCOs operating in Maryland and was weighted by plan enrollment. *Caution should be taken when evaluating this data. Due to the small base (n=<35) there is a high level of sampling error around this data. 1 The composite scores for Getting Needed Care and Getting Care Quickly in 2003 are not trendable with the 2001 and 2002 composite scores. The changes made to two of the questions within each composite in 2003 were substantial enough to significantly impact the composite results

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 17 Executive Summary (cont’d) AMERIGROUP Helix Family Choice Jai Maryland Physicians Care Priority Partners United Healthcare CSHCN Members Percent rated “Always” or “Not a Problem” Getting Needed Care 1 Getting Care Quickly 1 How Well Doctors Communicate Courteous & Helpful Office Staff Customer Service AMERIGROUP Helix Family Choice Jai Maryland Physicians Care Priority Partners United Healthcare Notes: The HealthChoice Overall Average was not calculated for CSHCN and non-CSHCN members because these segments were defined by the way in which respondents answered the measurement set of questions regarding special health care needs. *Caution should be taken when evaluating this data. Due to the small base (n=<35) there is a high level of sampling error around this data. 1 The composite scores for Getting Needed Care and Getting Care Quickly in 2003 are not trendable with the 2001 and 2002 composite scores. The changes made to two of the questions within each composite in 2003 were substantial enough to significantly impact the composite results.

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 18 AMERIGROUP Helix Family Choice Jai Maryland Physicians Care Priority Partners United Healthcare Executive Summary (cont’d) AMERIGROUP Helix Family Choice Jai Maryland Physicians Care Priority Partners United Healthcare Non-CSHCN Members Percent rated “Always” or “Not a Problem” Getting Needed Care 1 Getting Care Quickly 1 How Well Doctors Communicate Courteous & Helpful Office Staff Customer Service Notes: The HealthChoice Overall Average was not calculated for non-CSHCN and non-CSHCN members because these segments were defined by the way in which respondents answered the measurement set of questions regarding special health care needs. *Caution should be taken when evaluating this data. Due to the small base (n=<35) there is a high level of sampling error around this data. 1 The composite scores for Getting Needed Care and Getting Care Quickly in 2003 are not trendable with the 2001 and 2002 composite scores. The changes made to two of the questions within each composite in 2003 were substantial enough to significantly impact the composite results

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 19 Executive Summary (cont’d) Conclusions n Consistent with the previous survey results, adult members across all MCOs in 2003 continue to be most satisfied with their personal doctor, followed by their specialist and the health care they received, and are least satisfied with their health plan. n Meanwhile, child members across all MCOs in 2003 continue to be most satisfied with their personal doctor and the health care they received, and are less satisfied with their specialist and their health plan. n By investigating the individual questions of each composite measure within this survey, the areas where the MCOs (either individually or collectively) are performing well and the main areas of concern can be identified. n The results in this section for adult and child members are reported using HealthChoice overall average. The results for the CSHCN and non-CSHCN members are reported in ranges lowest to highest. n Among adult members in 2003, positive ratings for the individual questions of each composite measure all scored below 80%. n The individual questions where child members gave positive ratings of 80% or more in 2003 include the following:  91% of child members reported having no problems with delays in health care while waiting for approval from their health plan;  80% of child members felt that office staff always treated them with courtesy and respect; and  80% of child members reported that it was not a problem to find or understand information about how their health plan works in written materials or on the Internet. n Furthermore, among CSHCN and non-CSHCN members, the area where the MCOs collectively gave positive ratings of 80% or more in 2003 includes the following:  80%-88% 1 of CSHCN across all MCOs and 94%-97% 1 of non-CSHCN across all MCOs reported having no problems with delays in health care while waiting for approval from their child’s health plan. 1 The Maryland HealthChoice overall average was not calculated for CSHCN and non-CSHCN members because these segments were defined by the way in which respondents answered the measurement set of questions regarding special health care needs.

Maryland Department of Health and Mental Hygiene WB&A Market Research Executive Summary 20 Executive Summary (cont’d) Conclusions (cont’d) n On the other hand, it can also be determined by investigating the individual questions of each composite measure that the main areas of concern for HealthChoice among adult members in 2003 include the following:  57% of adult members were never or only sometimes taken to the exam room within 15 minutes of their appointment time;  24% of adult members reported that it was a big problem to see the specialist that they needed to see;  22% of adult members never or only sometimes received the help or advice needed when calling during regular office hours;  22% of adult members never or only sometimes received an appointment for health care as soon as they wanted;  20% of adult members never or only sometimes received the care needed for an illness, injury, or condition as soon as they wanted; and  20% of adult members never or only sometimes reported having doctors or other health providers spend enough time with them. n And, the main areas of concern for HealthChoice among child members in 2003 include the following:  50% of child members were never or only sometimes taken to the exam room within 15 minutes of their child’s appointment time; and  21% of child members reported that it was a big problem to see the specialist that their child needed to see. n Furthermore, among CSHCN and non-CSHCN members, the main area of concern across all MCOs collectively in 2003 includes the following:  41%-56% 1 of CSHCN and 47%-59% 1 of non-CSHCN across all MCOs were never or only sometimes taken to the exam room within 15 minutes of their child’s appointment time. 1 The Maryland HealthChoice overall average was not calculated for CSHCN and non-CSHCN members because these segments were defined by the way in which respondents answered the measurement set of questions regarding special health care needs.