MEMBER SATISFACTION

Working With Provider Groups to Improve Service

Perhaps one of the most difficult situations to face a plan occurs when a major provider group fails to perform to plan expectations. Some plans take the path of avoidance and procrastination until the situation becomes intolerable. This plan's staff tackled the situation head-on, providing the medical group with resources and assistance and monitoring progress along the way.

Through 1994 survey data and member calls, this health plans' staff observed that nearly a third of the total health plan complaints resulted from member interaction with a specific medical group. This group, with eight clinic locations throughout the service area, was very important to the plan because it provided primary care services for 11.5% of the total health plan population.

Service data indicated widespread dissatisfaction among members regarding referrals, wait times, and provider communication.

The plan needed to act quickly to reduce complaint volume for this medical group and to improve member satisfaction.

The target population consisted of all plan members who received care from the identified medical group. The plan selected two performance measures.

The first measure was the percentage of all complaints that originated with the identified medical group versus the health plan member complaints. The plan's research into its member services database helped identify a baseline of 32% for calendar year 1994.

The second measure selected was the percentage of patients indicating overall satisfaction with the group on a member satisfaction survey. During each predetermined survey period, a patient satisfaction survey was distributed to all patients following their visit to one of the eight clinics operated by the medical group. The 1994 survey data showed that only 52% of members were satisfied with the medical group.

Benchmarks for these measures were not established. The plan identified two performance goals: a decrease in complaint volume for this specific provider group to <10% of all plan complaints, and a 95% member satisfaction rate with the group.

The plan addressed the identified barriers to good service with a number of strong actions. Initially, plan staff worked with the group to subcontract referral management to an IPA until the medical group's capabilities to manage referrals were improved.

The health plan provided customer service training for the clinic staff. An appointment system was initiated to replace the walk-in system, and the patient check-in system was automated.

Further, the health plan assisted the medical group with recruitment of a new president and medical director. In addition, the plan suggested that the medical group hire more clinic staff and full-time physicians to assist with managing the patient volume of the group.

The first remeasurement, based on 1995 data, documented a complaint volume of 16% for the medical group - half what it was in 1994. Member satisfaction for the medical group increased to 73%. These significant improvements seemed to indicate that the interventions were beginning to produce results.

However, several problems remained. A new barrier analysis revealed that although the complaint level had declined, performance was still being hindered by:

• Lack of medical director leadership
• Referral delays from the IPA managing the group's referrals
• Long wait times

As a result of the analysis, the health plan decided that its top priority was to work more aggressively with the medical group to identify a medical director for the open position.

LEADERSHIP Just as efforts to produce a meaningful improvement in care require a clinical champion, efforts to produce a meaningful improvement in service require leadership. Without adequate medical director support and supervision, it was difficult to implement changes in clinic work flow and practitioner scheduling.

The plan completed the education and work flow improvements needed to return the referral management process back to the medical group. In addition, the plan worked with the medical group to improve wait times by implementing a quality action team. This team was responsible for:

• Restructuring physician coverage to improve access
• Creating physician/nurse care teams to reduce reception and exam room wait times
• Installing a separate prescription drug telephone line to improve access
• Assigning accountability for functions such as check-in to specific staff
• Improving record-keeping procedures

The second remeasurement, based on 1996 data, showed that this group accounted for 9% of total health plan complaints. This significant improvement met the health plan's performance goal. The plan reported an 82% member satisfaction rate with the provider group. This represented a significant improvement, but was still short of the performance goal.

Although referral management responsibility was returned to the medical group, improvement to the process was needed. The health plan worked with the group to place a full-time referral clerk at each clinic site. This clerk was responsible for assuring that referrals were appropriately reviewed and either approved or denied within a prescribed time frame. An incentive system was developed to reward physicians for fully completing a referral form at the time of initial submission.

Wait times at each clinic were monitored and reported monthly, with immediate corrective action plans implemented as needed.

This plan has demonstrated excellent use of complaint and satisfaction data to identify delivery system problems. Its strong interventions have had a significant impact on member satisfaction.