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The Myers group present ideas and recommendations for monitoring
access to care.
Health care reform means millions of people will gain access to health insurance,
prompting some concern about the availability of ***'s and specialists.
There's also concern that the narrow networks being
offered by many health plans to contain costs will limit access.
Health plans could be required to monitor their member's access
to appropriate and timely care by state and federal regulatory authorities.
As well,
In order to meet standards for accreditation by entities such as NCQA,
health plans are also required to monitor members' access to care.
To monitor member perception of access to care,
some health plans use the CAHPS survey.
Overall, national results for commercial health plans show that approximately
86% of members always or usually
get the care or appointment that they needed right away.
As mentioned previously, health plans are required to monitor
access for accreditation. If health plans notice problems with access
from their CAHPS
results or from other measurements,
new updates to standards require the plan to drill down for more information.
The Myers Group recommends
two drill down solutions to identify issues with access:
Provider Access Audits
and Member Access Surveys. When The Myers Group conducts provider access audits,
our experienced agents contact provider offices
to ask about and document appointment availability
and after hours protocol. The Myers Group collects appointment dates and times
so that we can calculate the amount of time between the call date
and time and the appointment dates and times. These wait times
are compared to the plan's
access to care standards to provide
pass/fail information and compliance rates
that plans can use to follow up with its network providers.
The Member Access to Care Tracking Study consists of outreach to members
outreach to memebers who have recently had a visit to the doctor, and serves to measure satisfaction
with several topics related to access and satisfaction in the doctor's office.
For example: office wait time,
appointment wait time, ease of scheduling an appointment,
and doctor communication at that visit.
The study is recommended on an ongoing basis to keep a pulse on what's going on
in the provider network.
If you'd like more information about monitoring access to care both at the
provider and
member level, we invite you to contact
The Myers Group today. info@themyersgroup.net