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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
3
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
8
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.
10
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
11
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
17
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
18
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
20
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
23
DIVISION OF RESPONSIBILITIES
24
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
25
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.
26
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
27
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
31
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
36
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
37
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
38
Reporting
INTERIM REPORTS
Interim reports provide a snapshot of how plan is progressing throughout the survey process for each Provider Survey Type
40
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
41
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)
42
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)
44
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
45
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
WWW.QMETRICS.US