MY2020 Provider Appointment Availability Survey (PAAS ... · invitation (email / fax) within 5 business days Initiate phone survey 6 – 15 business days of sending the initial survey

MY2020 Provider Appointment

Availability Survey (PAAS):

Methodology Review

June 25th & 26th 2020

A DMHC Timely Access Reporting Requirement

PRESENTERS

Suzan Mora Dalen Erin McGlone

MPH, Surveys Program AdministratorMPA, CHCA, Founder, President & HEDIS Auditor

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TODAY’S AGENDA

About QMetricsSurvey Division ServicesPAAS Measurement Year (MY) 2020

• Key Dates & Documents• Provider Contact Lists• Prevalidation Process• Survey Sampling, Tool, and Administration• Operational Procedures• Reporting

Important Resources

About QMetrics

QMETRICS SURVEY TEAM

Suzan Mora DalenFounder, President &

HEDIS® Auditor

Jim Dalen, MAChief Health Economist

Stacy Baker, JDCompliance Officer & SVP Regulatory Affairs

Erin McGlone, MPHSurvey Programs

Administrator

Rachael MoraAdministrative Project

Manager

Jeff Lucas, MASenior Data Analyst

AREAS OF EXPERTISE

HEDIS® & STARS Improvement

Encounter DataCompleteness Assessment

& Improvement

Advanced Analytics Managed Care Data & Reporting

Pay for Performance(Align.Measure.Perform)

Predictive Modeling Provider Appointment Availability Surveys (PAAS)

Provider Satisfaction &After Hours Surveys

Regulatory Compliance & Oversight

Risk Score Optimization Supplemental DataCapture & Review6

Quality Reporting

Timely Access Report (TAR)Compliance Assessment & Validation

Survey Division Services

SURVEY SERVICES EXPANSION

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SURVEY OFFERINGS 2016 2017 2018 2019 2020

PAAS Validation

PAAS Administration

PAAS Prevalidation

Provider Satisfaction Survey

After Hours Survey

TAR G Assessment & Validation

Expanded Appointment Availability Survey

Emergency Instruction Survey

Telehealth Survey

Advanced Access Program Development

PAAS MY2020Key Dates & Documents

CLIENT QUESTIONNAIRE CHECKLIST ATTESTATION

Provides health plan profile information

Identifies scope of work• PAAS, validation, Provider Satisfaction Survey, After-Hours,

customization, other services

Checklist• Identifies required documentation to assess provider counts,

networks, and work estimates for resource allocation

Attestation• Identifies executive level sign-on off of organizational profile that drive

key factors in survey administration, i.e. FQHC, networks, products, etc.

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DMHC PAAS UPDATES

DMHC Timely Access email - 12/23/19

• DMHC will not be issuing Measurement Year (MY) 2020 Timely Access Compliance Report documents

• Health Plans should follow the MY 2019 Timely Access Compliance Report documents until the amended timely access regulation is promulgated through the Office of Administrative Law.

• Plans should continue using the MY 2019 PAAS Methodology, Contact Lists, and Templates

DMHC All-Plan Letter 20-018 - 4/29/20

• Surveys may not be conducted until after August 1st, 2020 due to COVID

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Key Dates & DeliverablesPreparing to field August 3rd, 2020

May-July2020

Document Exchange & PrevalidationClient Attestation

Contact Lists

Prevalidation complete by July

17th

July2020

Provider Notification,

Testing & Configurations

Sampling & File Prep

2020

White Glove Process

Quality Assurance

Interim Reporting

Jan-Feb2021

Raw Data Template

Results Template

Feb-Mar2021

Validation of Templates

Validation of Compliance

Rates

Validation Reports

Fielding Preparation

Aug-Dec

Survey Fielding

Data Aggregation

Validation

TIMELY ACCESS STANDARD OVERVIEW

Urgent Appts- Measured in

hours- Include

weekends & holidays

PCP appt w/in 48 hours

SCP, PSY & NPMH w/in 96 hours

Non-Urgent Appts- Count 14

calendar days for 10 business days

- Count 21 calendar days for 15 business days

Non-Urgent Appts - Day 1 = Day

after the survey was completed

- Holidays in Government Code section 6700 are excluded

Provider Contact Lists

PROVIDER CONTACT LISTS

Survey Type MY 2020 Contact List Requirements

Primary Care Providers

Primary Care Physicians and Non-Physician Medical Practitioners (NPMP -Nurse Practitioners and Physician Assistants)

Advanced Access PCPs

Specialist Physicians Cardiovascular Disease, Endocrinology, and Gastroenterology

Psychiatrists As of MY2019, reported on its own separate Contact List template

Non-Physician Mental Health

Providers (NPMH)

4 provider licensure types Licensed Professional Clinical Counselor (LPCC), Psychologist (PhD-Level),

Marriage and Family Therapist/Licensed Marriage and Family Therapist and Master of Social Work/Licensed Clinical Social Worker

Ancillary Service Providers

Facilities or entities providing mammogram or physical therapy appointments

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Providers that are hospital-based only and do not provide member appointments should not be included on Contact List.

Providers who have termed since 1/1/20 need to remain on Contact List; send separate Termed Provider file to QMetrics (one excel spreadsheet)

Pediatric providers should be included on Contact Lists, see FAQ #38

All changes to Contact Lists need to be made by the Plan; as your vendor we are not allowed to make changes to your Contact Lists

PROVIDER CONTACT LIST NOTES

CONTACT LISTS: COMMON ERRORS

De-duplicating the Provider Contact List

Duplicate entries are where the same provider in the same network is listed more than once in the same county.

De-duplication rules for all Provider Survey Types:

• Last Name and First Name (ANC – Other Name)

• FQHC/RHC Name (NA for all non-FQHC Records)

• NPI

• County

• Name of Network

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Federally Qualified Health Centers and Rural Health Centers (FQHC’s/RHC’s) FQHC’s and RHC’s have distinct Contact List requirements.

• First Name and Last Name for a provider associated with an FQHC is “NA”

• Organizational NPI must be used• “NA” to be used in several fields (e.g. CA License, Type of

Licensure, Specialty)• There will be valid variation between Contact List and Network

Filing during validation process due to differences in NPI reporting

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CONTACT LISTS: COMMON ERRORS

QMetrics Keystone: Prevalidation

Up to 3 rounds of Contact List review and analysis Provider Inclusion/Exclusion: Confirms that the Plan is including the

correct and required provider types in each Contact List Template. Thorough check against the Network Files is conducted.

Formatting Review: Full formatting review of each field that is required in each of the Contact List Templates against the specific requirements of the DMHC instructions for each template.

De-Duplication: Ensures that the Plan de-duplicated its Contact Lists according to the DMHC methodology

The completion date for Prevalidation is July 17th to be ready for fielding on August 3rd

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QMETRICS KEYSTONE: PREVALIDATION

Survey Sampling, Tool & Administration

RANDOM SAMPLE VERSUS CENSUS

For each Provider Survey Type in each Network/County, plans shall either survey:

• A sample of providers until the target sample size has been met; or

• All providers in the County/Network (census)

The Methodology applies the Target Sample Size requirements regardless of whether a sample or census is surveyed.

• Footnote 12 - “Unless the health plan is unable to meet the target sample size due solely to ineligible providers, it must obtain enough valid survey responses to meet the target sample size regardless of whether a sample or census is surveyed.”

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SAMPLING

Counties with Multiple Networks

Apply the responses from the providers sampled from the largest network to all of the smaller networks in which the sampled provider participates.

• Each provider is surveyed once with their response applied to all relevant overlapping networks in that county

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DIVISION OF RESPONSIBILITIES

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PREPARATION FOR FIELDING PLAN QMFollow Contact List instructions to prepare Contact Lists

De-duplicate by inserting Y/N in Unique Provider Field

Prevalidate Contact Lists, including validating de-duplication

Make all necessary corrections to Contact Lists

Develop Sampling Plan

Approve Sampling Plan

Create fielding file with de-duplication and network rules

Apply survey results to all applicable networks

LESSONS LEARNED: MEETING TARGET SAMPLE SIZE

The past 4 years demonstrated that number of ineligible and unresponsive providers is higher than expected

Oversample approach of 400% or full census is recommended

Census Approach is strongly recommended

Contact Attempts• Fax – 3 Attempts if busy (For each unique telephone number provided)

• Email – includes provider inquiry inbox (monitored daily)

• Telephonic - 3 attempts (busy, disconnected/hang up, no answer, exceeded hold time) – 30 minutes between attempts per number on file.

“White Glove” Outreach for High Volume Provider Offices

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SURVEY TOOL & SCRIPT

Continues to include only two appointment date/time questions (one for ancillary)

1. “Urgent services are for a condition which requires prompt attention, but does not rise to the level of an emergency. When is _____________’s next available appointment date and time for urgent services?”

2. “When is _______________’s next available appointment date and time for non-urgent services?”

For Ancillary surveys, the urgent question is removed and question #2 becomes question #1.

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SURVEY ADMINISTRATION

Timeframe

• All surveys must occur between August 1st and December 31st , 2020

Waves

• Two waves – 50% (and no more than 60%) of providers in each survey type to be surveyed in each wave

• Waves must be spaced at least 3 weeks apart

o Second Wave shall begin no sooner than 3 weeks after the final survey of the 1st wave has been completed.

• Waves are defined by Provider Survey Type and County

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SURVEY ADMINISTRATION

Option 1 Option 2 Option 3

Manual or Electronic Extraction

The Three Step Protocol

1. Email or Fax

2. Send a Reminder (optional)

3. Phone Call

Verified Advanced

Access Program

SURVEY PROCESS FLOW

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SURVEY ADMINISTRATION: 3-STEP PROTOCOL

Option 2 – Three-Step Protocol

Health Plan Outreach Strongly Recommended

STEP 1: Survey: Fax or Email 5 business day response deadline Responses permitted via fax, email or online portal

STEP 2: Survey Reminder Optional Within 2 business days of initial survey invitation

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SURVEY ADMINISTRATION: 3-STEP PROTOCOL

STEP 3: Telephone Follow-Up Survey

Contact providers that have not responded to initial survey invitation (email / fax) within 5 business days

Initiate phone survey 6 – 15 business days of sending the initial survey attempt conducted via email or fax• If a provider responds to the email/fax survey prior to the initiation of the

phone survey, a phone survey will not be initiated

Provider willing to complete at a later date/time – scheduled or unscheduled agent call-back within 2 business days of message• If provider does not respond within 2 business days Non-Responder

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SURVEY OUTCOMES

Ineligible Providers – Ineligible providers are to be entered on the Raw Data Template with one of the following dispositions and replaced with a provider from the oversample (if sampling was used):

Reasons for Ineligibility:

• Provider not in Plan Network - Provider no longer participates in the health plan network

• Provider not in County - Provider does not practice in that county

• Provider retired or ceasing to practice - Provider retried or no longer practicing

• Provider Listed under Incorrect Specialty – Listed in Contact List under wrong Provider Survey Type

• Contact Information Issue (Incorrect Phone or Fax Number/Email) - Provider listed with incorrect contact information that cannot be corrected

• Provider does not offer Appointments - Provider does not offer enrollee appointments (e.g., provides only hospital-based or peer-to-peer services)32

SURVEY OUTCOMES

Non-Responding Providers • A non-responding provider is a provider that does not respond to one

or more applicable outreaches within the required time-frame or declines to participate in the survey.

• Non-responding providers when sampling is employed are augmented with providers from the oversample

• Non-responding providers are entered on the Raw Data Template with either of the following dispositions

• "Refused – Refused/Declined to Respond“

• "Refused – No Response"

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SURVEY ADMINISTRATION CLARIFICATIONS

If the provider indicates that a new or existing patient impacts the date / time of the next available appointment, the earliest date / time is requested.

If the provider reports that patients are served on walk-in or same day basis, then the provider should indicate the date and approximate time that a walk-in patient would be seen.

• NOTE: Appointment date / time cannot be prior to date / time of the call

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Operational Procedures

HIGH VOLUME OFFICES: WHITE GLOVE APPROACH

Applicable to high volume provider offices to minimize provider burden

• Defined generally as (can be customized)o 10 or more providers with the same FAX Number

o 10 or more providers with the same Email Address

o 10 or more providers with the same Telephone number

Identified during the prevalidation process

Custom approach designed collaboratively with Health Plan to minimize provider burden, while maximizing response rate

Can be applied to any survey mode

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TECHNOLOGY

FAX• High Resolution FAX out

• OCR & ICR of FAX Images for data capture

EMAIL• Email sent with unique link to online survey for each provider

• User friendly online survey process

• Dedicated email address for provider comments

TELEPHONIC• Grouping by phone number and sorting by specialty allows reduced

provider abrasion and ability to be transferred within departments

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QUALITY PROGRAMS & PROCEDURES

Quality Assessment is Performed Throughout the Process

Pre-survey Administration: Validation of Contact Lists• Comparison to DMHC specifications• Reconciliation of Contact Lists to Network Filing (‘G’ Data)

Throughout Survey Administration• Programmatic evaluation of survey results from each modality done as

data is collected to ensure compliance to DMHC Specifications

Post-Survey Administration• Programmatic evaluation of survey results ensuring compliance with all

specifications• Reconciliation of Raw Data to Contact Lists• Reconciliation of Results to Raw Data

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Reporting

INTERIM REPORTS

Interim reports provide a snapshot of how plan is progressing throughout the survey process for each Provider Survey Type

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Analysis against every element of methodology

Executive Summary provided to plans with other validation vendors

Full Quality Assurance Report that exceeds all criteria in the DMHC Checklist for Health Care Service Plan Vendor Agreements for Quality Assurance Reports

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VALIDATION REPORT

PLAN-TO-PLAN AGREEMENTS

Secondary Plan also submits a Timely Access Compliance Report

• Both plans indicate relationship in the Timely Access Portal Plan Profile.

• Secondary Plan surveys and submits separate PAAS Templates for the Primary Plan to file in its Other Plan Network tab of the Portal.

• Primary Plan must validate the secondary plan’s data

Secondary Plan does NOT submit a Timely Access Compliance Report

• Primary Plan includes the data for the relevant providers from the Secondary Plan in the Primary Plan’s own PAAS Templates

• This is rare (dental plans, vision plans, restricted plans)

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Tips & Resources

IMPORTANT TIPS

Use the MY 2019 Methodology, Contact Lists, and Templates

Continue to watch for updates from DMHC

Pay close attention to already existing MY 2019 FAQ documents and newly released updates. Most recent FAQ document is dated 6/04/20.

Keep termed providers on Contact Lists and submit termed provider file to QMetrics (termed providers as of 1/01/20)

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IMPORTANT RESOURCES

MY 2019 documents (to be used for MY2020) are posted on the “Resources” section of the DMHC Timely Access Compliance Reporting Web Portal (log-in required)

• Methodology• Survey Tool• Contact Lists• Vendor Checklist• All Plan Letter• FAQs

DMHC website (historical docs only) http://dmhc.ca.gov/LicensingReporting/SubmitHealthPlanFilings/TimelyAccessReport.aspx#.WMC8wTvyu01

DMHC Timely Access Email Notifications

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NEW OPEN PENDING REGULATION

New Timely Access Open Pending Regulation

• 2019-5239:Timely Access to Non-Emergency Health Care Services

• Comment Period 6/12/20 – 7/27/20

Notice of Proposed Rulemaking Action

• Proposed text of the regulation and the Initial Statement of Reasons are available on the Department website

• www.dmhc.ca.gov/LawsRegulations.aspx#[email protected]

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CAHP LETTER TO DMHC

Many plans collaborated on a California Association of Health Plans (CAHP) letter to DMHC on 5/28/20, requesting that DMHC:

• Release formal guidance on the MY2020 PAAS Methodology• Allow acceptance of either a telehealth or in-person appointment• Exclude the Telehealth Provider Contact List (PCL) and instead use a

single PCL for each reportable specialty• Consider suspending the requirement for the survey to be conducted

in two waves or allow for more flexibility on the number of surveys conducted per wave

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CONTACT INFORMATION

Suzan Mora Dalen, MPA, CHCADirect: (888) 388-9111 (ext. 1)

Email: [email protected]

Stacy Baker, JDDirect: (888) 388-9111 (ext. 2)

Email: [email protected]

MAIN PAAS CONTACT :Erin McGlone, MPH – Survey Program Administrator

Direct: (888) 388-9111 (ext. 120)

Email: [email protected]

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THANK YOU

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