Provider Access to Care Audits
SPH Analytics conducts Provider Access Audits to ensure patients and members have appropriate access to care and providers are meeting health plan standards. For health plans, access to care can have a significant impact on the members’ overall satisfaction and loyalty to the plan. In fact, most states have requirements around member access to physicians. For providers, access to care also influences patient satisfaction and can have a serious impact on the patient’s quality of care and health outcomes. SPH offers two methods for gauging patient/member access to care.
1. Auditing Provider Offices
SPH measures access to care by directly contacting providers’ offices during regular operating hours. Professional phone agents contact the provider’s office to determine appointment availability for several appointment types based on the client’s provider access standards. In addition, a separate audit is conducted by contacting provider offices after operating hours. This audit evaluates after-hours protocol and captures information about the initial phone response (e.g., live person, recording or auto-attendant) and whether it includes information on how to contact a physician or what to do in an emergency situation. SPH provides in-depth reporting and optional provider- or office-level report cards, so health plans can follow up with providers who are not meeting standards and provider offices can make needed adjustments.2. Surveying Patients and Members
Another method SPH offers for measuring access to care is to survey the provider’s patients and/or the health plan’s members directly to determine their experience and perception of the providers’ appointment availability and after-hours care. The survey helps ensure that the provider is meeting the patients’ healthcare needs. In addition to measuring appointment wait times, this study can also determine if the patient or member has access to providers who meet their cultural and/or language needs and are located a reasonable distance from their homes. The survey is administered by phone and generally takes about five minutes to complete.