STATE OF MARYLAND PROVIDER POPULATION AMERIGROUP … Documents/MDMD_CAID_P… · PROVIDER POPULATION AMERIGROUP Community Care 2017 Provider Satisfaction Survey Final Report Date:

STATE OF MARYLAND PROVIDER POPULATION

AMERIGROUP Community Care

2017 Provider Satisfaction SurveyFinal Report

Date: October 2017

Job Number: 17-202

2191 Defense Highway, Suite 401 Crofton, MD 21114

Phone: 410.721.0500 Fax: 410.721.7571

www.WBAresearch.comMDPEC-1440-17 December 2017

AF53888

Highlight

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2017 State of Maryland

AMERIGROUP Community Care ProviderTable of Contents

Page Number

Executive Summary ................................................................................................................... 4

Background, Purpose and Research Approach .......................................................................... 10

Profile of PCPs Surveyed ........................................................................................................... 15

Survey Results

Composite Measures ............................................................................................................ 17

Question Summaries ............................................................................................................ 24

Segmentation Analysis ............................................................................................................... 32

Loyalty Analysis .......................................................................................................................... 58

Key Driver/Correlation Analysis .................................................................................................. 61

Respondents’ Comments ........................................................................................................... 65

Glossary of Terms ...................................................................................................................... 71

Survey Tool ................................................................................................................................ 73

Executive Summary

4


AMERIGROUP Community Care ProviderExecutive Summary

Starting in 2008, the State of Maryland Department of Health and Mental Hygiene (DHMH) selected WBA Research (WBA), a

National Committee for Quality Assurance (NCQA) certified vendor, to conduct its Provider Satisfaction Survey. WBA administered

this survey to Primary Care Providers (PCPs) participating in Maryland’s Medicaid managed care program, HealthChoice, via a

mixed methodology survey (mail with telephone follow-up and an online survey option).

WBA mailed a total of 954 surveys among AMERIGROUP Community Care PCPs, from which 173 valid surveys were completed

between March and June 2017. Specifically, 88 were returned by mail, 81 were conducted over the telephone and 4 were

completed online. The overall response rate for 2017 was 19%, compared to 20% in 2016.

KEY FINDINGS FROM THE 2017 PROVIDER SATISFACTION SURVEY

Overall Satisfaction

▪ In 2017, almost seven in ten of the PCPs surveyed are satisfied with AMERIGROUP Community Care (69.6%), which is

similar to the proportion satisfied with All Other HealthChoice MCOs (66.4%). The research also shows that about eight in

ten PCPs would recommend AMERIGROUP Community Care to their patients (81.6%) and/or to other physicians (80.1%).

Summary Rate – Very or

Somewhat Satisfied

Summary Rate – Definitely

or Probably Yes

Summary Rate – Definitely

or Probably Yes


Would Recommend to

Patients

Would Recommend to Other

Physicians

2017 HealthChoice Aggregate 75.7% 84.9% 84.6%

All Other HealthChoice MCOs 66.4% N/A N/A

AMERIGROUP Community Care 69.6% 81.6% 80.1%

N/A=These questions were not asked with regards to All Other HealthChoice MCOs.

5


AMERIGROUP Community Care ProviderExecutive Summary (continued)

Loyalty Analysis

▪ A loyal Primary Care Provider can be defined as someone who is both very satisfied with the MCO and willing to

recommend that MCO to patients and other physicians.

▪ It is important for AMERIGROUP Community Care to understand the loyalty of their provider base. From the survey, a

“loyalty” analysis was conducted by combining the responses to overall satisfaction with AMERIGROUP Community Care

(Q25), likelihood of recommending AMERIGROUP Community Care to patients (Q27) and likelihood of recommending

AMERIGROUP Community Care to other physicians (Q28). This analysis produced three categories which are used to

describe provider loyalty – Loyal, Not Loyal and Indifferent. (For a more detailed explanation of this analysis, please see the

section entitled Loyalty Analysis.)

▪ Among the PCPs surveyed, almost three in ten PCPs overall (27.9%) are considered “loyal PCPs”. This leaves 68.8% of

the PCPs as “indifferent” and only 3.2% of PCPs as “not loyal”.

Primary Care Provider Loyalty

Loyal Indifferent Not Loyal

2017 HealthChoice Aggregate 33.7% 63.5% 2.9%

AMERIGROUP Community Care 27.9% 68.8% 3.2%

6



Composite Measures

▪ Composite measures assess results for main issues/areas of concern. These composite measures are derived by

combining survey results of similar questions.

▪ Similar to 2016, AMERIGROUP Community Care received low ratings in 2017 among PCPs on many of the composite

measures. The composite measures that received the lowest ratings in 2017 were:

➢ Utilization Management (29.6% Summary Rate – Excellent/Very Good);

➢ Coordination of Care/Case Management (37.0% Summary Rate – Excellent/Very Good)

➢ Finance Issues (42.2% Summary Rate – Excellent/Very Good); and

➢ Customer Service/Provider Relations (42.3% Summary Rate – Excellent/Very Good).

▪ AMERIGROUP Community Care received more positive ratings for “No-Show HealthChoice Appointments” (78.3%

Summary Rate – 0%-25%) and “Overall Satisfaction” (77.1% Summary Rate – Very or Somewhat Satisfied/Definitely or

Probably Yes, down from 86.1% in 2016).

Composite Measure

2017 HealthChoice Aggregate

(Summary Rate – 0%-25%/Very or

Somewhat Satisfied/Definitely or

Probably Yes/Excellent or Very

Good)

2017

(Summary Rate – 0%-25%/Very or

Somewhat Satisfied/Definitely or

Probably Yes/Excellent or Very

Good)

2016

(Summary Rate – 0%-25%/Very

or Somewhat Satisfied/Definitely

or Probably Yes/Excellent or

Very Good)

2015

(Summary Rate – 0%-25%/Very

or Somewhat Satisfied/Definitely

or Probably Yes/Excellent or

Very Good)

No-Show HealthChoice

Appointments80.0% 78.3% 77.7% 81.4%

Overall Satisfaction 81.7% 77.1% (↓) 86.1% 81.0%

Customer Service/

Provider Relations44.3% 42.3% 44.3% 46.9%

Finance Issues 46.3% 42.2% 46.2% 43.4%

Coordination of Care/

Case Management40.6% 37.0% 41.4% 46.0%

Utilization Management 33.5% 29.6% 30.3% 35.6%

Arrows (h,i) indicate that the particular composite measure is performing statistically better or worse than it did in the previous year.

7



Composite Measures (continued)

▪ The individual questions (attributes) that comprise the composite measures where AMERIGROUP Community Care received

low ratings in 2017 are illustrated in the table below.

Attributes

2017

(Summary Rate –

Excellent or Very Good)

2016

(Summary Rate –

Excellent or Very Good)

Finance Issues:

Timeliness of initial claims processing 49.0% 50.0%

Accuracy of claims processing 45.7% 51.9%

Timeliness of adjustment/appeal claims processing 31.9% 36.8%

Customer Service/Provider Relations:

Responsiveness and courtesy of the health plan’s Provider Relations/Customer Service representative 48.1% 55.1%

Quality of written communications, policy bulletins and manuals 47.1% 46.9%

Customer Service/Provider Relations overall 45.1% 52.8%

Timeliness to answer questions and/or resolve problems 41.6% 43.8%

Accuracy and accessibility of drug formulary and formulary updates 37.6% 34.5%

Telephone system overall 35.5% 39.3%

Specialist network has an adequate number of specialists to whom I can refer patients 24.4% 28.7%

Utilization Management:

Timeliness of obtaining authorization for inpatient services 32.0% 37.6%

Timeliness of obtaining authorization for outpatient services 34.9% 29.4%

Timeliness of obtaining authorization for medication 26.3% 26.8%

Overall experience in obtaining prior authorization for medications 25.3% 27.4%

8



Noteworthy Findings and Conclusions/Recommendations

▪ The findings obtained from the Provider Satisfaction Survey allow AMERIGROUP Community Care to measure how well the

MCO is meeting its PCPs’ expectations and health care needs. Further analysis of the survey results can illustrate potential

areas of opportunity for improvement.

▪ How PCPs rate their overall satisfaction is an important indicator of quality. It is important to understand what is driving

PCPs’ overall satisfaction ratings.

▪ Correlation analyses were conducted between each survey question that comprised the composite measures (attributes)

and overall rating of satisfaction (Q25). As a result, AMERIGROUP Community Care can ascertain which attributes have

the greatest impact on PCPs’ overall satisfaction ratings and ultimately determine where to direct quality improvement

efforts.

Relationship with Overall Satisfaction

▪ The attributes “Coordination of Care/Case Management”, “Customer Service/Provider Relations overall”, “Timeliness to

answer questions and/or resolve problems”, “Accuracy of claims processing” and “Timeliness of initial claims processing”

are identified as key drivers of high importance to PCPs where they perceive AMERIGROUP Community Care to be

performing at a comparatively lower level (Summary Rate is less than 50%).

➢ These attributes are referred to as unmet needs and should be considered priority areas for AMERIGROUP

Community Care. If performance on these attributes is improved, it could have a positive impact on PCPs’ overall

satisfaction.

▪ There are several other attributes that are identified as being of moderate importance and on which AMERIGROUP

Community Care performs at a comparatively lower level (Summary Rate is less than 50%): “Timeliness of

adjustment/appeal claims processing”, “Overall experience in obtaining prior authorization for medications”, “Timeliness of

obtaining authorization for outpatient services”, “Telephone system overall”, “Quality of written communications, policy

bulletins and manuals”, “Responsiveness and courtesy of the health plan’s Provider Relations/Customer Service

representative”, “Specialist network has an adequate number of specialists to whom I can refer patients”, “Timeliness of

obtaining authorization for medication” and “Timeliness of obtaining authorization for inpatient services”. These should be

considered secondary priorities for AMERIGROUP Community Care. If performance on these attributes is improved, it

could have a positive impact on PCPs’ overall satisfaction.

Background, Purpose and

Research Approach

10


AMERIGROUP Community Care ProviderBackground, Purpose and Research Approach

Background and Purpose

▪ Beginning in 2008, the State of Maryland Department of Health and Mental Hygiene (DHMH) selected WBA Research to

conduct its Provider Satisfaction Survey. WBA administered this survey to PCPs participating in Maryland’s Medicaid

managed care program, HealthChoice.

▪ The provider survey measures how well Managed Care Organizations (MCOs) are meeting their PCPs’ expectations and

health care needs. From this survey, we can determine PCPs’ ratings of and experiences with the MCOs with which they

participate. Then, based on PCPs’ experiences, potential opportunities for improvement can be identified.

▪ Specifically, the results obtained from this provider survey will allow AMERIGROUP Community Care to determine how

well participating MCOs are taking appropriate and timely actions in processing claims, assisting provider offices through

accessible and helpful representatives, maintaining an adequate network of specialists and providing timely

authorizations.

▪ Results from the provider survey summarize satisfaction through ratings, composite measures and question Summary

Rates.

➢ In general, Summary Rates represent the percentage of respondents who chose the most positive response

categories.

▪ Ratings and composite measures in the provider survey include:

➢ Finance Issues

➢ Customer Service/Provider Relations

➢ Coordination of Care/Case Management

➢ No-Show HealthChoice Appointments

➢ Utilization Management

➢ Overall Satisfaction

11


AMERIGROUP Community Care ProviderBackground, Purpose and Research Approach (continued)

Research Approach

▪ PCPs from AMERIGROUP Community Care who provide Medicaid services in the HealthChoice program participated in this

research.

▪ WBA administered a mixed-methodology survey which involved mail with telephone follow-up and an online survey option.

➢ Specifically, two survey questionnaire packages and follow-up reminder postcards were sent to a random sample of

eligible PCPs from AMERIGROUP Community Care with “Return Service Requested” and WBA’s toll-free telephone

number included. The mail materials also included a toll-free telephone number for Spanish-speaking PCPs to complete

the survey over the telephone. Additionally, the materials included a web address providers could visit to complete the

survey online, if desired. Those who did not respond by mail were contacted by telephone to complete the survey. During

the telephone follow-up, PCPs had the option to complete the survey in either English or Spanish.

▪ WBA received an electronic sample file of participating PCPs from each of the eight MCOs. WBA then combined the sample

files, sorted the list by the PCP’s license number and de-duplicated so that a PCP only received one survey from a specified

MCO regardless of the number of MCOs with which they participate.

▪ In total, WBA mailed surveys to 954 AMERIGROUP Community Care PCPs.

Survey and Reporting Changes in 2017

▪ The Maryland Department of Health and Mental Hygiene (DHMH) made one change to the Provider Satisfaction Survey

reporting in 2017.

➢ Disposition codes were changed from the alphanumeric system signifying survey administration method and status of the

Provider record (e.g., M21=Mail, Ineligible; T10=Phone, Complete) to a more simplified numeric system focusing on the

status of the record (0=Complete, 1=Does Not Meet Eligible Population Criteria, 2=Incomplete (but Eligible), 3=Language

Barrier, 4=Physically or Mentally Incapacitated, 5=Deceased, 6=Refusal, 7=Non-Response After Maximum Attempts,

8=Added to Do Not Call List).

12


AMERIGROUP Community Care ProviderBackground, Purpose and Research Approach (continued)

Response Rates

▪ WBA collected 173 valid surveys between March and June 2017, yielding a response rate of 19%. Of the 173 valid surveys

received, 88 were returned by mail, 81 were conducted via telephone and 4 were completed online. None of the surveys

were completed in Spanish.

▪ Ineligible PCPs included those who are deceased, did not meet eligible population criteria (indicated non-participation in the

specific MCO) or had a language barrier (non-English or Spanish). Non-respondents included those who refused to

participate, could not be reached due to a bad address or telephone number (were added to the do not call list), did not

complete the survey or were unable to be contacted during the survey time period.

▪ The table below shows the total number of PCPs in the sample that fell into each disposition code.

▪ Ineligible surveys are subtracted from the sample size when computing a response rate as shown below.

Completed surveys (mail + phone + online)

Sample size – Ineligible surveys = 19%= Response Rate

*Maximum attempts made include two survey mailings and an average of three to four call attempts during office hours.1Disposition code is the final status given to each Provider record within the sample surveyed.

Disposition Group Disposition Code1 Number

Ineligible

Deceased (5) 0

Does not meet eligibility criteria (1) 51

Language barrier (3) 0

Mentally/Physically incapacitated (4) 0

Total Ineligible 51

Non-Response

Incomplete but eligible (2) 3

Refusal (6) 88

Maximum attempts made* (7) 639

Added to Do Not Call List (8) 0

Total Non-Response 730

173

954 – 51

13


AMERIGROUP Community Care Provider

How to Read and Interpret the Results

▪ This report includes the results of the provider survey questions about PCPs’ experiences with the MCO with which they

participate.

▪ Throughout this report, results are shown as “Summary Rates”. Summary Rates represent the most favorable responses for

that question.

▪ Within the report, comparisons to the previous waves of research have been made only when significant differences (at the 95%

confidence level) are present. Arrows (h,i) indicate that the particular variable is performing statistically better or worse than it

did in the previous year. Therefore, if no comparison was made to the previous research, then the survey results are relatively

consistent with what was seen in the previous year. Comparisons have also been made to the 2017 HealthChoice Aggregate

when significant differences (at the 95% confidence level) are present.

▪ For various questions, the survey instrument asked respondents to rate AMERIGROUP Community Care as well as All Other

HealthChoice MCOs in which they participate. Comparisons have been made within this report, where appropriate.

▪ Caution should be taken when comparing results to All Other HealthChoice MCOs and when evaluating data with a small

sample size or base (n<35) due to the high level of sampling error around the data, which can lead to results that do not

accurately represent the MCO population as a whole.

▪ Percentages do not always add up to 100% due to rounding.

Background, Purpose and Research Approach (continued)

Profile of PCPs Surveyed

15



22.6% 15.7%

32.7% 28.9%25.9%

14.9%

36.2%

23.0%23.3% 15.5%

34.6%26.5%

0%-10% 11%-20% 21%-50% 51% or more

2017 2016 2015

Profile of PCPs Surveyed

h significant increase from previous year

i significant decrease from previous year

Base=Those answering

Physician in Practice (Q1)

HealthChoice Patient Volume (Q3)

Mid-Level Practitioners in Practice (Q2)

How 24-Hour Availability Provided (Q5)*

30.0%

48.2%

21.8%

41.4%36.5%

22.1%

52.0%

35.6%

12.4%

Solo 2-5 physicians More than 5 physicians

2017 2016 2015

35.5%

58.1%

6.4%

37.8%

53.5%

8.6%

57.1%

40.8%

2.1%

None 1-5 practitioners More than 5 practitioners

2017 2016 2015

Respondent Role (Q32)

*Multiple Responses Accepted

AMERIGROUP Community Care Patient Volume (Q4)

33.8%

20.0%31.9%

14.4%

40.2%

15.6%

32.4%

11.7%

32.3%23.0%

29.4%

15.3%

0%-10% 11%-20% 21%-50% 51% or more

2017 2016 2015

45.2%

26.2%

4.2%

24.4%

48.4%

19.8%

4.9%

26.9%

46.1%

28.3%

4.7%

20.9%

Office Manager Physician Nurse Other Staff

2017 2016 2015

53.5% 54.1%

23.8%

12.8% 5.8%

53.8%47.3%

25.0% 14.7%

2.2%

62.4%

48.9%

34.6%

22.9%

1.5%

Always on call Forward calls toanswering

service

Arrange forcoveringphysician

Send toemergency room

Do not provide24-hour

availability

2017 2016 2015

(↓)

(↑)(↓)

(↑)

(↓)

(↑)

(↑)

(↓)

(↓)(↓)

(↓)

Survey Results

17

Composite Measures 2017 State of Maryland


▪ Composite measures are derived by combining survey results of similar questions (note: two of the composite measures are

comprised of only one question). The table below shows how each standard composite measure is defined.

▪ Within this section, Summary Rates for AMERIGROUP Community Care have been compared to All Other HealthChoice MCOs,

where applicable.

Composite Measure/Rating Item Survey Question Number What is Measured Summary Rate1

Finance Issues 6 – 8

Measures PCPs’ experiences with the accuracy of

claims processing, the timeliness of initial claims

processing and the timeliness of adjustment/appeal

claims processing

% of PCPs who responded

“Excellent or Very Good”

Customer Service/

Provider Relations9 – 16

Measures PCPs’ experiences with the process of

obtaining member eligibility information, the PCPs’

interactions with Customer Service/Provider

Relations, the quality of written communications, as

well as the adequacy of the specialist network




Case Management19

Measures PCPs’ experiences with coordination of

care and case management



No-Show HealthChoice

Appointments20

Asks PCPs to give the percentage of no-show

appointments each week


“None or 1%-25%”

Utilization Management 21 – 24Measures PCPs’ experiences with the timeliness of

the authorization process



Overall Satisfaction 25, 27 and 28

Measures PCPs’ overall satisfaction with health plan,

likelihood of recommending health plan to patients

as well as to physicians


“Very Satisfied or Somewhat Satisfied”

or “Definitely Yes or Probably Yes”

1Summary Rates most often represent the most favorable responses for that question.

Composite Measures

18



17.3%

9.1%

17.1%

13.8%

34.2%

39.0%

37.1%

51.2%

48.6%

51.9%

45.7%

35.0%

13.5%

11.0%

14.7%

14.6%

36.7%

39.0%

36.4%

49.6%

49.8%

50.0%

49.0%

35.8%

26.1%

18.7%

21.0%

20.8%

42.1%

44.5%

47.1%

49.2%

31.8%

36.8%

31.9%

30.0%

2015

2016

2017

All Other HealthChoiceMCOs

Fair/Poor Good Excellent/Very Good

18.9%

12.9%

17.6%

16.4%

37.7%

40.8%

40.2%

50.0%

43.4%

46.2%

42.2%

33.6%

2015

2016

2017

All Other HealthChoice MCOs



Finance Issues

Base=Those able to rate



Accuracy of claims processing (Q6)

Timeliness of initial claims

processing (Q7)

Timeliness of adjustment/appeal

claims processing (Q8)

▲ significantly higher than All Other HealthChoice MCOs

▼ significantly lower than All Other HealthChoice MCOs

(▼) (▼) (▲)

(↓)

(↑)

19


AMERIGROUP Community Care ProviderComposite Measures (continued)

18.9%

17.8%

20.5%

19.8%

34.1%

37.9%

37.2%

50.0%

46.9%

44.3%

42.3%

30.3%

2015

2016

2017





Customer Service/Provider Relations



(▼) (▲)

20



Accuracy and

accessibility of drug

formulary and formulary

updates (Q13)

Customer Service/

Provider Relations

overall (Q14)

Telephone system

overall (Q15)

Specialist network has

an adequate number of

specialists to whom I

can refer patients (Q16)

21.1%

21.4%

25.5%

22.8%

40.1%

44.0%

36.9%

50.4%

38.8%

34.5%

37.6%

26.8%

15.6%

12.2%

15.4%

17.4%

33.0%

35.0%

39.5%

52.2%

51.4%

52.8%

45.1%

30.4%

16.9%

17.3%

23.9%

22.1%

40.9%

43.4%

40.6%

53.4%

42.2%

39.3%

35.5%

24.4%

38.5%

39.7%

41.7%

40.9%

31.7%

31.6%

34.0%

38.6%

29.8%

28.7%

24.4%

20.5%

2015

2016

2017





Process for obtaining

member eligibility

information (Q9)

Responsiveness and

courtesy of the health

plan’s Provider Relations/

Customer Service

representative (Q10)

Timeliness to answer

questions and/or resolve

problems (Q11)

Quality of written

communications, policy

bulletins and manuals

(Q12)

10.5%

13.1%

12.6%

5.8%

31.5%

33.5%

28.3%

47.4%

58.0%

53.4%

59.1%

46.7%

14.1%

11.9%

12.3%

15.7%

27.5%

33.0%

39.5%

50.7%

58.5%

55.1%

48.1%

33.6%

19.9%

14.2%

15.5%

16.4%

36.0%

42.0%

42.9%

55.7%

44.1%

43.8%

41.6%

27.9%

14.9%

12.4%

17.0%

16.8%

32.4%

40.7%

35.9%

51.1%

52.8%

46.9%

47.1%

32.1%

2015

2016

2017







(▲) (▼)(▼) (▲)(▲) (▼) (▲) (▼) (▲)

(▼) (▲)(▼) (▼)

21



Coordination of Care/Case Management (Q19)h significant increase from previous year


No-Show HealthChoice Appointments (Q20)




16.8%

14.2%

24.7%

37.2%

44.4%

38.4%

46.0%

41.4%

37.0%

2015

2016

2017


8.1%

70.2%

18.0%

3.7%8.0%

69.7%

16.0%6.3%7.7%

73.7%

14.1%4.5%

None 1%-25% 26%-50% 51% or more

2017 2016 2015

(↑)

22



Timeliness of obtaining

authorization for

outpatient services

(Q21)


authorization for

inpatient services (Q22)


authorization for

medication (Q23)

Overall experience in

obtaining prior

authorization for

medications (Q24)

21.8%

20.0%

28.9%

26.2%

41.6%

50.6%

36.2%

47.7%

36.5%

29.4%

34.9%

26.2%

16.9%

11.9%

23.7%

21.1%

45.5%

50.5%

44.3%

55.6%

37.6%

37.6%

32.0%

23.3%

30.0%

31.0%

33.6%

29.9%

36.4%

42.3%

40.1%

50.0%

33.7%

26.8%

26.3%

20.1%

30.8%

33.9%

39.0%

36.6%

34.4%

38.7%

35.7%

42.5%

34.8%

27.4%

25.3%

20.9%

2015

2016

2017




i significant decrease from previous yearUtilization Management


24.9%

24.2%

31.3%

28.4%

39.5%

45.5%

39.1%

48.9%

35.6%

30.3%

29.6%

22.6%

2015

2016

2017





(↑)(↓)

23




81.0%

86.1%

77.1% (↓)

2015

2016

2017

Very or Somewhat Satisfied/Definitely or Probably Yes



11.4%

4.9%

15.8%

14.8%

13.6%

14.6%

73.8%

81.5%

69.6%(i)

2015

2016

2017

Dissatisfied Neither Satisfied nor Dissatisfied Satisfied

Overall satisfaction with

AMERIGROUP Community Care (Q25) Would recommend to patients (Q27)Would recommend to other

physicians (Q28)

15.7%

11.0%

18.4%

84.3%

89.0%

81.6%

15.2%

12.3%

19.9%

84.8%

87.7%

80.1%

Definitely/Probably No Definitely/Probably Yes



Summary Rate (Satisfied)

All Other HealthChoice MCOs (Q26) 66.4%

AMERIGROUP Community Care (Q25) 69.6%



(↑)

(↓)

(h)

24


AMERIGROUP Community Care ProviderQuestion Summaries

▪ The tables on the following pages illustrate the proportion of PCPs that fall into each response category for all survey

questions.

➢ Question Summary topics include:

– Finance Issues

– Customer Service/Provider Relations

– Coordination of Care/Case Management

– No-Show HealthChoice Appointments

– Utilization Management

– Overall Satisfaction

▪ Summary Rates have been calculated and are used to track the results from 2016 to 2017 where appropriate, as well as

to make comparisons to the 2017 HealthChoice Aggregate. The Summary Rates shown represent the percentage of

respondents who answered in the most positive way. Please keep in mind when reviewing this section that not all

questions are designed for Summary Rates (e.g., questions that instruct the respondent to mark all that apply).

▪ For most of the questions, the 2017 Summary Rate for AMERIGROUP Community Care has also been compared to the

2017 Summary Rate for All Other HealthChoice MCOs.

25


AMERIGROUP Community Care ProviderQuestion Summaries (continued)

# Question

n

size1

Response Categories

(Blue indicates inclusion in Summary Rate responses)

Summary Rate2

All Other

HC MCOs

2017 2016

2017 HC

Aggregate 2017

6

Accuracy of claims

processing


140 45.7% 51.9% 51.6% 35.0%

7

Timeliness of initial claims

processing


143 49.0% (▲) 50.0% 50.7% 35.8%

8

Timeliness of

adjustment/appeal claims

processing


138 31.9% 36.8% 36.7% 30.0%

Significant differences at the 95% confidence level are shown through the use of symbols.

A significant increase/decrease from the 2016 Summary Rate to the 2017 Summary Rate is indicated by a h/i by the 2017 percentage.

A / by the 2017 Summary Rate percentage indicates that the 2017 Summary Rate is significantly higher/lower than the 2017 HC (HealthChoice) Aggregate.

A▲/▼ by the 2017 Summary Rate percentage indicates that the 2017 Summary Rate is significantly higher/lower than All Other HC (HealthChoice) MCOs. 1n size=The number of respondents answering a particular question.


Finance Issues

17.1%

37.1%45.7%


14.7%

36.4%49.0%


21.0%

47.1%31.9%


26



# Question

n

size1

Response Categories


Summary Rate2

All Other

HC MCOs

2017 2016

2017 HC

Aggregate 2017

9

Process for obtaining

member eligibility

information


159 59.1% (▲) 53.4% 56.9% 46.7%

10

Responsiveness and

courtesy of the health

plan’s Provider

Relations/Customer

Service representative


162 48.1% (▲) 55.1% 52.8% 33.6%

11

Timeliness to answer

questions and/or resolve

problems


161 41.6% (▲) 43.8% 45.1% 27.9%

12

Quality of written

communications, policy



153 47.1% (▲) 46.9% 44.3% 32.1%






Customer Service/Provider Relations

12.6%28.3%

59.1%


12.3%

39.5%48.1%


15.5%

42.9% 41.6%


17.0%

35.9%47.1%


27



# Question

n

size1

Response Categories


Summary Rate2

All Other

HC MCOs

2017 2016

2017 HC

Aggregate 2017

13

Accuracy and accessibility of

drug formulary and formulary

updates


149 37.6% 34.5% 36.8% 26.8%

14

Customer Service/

Provider Relations overall


162 45.1% (▲) 52.8% 48.7% 30.4%

15Telephone system overall


155 35.5% (▲) 39.3% 38.6% 24.4%

16

Specialist network has an

adequate number of

specialists to whom I can

refer patients


156 24.4% 28.7% 31.4% 20.5%






Customer Service/Provider Relations (continued)

25.5%36.9% 37.6%


15.4%

39.5% 45.1%


23.9%40.6% 35.5%


41.7%34.0%

24.4%


28



# Question

n

size1

Response Categories


Summary Rate2

All Other

HC MCOs

2017 2016

2017 HC

Aggregate 2017

19


Case Management


146 37.0% 41.4% 40.6% N/A

20

Percentage of scheduled

HealthChoice appointments

that are “no-show”

appointments each week


161 78.3% 77.7% 80.0% N/A




1n size=The number of respondents answering a particular question.


N/A=This question was not asked of All Other HC (HealthChoice) MCOs.

Coordination of Care/Case Management and No-Show HealthChoice Appointments

24.7%38.4% 37.0%


3.7%18.0%

70.2%

8.1%

51% or more 26%-50% 1%-25% None

29



# Question

n

size1

Response Categories


Summary Rate2

All Other

HC MCOs

2017 2016

2017 HC

Aggregate 2017

21


authorization for outpatient

services


149 34.9% 29.4% 37.1% 26.2%

22


authorization for inpatient

services


97 32.0% 37.6% 37.0% 23.3%

23


authorization for medication


152 26.3% 26.8% 30.4% 20.1%

24

Overall experience in

obtaining prior authorization

for medications


154 25.3% 27.4% 29.6% 20.9%






Utilization Management

28.9% 36.2% 34.9%


23.7%

44.3%32.0%


33.6% 40.1%26.3%


39.0% 35.7%25.3%


30



# Question

n

size1

Response Categories


Summary Rate2

All Other

HC MCOs

2017 2016

2017 HC

Aggregate 2017

25

Overall satisfaction with

AMERIGROUP Community

Care3


171 69.6% (↓) 81.5% 75.7% 66.4%

27

Would recommend to

patients


158 81.6% 89.0% 84.9% N/A

28

Would recommend to other

physicians


156 80.1% 87.7% 84.6% N/A




A▲/▼ by the 2017 Summary Rate percentage indicates that the 2017 Summary Rate is significantly higher/lower than All Other HC (HealthChoice) MCOs.

1n size=The number of respondents answering a particular question.


3Overall satisfaction with the specified MCO is compared to Q26 – Overall satisfaction with All Other HC (HealthChoice) MCOs.

N/A=This question was not asked of All Other HC (HealthChoice) MCOs.


Question Summaries (continued)

15.8% 14.6%

69.6%

Dissatisfied Neither Satisfied nor Dissatisfied Satisfied

18.4%

81.6%

No Yes

19.9%

80.1%

No Yes

Segmentation Analysis

32


AMERIGROUP Community Care ProviderSegmentation Analysis

▪ The provider survey asks various demographic questions about the respondent. As part of the analysis, several of these

questions have been cross-tabulated with the composite measures and their attributes. In doing this, it can be

determined whether AMERIGROUP Community Care is meeting the needs of a particular population.

▪ On the following pages, Summary Rates for composite measures and their attributes are analyzed by the following

demographics:

➢ Number of Physicians in Practice (Q1)

➢ Number of Mid-level Practitioners in Practice (Q2)

➢ Percent of Total Volume Represented by HealthChoice (Q3)

➢ Percent of Total Volume Represented by AMERIGROUP Community Care (Q4)

➢ Who Completed the Survey (Q32)

➢ Method of Completing Survey (Mail, Telephone or Online)

▪ The percentages shown represent the Summary Rate for each segment of a demographic category. In the example

below, the Summary Rate is the percentage of respondents who gave a rating of excellent or very good. The

interpretation would be that 60.0% of respondents in practices with 2-5 physicians rated “Timeliness of initial claims

processing” as excellent or very good, which is a significantly higher proportion than among respondents in practices with

more than 5 physicians (32.1%).

#

Attribute Ratings

(Summary Rate –

Excellent & Very Good)

Physician Segments

Solo (B)

2-5

Physicians

(C)

More than 5

Physicians

(D)

7Timeliness of initial claims processing


Significant differences at the 95% confidence level are shown through the use of letters. Therefore, if there is a significant difference between two segments’ percentages, there

would be a letter with the significantly higher segment’s percentage.

*Caution: Small Base

43.8%60.0% (D)

32.1%

(B) (n=48) (C) (n=65) (D) (n=28) *

33


AMERIGROUP Community Care ProviderSegmentation Analysis (continued)

#

Composite Ratings

(Summary Rate1 –


Physician and MLP Segments

Solo (B)

2-5 Physicians

(C)

More than 5

Physicians (D) No MLPs (E)

1-5

MLPs (F)

More than 5

MLPs (G)

Finance Issues

6Accuracy of claims processing




8

Timeliness of adjustment/appeal claims

processing


MLP=Mid-Level Practitioner

Significant differences at the 95% confidence level are shown through the use of letters. Therefore, if there is a significant difference between two segments’ percentages, there would be a letter with the significantly higher segment’s percentage.



38.5%49.0%

32.9%41.2% 44.9%

15.9%

(B) (n=48) (C) (n=64) (D) (n=27) * (E) (n=53) (F) (n=81) (G) (n=6) *

44.7% 50.0%37.0%

45.3% 48.1%

16.7%

(B) (n=47) (C) (n=64) (D) (n=27) * (E) (n=53) (F) (n=81) (G) (n=6) *

43.8%60.0% (D)

32.1%50.0% (G) 51.2% (G)

14.3%

(B) (n=48) (C) (n=65) (D) (n=28) * (E) (n=54) (F) (n=82) (G) (n=7) *

27.1%37.1% 29.6% 28.3% 35.4%

16.7%

(B) (n=48) (C) (n=62) (D) (n=27) * (E) (n=53) (F) (n=79) (G) (n=6) *

34



#

Composite Ratings

(Summary Rate1 –



Solo (B)

2-5 Physicians

(C)

More than 5


1-5

MLPs (F)

More than 5

MLPs (G)

Customer Service/

Provider Relations

9

Process for obtaining member eligibility

information


10

Responsiveness and courtesy of the

health plan’s Provider

Relations/Customer Service

representative


11

Timeliness to answer questions and/or

resolve problems


12

Quality of written communications,

policy bulletins and manuals



Significant differences at the 95% confidence level are shown through the use of letters. Therefore, if there is a significant difference between two segments’ percentages, there would be a letter with the significantly higher segment’s

percentage.



42.4% 46.1%33.4% 39.0% 44.6% 40.9%

(B) (n=47) (C) (n=75) (D) (n=33) * (E) (n=58) (F) (n=90) (G) (n=9) *

61.2% 63.5%47.1%

62.1% 59.3%40.0%

(B) (n=49) (C) (n=74) (D) (n=34) * (E) (n=58) (F) (n=91) (G) (n=10) *

51.0% 47.4% 45.7% 44.1%52.2%

36.4%

(B) (n=49) (C) (n=76) (D) (n=35) (E) (n=59) (F) (n=92) (G) (n=11) *

42.9% 45.3%31.4% 38.3% 44.4%

36.4%

(B) (n=49) (C) (n=75) (D) (n=35) (E) (n=60) (F) (n=90) (G) (n=11) *

45.7% 52.0%36.7% 43.1% 50.0% 42.9%

(B) (n=46) (C) (n=75) (D) (n=30) * (E) (n=58) (F) (n=88) (G) (n=7) *

35



#

Composite Ratings

(Summary Rate1 –



Solo (B)

2-5 Physicians

(C)

More than 5


1-5

MLPs (F)

More than 5

MLPs (G)

13

Accuracy and accessibility of drug

formulary and formulary updates


14

Customer Service/





16

Specialist network has an adequate

number of specialists to whom I can

refer patients






36.4%47.2% (D)

19.4%35.8% 38.6% 37.5%

(B) (n=44) (C) (n=72) (D) (n=31) * (E) (n=53) (F) (n=88) (G) (n=8) *

41.7%51.3%

35.3% 36.8%50.5%

40.0%

(B) (n=48) (C) (n=78) (D) (n=34) * (E) (n=57) (F) (n=95) (G) (n=10) *

34.8% 39.2%27.3% 33.9% 35.2%

50.0%

(B) (n=46) (C) (n=74) (D) (n=33) * (E) (n=59) (F) (n=88) (G) (n=8) *

25.5% 23.0% 24.2% 17.5%26.7%

44.4%

(B) (n=47) (C) (n=74) (D) (n=33) * (E) (n=57) (F) (n=90) (G) (n=9) *

36



#

Composite Ratings

(Summary Rate1 –

Excellent & Very Good

or 0%-25%)


Solo (B)

2-5 Physicians

(C)

More than 5


1-5

MLPs (F)

More than 5

MLPs (G)

19


Case Management


20No-Show HealthChoice Appointments






37.8% 43.3% (D)24.2%

36.0% 37.5% 37.5%

(B) (n=45) (C) (n=67) (D) (n=33) * (E) (n=50) (F) (n=88) (G) (n=8) *

78.7% 77.9% 79.4% 76.3% 80.6%62.5%

(B) (n=47) (C) (n=77) (D) (n=34) * (E) (n=59) (F) (n=93) (G) (n=8) *

37



#

Composite Ratings

(Summary Rate1 –



Solo (B)

2-5 Physicians

(C)

More than 5


1-5

MLPs (F)

More than 5

MLPs (G)


21

Timeliness of obtaining authorization for

outpatient services


22


inpatient services


23


medication


24

Overall experience in obtaining prior

authorization for medications




percentage.



36.3% 29.4% 22.0% 26.5% 31.1% 36.8%

(B) (n=42) (C) (n=66) (D) (n=28) * (E) (n=49) (F) (n=82) (G) (n=7) *

43.5%33.8% 26.7% 32.1% 36.0% 42.9%

(B) (n=46) (C) (n=71) (D) (n=30) * (E) (n=53) (F) (n=89) (G) (n=7) *

32.3% 33.3% 31.6% 26.5% 33.3%

66.7%

(B) (n=31) * (C) (n=45) (D) (n=19) * (E) (n=34) * (F) (n=60) (G) (n=3) *

37.0% (D)23.3% 16.7% 24.1% 28.1%

12.5%

(B) (n=46) (C) (n=73) (D) (n=30) * (E) (n=54) (F) (n=89) (G) (n=8) *

32.6% (D) 27.0%12.9%

23.2% 27.0% 25.0%

(B) (n=46) (C) (n=74) (D) (n=31) * (E) (n=56) (F) (n=89) (G) (n=8) *

38



#

Composite Ratings

(Summary Rate1 –

Very & Somewhat Satisfied or

Definitely & Probably Yes)


Solo (B)

2-5 Physicians

(C)

More than 5


1-5

MLPs (F)

More than 5

MLPs (G)


25

Overall satisfaction with AMERIGROUP

Community Care


27Would recommend to patients


28Would recommend to other physicians






73.4% 80.9% 75.0% 74.6% 80.2%60.7%

(B) (n=49) (C) (n=78) (D) (n=32) * (E) (n=57) (F) (n=94) (G) (n=10) *

70.6% 72.8%61.1% 63.9%

75.5%

45.5%

(B) (n=51) (C) (n=81) (D) (n=36) (E) (n=61) (F) (n=98) (G) (n=11) *

75.0% 85.5% 83.9% 81.8% 82.6%70.0%

(B) (n=48) (C) (n=76) (D) (n=31) * (E) (n=55) (F) (n=92) (G) (n=10) *

74.5%84.2% 80.0% 78.2% 82.4%

66.7%

(B) (n=47) (C) (n=76) (D) (n=30) * (E) (n=55) (F) (n=91) (G) (n=9) *

39



#

Composite Ratings

(Summary Rate1 –


HealthChoice Volume Segments

HealthChoice

Volume

0%-10% (H)

HealthChoice

Volume

11%-20% (I)

HealthChoice

Volume

21%-50% (J)

HealthChoice

Volume

51%-100% (K)

Finance Issues





8


processing


Significant differences at the 95% confidence level are shown through the use of letters. Therefore, if there is a significant difference between two segments’ percentages, there would be a letter with the

significantly higher segment’s percentage.



50.7%38.3% 35.1%

47.9%

(H) (n=30) * (I) (n=23) * (J) (n=43) (K) (n=40)

54.8%40.9% 39.5%

51.3%

(H) (n=31) * (I) (n=22) * (J) (n=43) (K) (n=39)

58.1%43.5% 41.9%

55.0%

(H) (n=31) * (I) (n=23) * (J) (n=43) (K) (n=40)

39.3%30.4% 23.8%

37.5%

(H) (n=28) * (I) (n=23) * (J) (n=42) (K) (n=40)

40



#

Composite Ratings

(Summary Rate1 –



HealthChoice

Volume

0%-10% (H)

HealthChoice

Volume

11%-20% (I)

HealthChoice

Volume

21%-50% (J)

HealthChoice

Volume

51%-100% (K)

Customer Service/

Provider Relations

9


information


10

Responsiveness and courtesy of the health

plan’s Provider Relations/Customer Service

representative


11


resolve problems


12

Quality of written communications, policy







42.0% 42.6% 36.9%49.9%

(H) (n=34) * (I) (n=24) * (J) (n=49) (K) (n=42)

62.9% 64.0%50.0%

68.3%

(H) (n=35) (I) (n=25) * (J) (n=50) (K) (n=41)

50.0%60.0%

34.0%

58.1%

(H) (n=34) * (I) (n=25) * (J) (n=50) (K) (n=43)

44.1% 40.0% 34.7%50.0%

(H) (n=34) * (I) (n=25) * (J) (n=49) (K) (n=42)

45.5% 43.5% 44.7%53.5%

(H) (n=33) * (I) (n=23) * (J) (n=47) (K) (n=43)

(J)(J)

41



#

Composite Ratings

(Summary Rate1 –



HealthChoice

Volume

0%-10% (H)

HealthChoice

Volume

11%-20% (I)

HealthChoice

Volume

21%-50% (J)

HealthChoice

Volume

51%-100% (K)

13




14

Customer Service/





16


number of specialists to whom I can refer

patients






33.3% 30.4% 34.9%48.8%

(H) (n=33) * (I) (n=23) * (J) (n=43) (K) (n=41)

47.1%37.5% 39.2%

55.8%

(H) (n=34) * (I) (n=24) * (J) (n=51) (K) (n=43)

35.3% 36.4% 35.4% 35.7%

(H) (n=34) * (I) (n=22) * (J) (n=48) (K) (n=42)

18.2%29.2% 22.0% 28.6%

(H) (n=33) * (I) (n=24) * (J) (n=50) (K) (n=42)

42



#

Composite Ratings

(Summary Rate1 –


or 0%-25%)


HealthChoice

Volume

0%-10% (H)

HealthChoice

Volume

11%-20% (I)

HealthChoice

Volume

21%-50% (J)

HealthChoice

Volume

51%-100% (K)

19


Case Management








29.0% 30.4% 36.4%52.6%

(H) (n=31) * (I) (n=23) * (J) (n=44) (K) (n=38)

80.6% 73.9% 81.6% 73.3%

(H) (n=36) (I) (n=23) * (J) (n=49) (K) (n=45)

(H)

43



#

Composite Ratings

(Summary Rate1 –



HealthChoice

Volume

0%-10% (H)

HealthChoice

Volume

11%-20% (I)

HealthChoice

Volume

21%-50% (J)

HealthChoice

Volume

51%-100% (K)


21


outpatient services


22


inpatient services


23


medication


24








18.3%26.9% 26.1%

45.2% (H)

(H) (n=28) * (I) (n=23) * (J) (n=43) (K) (n=37)

24.1% 32.0% 24.5%

55.0%

(H) (n=29) * (I) (n=25) * (J) (n=49) (K) (n=40)

21.1%38.9%

30.0%40.7%

(H) (n=19) * (I) (n=18) * (J) (n=30) * (K) (n=27) *

18.8% 20.0% 23.9%41.0%

(H) (n=32) * (I) (n=25) * (J) (n=46) (K) (n=39)

9.1% 16.7%26.1%

43.9%

(H) (n=33) * (I) (n=24) * (J) (n=46) (K) (n=41)

(H,J)

(H)

(H)

(H,I)

44



#

Composite Ratings

(Summary Rate1 –

Very & Somewhat Satisfied or Definitely

& Probably Yes)


HealthChoice

Volume

0%-10% (H)

HealthChoice

Volume

11%-20% (I)

HealthChoice

Volume

21%-50% (J)

HealthChoice

Volume

51%-100% (K)


25


Community Care










72.4% 73.3% 76.7% 84.5%

(H) (n=35) (I) (n=25) * (J) (n=47) (K) (n=43)

66.7% 64.0% 63.5%84.4%

(H) (n=36) (I) (n=25) * (J) (n=52) (K) (n=45)

77.1% 80.0% 84.4% 83.3%

(H) (n=35) (I) (n=25) * (J) (n=45) (K) (n=42)

73.5% 76.0% 82.2% 85.7%

(H) (n=34) * (I) (n=25) * (J) (n=45) (K) (n=42)

(J)

45



#

Composite Ratings

(Summary Rate1 –


Health Plan Volume Segments

AMERIGROUP

Community Care

Volume

0%-10% (L)

AMERIGROUP

Community Care

Volume

11%-20% (M)

AMERIGROUP

Community Care

Volume

21%-50% (N)

AMERIGROUP

Community Care

Volume

51%-100% (O)

Finance Issues





8


processing






41.1%54.0%

34.6%45.7%

(L) (n=43) (M) (n=29) * (N) (n=42) (O) (n=23) *

43.2%58.6%

38.1%50.0%

(L) (n=44) (M) (n=29) * (N) (n=42) (O) (n=22) *

53.3% 58.6%41.9% 47.8%

(L) (n=45) (M) (n=29) * (N) (n=43) (O) (n=23) *

26.8%44.8%

23.8%39.1%

(L) (n=41) (M) (n=29) * (N) (n=42) (O) (n=23) *

46



#

Composite Ratings

(Summary Rate1 –



AMERIGROUP

Community Care

Volume

0%-10% (L)

AMERIGROUP

Community Care

Volume

11%-20% (M)

AMERIGROUP

Community Care

Volume

21%-50% (N)

AMERIGROUP

Community Care

Volume

51%-100% (O)

Customer Service/

Provider Relations

9


information


10

Responsiveness and courtesy of the health

plan’s Provider Relations/Customer Service

representative


11


resolve problems


12

Quality of written communications, policy







36.4%55.5%

40.5% 43.1%

(L) (n=50) (M) (n=30) * (N) (n=48) (O) (n=21) *

53.8%71.0%

59.6% 68.2%

(L) (n=52) (M) (n=31) * (N) (n=47) (O) (n=22) *

42.0%51.6% 48.0%

59.1%

(L) (n=50) (M) (n=31) * (N) (n=50) (O) (n=22) *

40.0%51.6%

37.5% 40.9%

(L) (n=50) (M) (n=31) * (N) (n=48) (O) (n=22) *

42.0%

66.7%

42.6% 42.9%

(L) (n=50) (M) (n=30) * (N) (n=47) (O) (n=21) *

(L,N)

47



#

Composite Ratings

(Summary Rate1 –



AMERIGROUP

Community Care

Volume

0%-10% (L)

AMERIGROUP

Community Care

Volume

11%-20% (M)

AMERIGROUP

Community Care

Volume

21%-50% (N)

AMERIGROUP

Community Care

Volume

51%-100% (O)

13




14

Customer Service/





16


number of specialists to whom I can refer

patients






27.1%

58.6%34.8% 38.1%

(L) (n=48) (M) (n=29) * (N) (n=46) (O) (n=21) *

40.0%54.8%

46.0% 42.9%

(L) (n=50) (M) (n=31) * (N) (n=50) (O) (n=21) *

32.0%50.0%

31.9% 30.0%

(L) (n=50) (M) (n=30) * (N) (n=47) (O) (n=20) *

14.6%

40.0%24.0% 22.7%

(L) (n=48) (M) (n=30) * (N) (n=50) (O) (n=22) *

(L,N)

(L)

48



#

Composite Ratings

(Summary Rate1 –


or 0%-25%)


AMERIGROUP

Community

Care Volume

0%-10% (L)

AMERIGROUP

Community

Care Volume

11%-20% (M)

AMERIGROUP

Community

Care Volume

21%-50% (N)

AMERIGROUP

Community

Care Volume

51%-100% (O)

19


Case Management








24.4%

46.2% 42.2% 38.1%

(L) (n=45) (M) (n=26) * (N) (n=45) (O) (n=21) *

84.9%75.0% 74.5% 72.7%

(L) (n=53) (M) (n=28) * (N) (n=51) (O) (n=22) *

49



#

Composite Ratings

(Summary Rate1 –



AMERIGROUP

Community Care

Volume

0%-10% (L)

AMERIGROUP

Community Care

Volume

11%-20% (M)

AMERIGROUP

Community Care

Volume

21%-50% (N)

AMERIGROUP

Community Care

Volume

51%-100% (O)


21


outpatient services


22


inpatient services


23


medication


24








17.7%

45.0%29.0% 34.6%

(L) (n=43) (M) (n=27) * (N) (n=43) (O) (n=20) *

22.7%

44.8%34.0%

47.8%

(L) (n=44) (M) (n=29) * (N) (n=47) (O) (n=23) *

17.9%

45.5%31.2%

42.9%

(L) (n=28) * (M) (n=22) * (N) (n=32)* (O) (n=14) *

16.3%

44.8%

24.4% 23.8%

(L) (n=49) (M) (n=29) * (N) (n=45) (O) (n=21) *

14.0%

44.8%26.1% 23.8%

(L) (n=50) (M) (n=29) * (N) (n=46) (O) (n=21) *

(L)(L)

(L)

(L)

(L)

(L)

50



#

Composite Ratings

(Summary Rate1 –

Very & Somewhat Satisfied or Definitely

& Probably Yes)


AMERIGROUP

Community Care

Volume

0%-10% (L)

AMERIGROUP

Community Care

Volume

11%-20% (M)

AMERIGROUP

Community Care

Volume

21%-50% (N)

AMERIGROUP

Community Care

Volume

51%-100% (O)


25


Community Care










67.9%84.4% 84.3%

74.8%

(L) (n=51) (M) (n=29) * (N) (n=48) (O) (n=22) *

63.0%74.2% 78.4%

65.2%

(L) (n=54) (M) (n=31) * (N) (n=51) (O) (n=23) *

71.4%89.3% 87.5% 81.8%

(L) (n=49) (M) (n=28) * (N) (n=48) (O) (n=22) *

69.4%89.7% 87.0% 77.3%

(L) (n=49) (M) (n=29) * (N) (n=46) (O) (n=22) *

(L)(L)

(L) (L)

51



#

Composite Ratings

(Summary Rate1 –


Job Title and Survey Mode Segments

Physician (P)

Office Manager

(Q) Nurse/Other (R)

Completed

Survey by

Mail (S)

Completed

Survey by

Phone (T)

Completed

Survey Online

(U)

Finance Issues





8


processing





34.2%

55.6% (P,R)

28.6%39.8% 45.0% 50.0%

(P) (n=40) (Q) (n=63) (R) (n=34) * (S) (n=80) (T) (n=57) (U) (n=4) *

37.5%

57.8%

33.3%45.6% 45.6% 50.0%

(P) (n=40) (Q) (n=64) (R) (n=33) * (S) (n=79) (T) (n=57) (U) (n=4) *

35.0%

67.2%

34.3%43.8%

55.9% 50.0%

(P) (n=40) (Q) (n=64) (R) (n=35) (S) (n=80) (T) (n=59) (U) (n=4) *

30.0%41.9% (R)

18.2%30.0% 33.3%

50.0%

(P) (n=40) (Q) (n=62) (R) (n=33) * (S) (n=80) (T) (n=54) (U) (n=4) *

(P,R)

(P,R)

52



#

Composite Ratings

(Summary Rate1 –



Physician (P)

Office Manager

(Q) Nurse/Other (R)

Completed

Survey by

Mail (S)

Completed

Survey by

Phone (T)

Completed

Survey Online

(U)

Customer Service/

Provider Relations

9


information


10

Responsiveness and courtesy of the

health plan’s Provider

Relations/Customer Service

representative


11


resolve problems


12

Quality of written communications,

policy bulletins and manuals



percentage.



35.7%48.3%

38.6%47.9%

37.6%

12.5%

(P) (n=41) (Q) (n=71) (R) (n=41) (S) (n=81) (T) (n=72) (U) (n=4) *

54.8%67.6% (R)

46.3%63.0% 55.4% 50.0%

(P) (n=42) (Q) (n=71) (R) (n=41) (S) (n=81) (T) (n=74) (U) (n=4) *

40.5%

60.6% (P,R)

34.1%53.7% (U)

44.7% (U)

0.0%

(P) (n=42) (Q) (n=71) (R) (n=44) (S) (n=82) (T) (n=76) (U) (n=4) *

31.0%47.9% 40.9% 48.8% (U)

36.0% (U)

0.0%

(P) (n=42) (Q) (n=71) (R) (n=44) (S) (n=82) (T) (n=75) (U) (n=4) *

38.1%52.1% 47.2% 50.6% 44.1%

25.0%

(P) (n=42) (Q) (n=71) (R) (n=36) (S) (n=81) (T) (n=68) (U) (n=4) *

53



#

Composite Ratings

(Summary Rate1 –



Physician (P)

Office Manager

(Q) Nurse/Other (R)

Completed

Survey by

Mail (S)

Completed

Survey by Phone

(T)

Completed

Survey Online

(U)

13




14

Customer Service/





16


number of specialists to whom I can

refer patients





29.3%41.2% 41.7% 40.7% 34.4%

25.0%

(P) (n=41) (Q) (n=68) (R) (n=36) (S) (n=81) (T) (n=64) (U) (n=4) *

34.1%52.7%

41.9% 49.4% (U) 42.9% (U)

0.0%

(P) (n=41) (Q) (n=74) (R) (n=43) (S) (n=81) (T) (n=77) (U) (n=4) *

30.8%40.8% 33.3% 41.0% (U)

31.5% (U)

0.0%

(P) (n=39) (Q) (n=71) (R) (n=42) (S) (n=78) (T) (n=73) (U) (n=4) *

27.5% 23.5% 23.3%36.1% (T,U)

11.6% (U)0.0%

(n=40) (n=68) (n=43) (n=83) (n=69) (n=4)*

54



#

Composite Ratings

(Summary Rate1 –


or 0%-25%)


Physician (P)

Office Manager

(Q) Nurse/Other (R)

Completed

Survey by

Mail (S)

Completed

Survey by Phone

(T)

Completed

Survey Online

(U)

19


Case Management







31.6%43.8%

33.3%41.3% 34.3%

0.0%

(P) (n=38) (Q) (n=64) (R) (n=39) (S) (n=75) (T) (n=67) (U) (n=4) *

72.1% 79.7% 79.5% 74.4% 84.0%

50.0%

(P) (n=43) (Q) (n=69) (R) (n=44) (S) (n=82) (T) (n=75) (U) (n=4) *

55



#

Composite Ratings

(Summary Rate1 –



Physician (P)

Office Manager

(Q) Nurse/Other (R)

Completed

Survey by

Mail (S)

Completed

Survey by

Phone (T)

Completed

Survey Online

(U)


21


outpatient services


22


inpatient services


23


medication


24





percentage.



32.5% 34.2%21.2%

38.8% (T,U)20.2% (U)

0.0%

(P) (n=38) (Q) (n=61) (R) (n=35) (S) (n=74) (T) (n=60) (U) (n=4) *

34.1%42.9%

27.5%42.5% (U)

27.7% (U)

0.0%

(P) (n=41) (Q) (n=63) (R) (n=40) (S) (n=80) (T) (n=65) (U) (n=4) *

41.4% 34.9%18.2%

42.6% (T,U)

20.5% (U)

0.0%

(P) (n=29) * (Q) (n=43) (R) (n=22) * (S) (n=54) (T) (n=39) (U) (n=4) *

30.0% 30.0%16.2%

37.0% (T,U)

14.9% (U)0.0%

(P) (n=40) (Q) (n=70) (R) (n=37) (S) (n=81) (T) (n=67) (U) (n=4) *

24.4% 29.0% 23.1%32.9% (T,U)

17.6% (U)0.0%

(P) (n=41) (Q) (n=69) (R) (n=39) (S) (n=82) (T) (n=68) (U) (n=4) *

56



#

Composite Ratings

(Summary Rate1 –

Very & Somewhat Satisfied or

Definitely & Probably Yes)


Physician (P)

Office Manager

(Q) Nurse/Other (R)

Completed

Survey by

Mail (S)

Completed

Survey by

Phone (T)

Completed

Survey Online

(U)


25


Community Care









67.4%84.0% 75.6% 73.2% 81.6% 75.0%

(P) (n=41) (Q) (n=75) (R) (n=42) (S) (n=83) (T) (n=75) (U) (n=4) *

60.5%80.3%

61.7%70.1% 71.2%

25.0%

(P) (n=43) (Q) (n=76) (R) (n=47) (S) (n=87) (T) (n=80) (U) (n=4) *

71.8%86.5% 82.9% 75.3%

87.7% 100.0%

(P) (n=39) (Q) (n=74) (R) (n=41) (S) (n=81) (T) (n=73) (U) (n=4) *

70.0%85.1% 82.1% 74.1%

85.9% 100.0%

(P) (n=40) (Q) (n=74) (R) (n=39) (S) (n=81) (T) (n=71) (U) (n=4) *

(U)(P,R)(U)

(S,T)(S)

(S,T)

Loyalty Analysis

58


AMERIGROUP Community Care ProviderLoyalty Analysis

Loyalty Analysis

▪ A loyal Primary Care Provider can be defined as someone who is very satisfied with the MCO and would recommend that

MCO to patients and other physicians.

▪ From this survey, we can determine PCP loyalty by examining responses to the following questions:

➢ Overall satisfaction with AMERIGROUP Community Care (Q25);

➢ Likelihood of recommending AMERIGROUP Community Care to patients (Q27); and

➢ Likelihood of recommending AMERIGROUP Community Care to other physicians (Q28).

▪ These three questions are combined to develop a “loyalty” analysis. The three categories within this analysis are as

follows:

➢ Loyal – PCPs who are very satisfied with and would recommend AMERIGROUP Community Care to patients and

other physicians.

➢ Not Loyal – PCPs who are very dissatisfied with and would not recommend AMERIGROUP Community Care to

patients and other physicians.

➢ Indifferent – PCPs who are mixed as to whether they are satisfied with or whether they would recommend

AMERIGROUP Community Care to patients and other physicians.

▪ The table below illustrates the category definitions.

Overall Satisfaction with

AMERIGROUP

Community Care (Q25)

Would Recommend

AMERIGROUP Community

Care to Patients (Q27)

Would Recommend

AMERIGROUP Community Care

to Other Physicians (Q28)

LOYAL Very Satisfied

AND Definitely Yes AND Definitely Yes

AND Definitely Yes AND Probably Yes

AND Probably Yes AND Definitely Yes

INDIFFERENT All other responses

NOT LOYAL Very Dissatisfied

AND Definitely Not AND Definitely Not

AND Definitely Not AND Probably Not

AND Probably Not AND Definitely Not

59



▪ Among the PCPs surveyed, almost three in ten overall (27.9%) are considered “loyal PCPs”. The remaining PCPs can be

classified as either “indifferent” (68.8%) or “not loyal” (3.2%).

Loyalty Analysis (continued)

Primary Care Provider Loyalty

35.5%

33.9%

27.9%

60.9%

65.0%

68.8%

3.6%

1.1%

3.2%

2015

2016

2017

Loyal Indifferent Not Loyal




Key Driver/Correlation Analysis

61


AMERIGROUP Community Care ProviderKey Driver/Correlation Analysis

Key Driver Analysis

▪ In an effort to identify the underlying components of PCPs’ ratings of their overall satisfaction with AMERIGROUP Community

Care, advanced statistical techniques were employed. Correlation analyses were conducted between each composite

measure attribute and overall satisfaction with AMERIGROUP Community Care (Q25) in order to ascertain which attributes

have the greatest impact on PCPs’ overall satisfaction.

Prioritizing Actions

▪ A key objective of any provider satisfaction research is to identify priorities for improving provider satisfaction. Doing this will

allow AMERIGROUP Community Care to focus resources on areas that are most important to PCPs and where the most

improvement is needed. These areas are referred to as unmet needs. In addition, areas that are most important to PCPs and

on which AMERIGROUP Community Care performs relatively well are driving strengths. Insights can be gained by plotting

these attributes based on their impact on PCPs’ overall satisfaction, as shown on the following pages.

62


AMERIGROUP Community Care ProviderKey Driver/Correlation Analysis (continued)

Attribute Relationship with Overall Satisfaction

▪ The attributes “Coordination of Care/Case Management”, “Customer Service/Provider Relations overall”, “Timeliness to

answer questions and/or resolve problems”, “Accuracy of claims processing” and “Timeliness of initial claims processing” are

identified as key drivers of high importance to PCPs where they perceive AMERIGROUP Community Care to be performing

at a comparatively lower level (Summary Rate is less than 50%).

➢ These attributes are referred to as unmet needs and should be considered priority areas for AMERIGROUP

Community Care. If performance on these attributes is improved, it could have a positive impact on PCPs’ overall

satisfaction.

▪ There are several other attributes that are identified as being of moderate importance and on which AMERIGROUP

Community Care performs at a comparatively lower level (Summary Rate is less than 50%): “Timeliness of

adjustment/appeal claims processing”, “Overall experience in obtaining prior authorization for medications”, “Timeliness of

obtaining authorization for outpatient services”, “Telephone system overall”, “Quality of written communications, policy

bulletins and manuals”, “Responsiveness and courtesy of the health plan’s Provider Relations/Customer Service

representative”, “Specialist network has an adequate number of specialists to whom I can refer patients”, “Timeliness of

obtaining authorization for medication” and “Timeliness of obtaining authorization for inpatient services”. These should be

considered secondary priorities for AMERIGROUP Community Care. If performance on these attributes is improved, it could

have a positive impact on PCPs’ overall satisfaction.

63


AMERIGROUP Community Care ProviderKey Driver/Correlation Analysis (continued)

ATTRIBUTE RELATIONSHIP WITH OVERALL SATISFACTION

High

❖ Coordination of Care/Case Management

❖ Customer Service/Provider Relations overall

❖ Timeliness to answer questions and/or resolve

problems

❖ Accuracy of claims processing

❖ Timeliness of initial claims processing

Moderate

❖ Timeliness of adjustment/appeal claims processing

❖ Overall experience in obtaining prior authorization for

medications

❖ Timeliness of obtaining authorization for outpatient

services

❖ Telephone system overall

❖ Quality of written communications, policy bulletins

and manuals

❖ Responsiveness and courtesy of the health plan’s

Provider Relations/Customer Service representative

❖ Specialist network has an adequate number of

specialists to whom I can refer patients

❖ Timeliness of obtaining authorization for medication

❖ Timeliness of obtaining authorization for inpatient

services

Low❖ Accuracy and accessibility of drug formulary and

formulary updates

❖ Process for obtaining member eligibility information

Lower Ratings Moderate Ratings Higher Ratings

Performance

Imp

act

on

Ove

rall

Sa

tis

fac

tio

n

❖ Finance Issues

❖Customer Service/Provider Relations

❖Coordination of Care/Case

Management

❖Utilization Management

Respondents’ Comments

65


AMERIGROUP Community Care ProviderRespondents’ Comments

Responses

2017

(n=64)

2016

(n=88)

Orthopedics/Orthopedic Surgery 28.1% 36.4%

Psychiatry/Mental Health 25.0% 27.3%

Dermatology 21.9% 19.3%

ENT/Otolaryngology 18.8% 18.2%

Gastroenterology/GI 12.5% 11.4%

Endocrinology 9.4% 9.1%

Rheumatology 7.8% 14.8%

Neurology 7.8% 6.8%

Cardiology 7.8% 6.8%

Urology 6.2% 2.3%

OB/GYN 6.2% 2.3%

Surgery (general) 6.2% 1.1%

Significant differences at the 95% confidence level are shown through the use of symbols where the difference is found. For example, a significant increase/decrease from 2016 to 2017 is indicated by a

h/i by the 2017 percentage.


Top Mentions

Multiple Responses Accepted

Are there any specialties that you find problematic when it comes to adequate care for AMERIGROUP Community Care members? (Q17)

66


AMERIGROUP Community Care ProviderRespondents’ Comments (continued)

Responses

2017

(n=50)

2016

(n=45)

There is limited availability of specialists/Need more local providers (not specific) 44.0% 55.6%

Send us an updated Provider Manual/Update the computer database/Make provider

information accurate/easier to find10.0% 17.8%

Patients have to wait long for appointments 8.0% 6.7%

Authorizations/Prescription authorizations are difficult/untimely 4.0% 4.4%

Get rid of/ simplify referrals/Have difficulty with referrals/ Improve referral process 4.0% 2.2%

Would like feedback after patient visits/Better follow-up 4.0% 2.2%

Offer poor communications/Don’t offer updates, changes to information 4.0% -%

Patients need help with transportation/Offices are often too far away 4.0% -%

Limited participating pharmacies 4.0% -%

Satisfied with specialty services/Thank you 12.0% 6.7%




Top Mentions


Please list any other comments or suggestions you have regarding the quality and availability of specialty care for your

AMERIGROUP Community Care members. (Q18)

67



Responses

2017

(n=113)

2016

(n=122)

Timely payments of claims 13.3% 13.1%

Good provider relations/provider alerts/support 7.1% 5.7%

Offer good coverage for patients 7.1% (↑) 1.6%

Helpful Customer Service/Can resolve problems/Give answers on the spot/Are well-trained 6.2% 12.3%

Easy/Timely electronic authorization systems/No need for authorizations 6.2% 6.6%

Accessibility/Always a person available to speak to/Don’t get put on hold 6.2% 6.6%

Good communications/Good updates and information 6.2% 5.7%

Overall ease to work with/Efficient management/No problems 6.2% 1.6%

Nothing/Nothing in particular 27.4% 21.3%

Significant differences at the 95% confidence level are shown through the use of symbols where the difference is found. For example, a significant increase/decrease from 2016 to 2017 is indicated by a h/i

by the 2017 percentage.


Top Mentions


What do you like best about AMERIGROUP Community Care? (Q29)

68



Responses

2017

(n=121)

2016

(n=128)

Unnecessary authorizations/Prescription authorizations/Pre-certification process is too

untimely13.2% 14.8%

Limited participating specialists/Not enough specialties covered/List of specialists is not

updated12.4% 10.9%

Drug formulary/Restrictive drug formulary 9.9% (↑) 3.1%

Slow claims processing, reimbursements/Too many denied claims/Don’t offer electronic

claims processing/Filing time limit/ Say claim was lost6.6% 3.1%

The referral process/Require too many referrals/takes too long/are denied/Patients don’t

understand referral process5.0% 3.9%

Limited participating providers/Need more local providers/List is not updated/Accurate 3.3% 5.5%

Would like a list of covered prescription medicines/drug formulary 3.3% 2.3%

Nothing/Nothing in particular 30.6% 28.9%




Top Mentions


What do you like least about AMERIGROUP Community Care? (Q30)

69



Responses

2017

(n=115)

2016

(n=133)

Offer more participating specialists/Local specialists/More specialists for faster

appointments10.4% 10.5%

Offer a better formulary plan/Drug formulary is too restrictive/difficult to understand 7.8% 6.0%

Make authorizations faster/easier/accessible online 6.1% 6.8%

Charge patients for missed appointments/Pay for “No Shows”/Hold patients

accountable/Offer outreach/Let patients know how important it is to keep appointments4.3% 3.0%

Improve customer service/ Faster response to problems/ Need more knowledgeable,

helpful customer service representatives/ Train representatives better4.3% -%

Offer better coverage (Not specific) 3.5% 0.8%

Offer more pediatric specialists 3.5% -%

Nothing 37.4% 35.3%




Top Mentions


What recommendations for improvements do you have for AMERIGROUP Community Care? (Q31)

Glossary of Terms

71



▪ Attributes are the questions that relate to a specific service area or composite.

▪ Complete and Valid Survey is determined by indication that the member meets the eligible population criteria (the Provider participates

in the specific MCO) and completion of the survey.

▪ Composite Measures are derived by combining the survey results of similar questions that represent an overall aspect of health plan

quality. Specifically, it’s the average of each response category of the attributes that comprise a particular service area or composite.

▪ Confidence Level is the degree of confidence, expressed as a percentage, that a reported number’s true value is between the lower and

upper specified range.

▪ Correlation Coefficient is a statistical measure of how closely two variables or measures are related to each other.

▪ Disposition Code is the final status given to a Provider record within the sample surveyed. 0=Complete, 1=Does Not Meet Eligible

Population Criteria, 2=Incomplete (but Eligible), 3=Language Barrier, 4=Physically or Mentally Incapacitated, 5=Deceased, 6=Refusal,

7=Non-Response After Maximum Attempts, 8=Added to Do Not Call List.

▪ Driving strengths are areas that, based on correlation analysis, are of high importance to Providers where HealthChoice MCOs perform

well.

▪ Key Drivers are composite measures that have been found to impact ratings of overall satisfaction (Q25) among HealthChoice MCO

PCPs.

▪ Question Summaries show the proportion of adult members that fall into each response category for all survey questions.

▪ Segmentation Analysis show results for overall ratings, composite measures and their attributes cross-tabulated by several key

demographic questions.

▪ Significance Test is a test used to determine the probability that a given result could not have occurred by chance.

▪ Summary Rates generally represent the most favorable responses for a particular question (e.g., Excellent and Very Good; Definitely

Yes and Probably Yes; Very Satisfied and Somewhat Satisfied). Keep in mind that a Summary Rate is not assigned to every question.

▪ Trending is the practice of examining several years of data in a comparative way to identify common attributes.

▪ Unmet needs are areas that, based on correlation analysis, are most important to Providers and where improvement is needed.

Glossary of Terms

Survey Tool

73


AMERIGROUP Community Care ProviderSurvey Tool

74


AMERIGROUP Community Care ProviderSurvey Tool (continued)