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Background
CHA Health, like other progressive managed care organizations, has a program in place to assess provider satisfaction with the service they receive from the organization. Providers included in this research include PCPs and specialists. This information will be used in CHA Health's quality improvement efforts. In addition, this information will provide rational direction for those efforts.
Additionally, CHA Health began administration of a physician satisfaction survey to satisfy the NCQA requirement (UM10 -- satisfaction with the utilization management process). The utilization management process is one component of the survey. Other programs and services related to physician satisfaction with the plan to be addressed include administration, medical policy, clinical quality management, compensation, and communication.
Executive Summary
CHA Health is perceived more favorably than the National Average. Most providers (90.1%) report that they are either very satisfied or satisfied with CHA Health, compared to the National Average of 73.7%. Satisfaction with CHA Health remained high from 2001 to 2002, a significant improvement over 1999 ratings. Furthermore, an impressive 94.5% of providers see their relationship with CHA Health continuing on a long-term basis, significantly higher than the National Average of 87.6%. Such high satisfaction levels result in the increased loyalty of CHA Health providers, who are significantly more likely than the National Average to recommend CHA Health to both patients and other physicians, as well as, to agree with the statement CHA Health is committed to working in partnership with physicians to provide quality care. Specific areas of satisfaction include:
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Network Quality. All providers report high levels of satisfaction with CHA Health's network in terms of specialists, hospitals, and pharmacies. For the years 2001-2002, CHA Health has outperformed the National Average on three out of four network quality measures: quality of network specialists, number of network specialists, and availability of network pharmacies.
Policies. For 2001-2002, CHA providers have been significantly more satisfied than the National Average with their ability to provide input on policies/procedures, and also with CHA Health's communication of treatment policies.
Staff. For 2001-2002, providers have been significantly more satisfied than the National Average with CHA Health staff in the areas of nurse professionals and provider relations. One notable improvement in 2002 is satisfaction with medical directors, a significant increase over the National Average and the previous 2001 and 1999 years.
Processes. Overall satisfaction with both claims and utilization management processes has been significantly higher than the National Average since 1999. Almost half, 42.9% report that CHA Health's utilization management process has become much better or somewhat better in the last 12 months. One aspect of the claims reimbursement process, accuracy of claim payments, improved significantly in 2002 over the previous 2001 and 1999 years.
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Physicians report a significantly higher degree of plan loyalty than specialists. While CHA Health's 2002 average is significantly higher than the National Average for the following measures of loyalty, physician ratings were significantly higher than those of specialists:
Would Recommend CHA Health to patients who asked about which managed care plan to join. Significantly more physicians, 90.8%, agreed with this statement than specialists (81.0%).
Would Recommend CHA Health to a physician who was interested in contracting with a managed care plan. Significantly more physicians, 93.9%, agreed with this statement than specialists (84.8%).
Physicians are also significantly more likely (99.0%) than specialists (90.4%) to see their relationship with CHA Health continuing on a long-term basis.
Satisfaction differs for physicians and specialists on several issues. Specific areas of concern for specialists are policies/procedures, claims reimbursement, and issues related to the medical director. Specialist were significantly less likely (73.3%) than physicians (87.2%) to agree with the statement CHA Health has administrative policies and procedures that encourage quality care. Regarding the claims reimbursement process, specialists were significantly less satisfied (83.0%) than physicians (92.9%) with the timeliness of claim payments. Regarding the medical director, specialists were significantly less satisfied with accessibility and knowledge, which resulted in significantly lower overall satisfaction with the medical director (88.2% specialists, 98.1% physicians).
Demand exists for accessibility of information via the Internet. Providers report significantly higher demand than the National Average for the following services, saying they definitely would use:
- Member eligibility inquiry, 67.2% (specialists, 76.9%, is significantly higher than physicians, 55.6%)
- Benefit inquiry, 65.3% (specialists, 73.8%, is significantly higher than physicians, 54.7%)
- Claim status inquiry, 63.9% (specialists 70.8%, physicians 55.6%)
- Credentialing form submission, 58.5% (specialists, 70.3% is significantly higher than physicians, 44.4%)
Opportunity exists for CHA Health in the areas of claims reimbursement, policies/procedures, and customer service. Although CHA Health is outperforming the National Average on virtually all satisfaction measures, opportunity does exist for improved provider satisfaction. Over one-third (35.3%) of providers dissatisfied with CHA Health cite claims related issues as the reason for dissatisfaction:
- Poor reimbursements (23.5%)
- Claims not paid in a timely manner (11.8%)
- Almost one-fourth (23.6%) of providers reporting dissatisfaction with CHA Health name policy/procedure issues as the cause:
- Inflexible/restrictive policies and procedures (11.8%)
- Problems with referrals (5.9%)
- The pre-certification process (5.9%)
- Other provider concerns include: poor customer service (17.6%), poor coverage (5.9%), and patient care suffers (5.9%).
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