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Drivers of Patient Experience in Medicaid Managed Care
November 30, 2016

Drivers of Patient Experience in Medicaid Managed Care

Though they may not directly provide patient care for their members, managed care organizations (MCOs) play a substantial role in the patient experience of millions of Medicaid enrollees.
Patient-Centered Provider Training
Provider training is essential to the success of any patient experience endeavor, and is particularly important when providers join Medicaid managed care networks for the first time and may not intuitively understand the complex factors affecting the health of enrollee populations. For instance, L.A. Care Health Plan—the country’s largest publicly operated health plan—conducts new provider orientation and offers ongoing training to educate providers on topics such as cultural and linguistic sensitivity, the social determinants of health, and emerging best practices in patient-centered care.

According to L.A. Care CEO John Baackes, focusing on patient satisfaction isn’t just the right thing to do—it’s a business imperative. When ACA provisions expanded Medicaid eligibility, the plan welcomed hundreds of thousands of new members. In order to quickly enhance its provider network without sacrificing customer satisfaction, L.A. Care made a strategic and enduring commitment to ensure each provider is properly trained and equipped to meet the specific needs of the plan’s diverse patient populations. In 2015, L.A. Care Health Plan offered more than 50 practice-based continuing medical education opportunities to help its network of providers stay on the cutting edge of population health management.

For-profit MCOs face the same challenges as publicly operated plans when it comes to maintaining high patient satisfaction while expanding provider networks to meet demand. For example, Molina Healthcare, Inc.—a Fortune 500 company with managed care contracts in 11 states and Puerto Rico—saw a 35% year-over-year increase in membership in 2015, prompting numerous new acquisitions to enhance the company’s provider networks. Incredibly, data from the National Committee for Quality Assurance (NCQA) suggests even with this explosive growth the company has kept pace with—and even exceeded—its previous patient satisfaction ratings. In order to achieve this, Mary Syiek, Molina's senior vice president for Provider and Member Engagement and Operations, led her team to develop numerous region-specific provider training programs to address the unique geographic, cultural, linguistic and other factors affecting each plan's membership. Molina conducts rigorous training for new providers, and offers robust ongoing patient-centered training to ensure providers develop and exhibit cultural competency, make high-quality care more accessible and understand what's most important to Molina's members.

Actionable, Provider-Specific Patient Satisfaction Data
To develop viable patient experience improvement initiatives, MCO leaders need timely, provider-specific patient satisfaction data, and many have developed new methodologies to obtain it. For example, Molina Healthcare has implemented an internal provider scorecard based in part on a proprietary post-appointment survey enrollees can complete through an online member portal. Survey questions are designed to approximate broader quality and performance standards such as those measured by the Healthcare Effectiveness Data and Information Set (HEDIS) produced by NCQA and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey administered by the US Agency for Healthcare Research and Quality.

According to Syiek, the information from these internal surveys is analyzed and shared with the provider to collaboratively identify specific opportunities for improvement. In addition, larger providers in Molina’s network may have adequate sample sizes to receive external scorecards based on their patients’ responses to CAHPS questionnaires. Syiek says the combination of these internal and external patient satisfaction metrics offer a realistic indication of how each provider in Molina’s networks is viewed by enrollees.

L.A. Care Health Plan also implemented an internal system for evaluating patient satisfaction across its network of 28 independent practice associations (IPAs). By gathering CAHPS survey results, HEDIS measures and access and availability metrics, then combining those with internal measures on utilization and timeliness of data submission, L.A. Care has instituted a provider rating system that Baackes says is nothing short of groundbreaking. The ratings are not consumer-oriented, and are issued to L.A. Care’s 28 participating IPAs as a ranked list from first to 28th. The list is blinded, meaning each IPA can see the percentile and rank it attained on each measure but the other 27 provider organizations are anonymized.

“We’re not just doing it for the scores,” Baackes explained. “To improve the scores, they’ll have to take actions that improve their patient services and outcomes.” Baackes and his team hope the program helps providers in L.A. Care’s network “focus their resources to move the needle significantly on a few discrete items,” using these specific, actionable data sets as a road map.



 
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