The population sampled included primary care practitioners with a panel size of
100 members or greater. The
specialty care practitioners sample included high-volume specialists with at
least 5 unique member visits and paid claims with a date of service between
5/1/09 and 5/31/10. 100 % of the
hospital network and a remaining sample of ancillary providers were also
surveyed.
The below percentages are Summary Rate Scores based on the two most favorable
response options:
| Question |
2010
PCP |
2010
SCP |
2010
Hospital |
2010
Ancillary |
| Continuity and Coordination of Care |
| PCPs Only-Receipt of Appropriate Documentation received from Specialty Care Practitioners |
83.9% |
N/A |
N/A |
N/A |
| PCPs Only-Receipt of Appropriate Documentation received from Hospitals |
87.3% |
N/A |
N/A |
N/A |
| PCPs Only-Receipt of Appropriate Documentation received from Skilled Nursing Facilities |
70.2% |
N/A |
N/A |
N/A |
| PCPs Only-Receipt of Appropriate Documentation received from Home Health Agencies |
95.3% |
N/A |
N/A |
N/A |
| Gateway Representative and Communication |
| Professionalism and Courtesy of your Gateway Provider Relations Representative |
95.5% |
90.9% |
80.0% |
88.5% |
| Timeliness of the Gateway Provider Relations Representative when responding to inquiries |
94.0% |
88.3% |
90.0% |
86.3% |
| Knowledge of the Provider Relations Representative regarding Gateway’s Policies and Procedures |
96.1% |
90.6% |
85.0% |
85.7% |
| Your Overall Satisfaction with the Quality of Service from your Gateway Provider Relations Representative |
94.2% |
88.8% |
90.0% |
81.2% |
| Quality of Written Communications, Policy Bulletins, and Manuals |
96.2% |
89.5% |
94.4% |
84.8% |
| Do you find written communications useful? |
92.1% |
93.3% |
73.3% |
93.4% |
| Provider Services and Claims |
| Consistency of Provider Services Representatives’ Answers to Inquiries |
95.8% |
88.2% |
82.4% |
84.4% |
| The Knowledge of the Provider Services Representative regarding Gateway’s Policies and Procedures |
95.8% |
87.9% |
83.3% |
84.6% |
| The Professionalism and Courtesy of the Provider Servicing Representative |
95.9% |
89.4% |
88.9% |
86.3% |
| Timeliness of Provider Servicing Staff when Responding to Inquiries |
95.2% |
85.9% |
77.8% |
83.9% |
| Your Satisfaction with Clean Claims being Processed Consistently |
90.7% |
86.8% |
73.3% |
79.4% |
| Your Satisfaction with Clean Claims being Paid in a Timely Manner |
92.0% |
90.3% |
85.7% |
81.5% |
| Your Overall Satisfaction with the Claims Review Process |
87.6% |
79.1% |
64.7% |
70.1% |
| Utilization Management |
| Your Knowledge of which Services Require an Authorization |
94.8% |
86.0% |
100.0% |
80.7% |
| Timeliness of UM Staff when Responding to Inquiries |
90.1% |
89.1% |
78.6% |
86.2% |
| UM Staff’s Clinical Knowledge |
94.0% |
89.7% |
92.3% |
89.3% |
| UM Staff’s Consistency in the Authorization Process |
90.8% |
89.3% |
84.6% |
87.3% |
| Medical Appropriateness of Gateway’s Physician Reviewer Decisions |
85.2% |
80.9% |
72.7% |
88.5% |
| Professionalism/Courtesy of the UM Staff Representative |
94.7% |
93.1% |
83.3% |
90.8% |
| Your Overall Satisfaction with the UM Process |
91.2% |
88.1% |
75.0% |
89.3% |
| Your Knowledge of which Services Require a Referral |
96.8% |
87.6% |
91.7% |
74.8% |
| The Ease of Use/Completion of the Paper Referral Form |
95.2% |
83.6% |
N/A |
N/A |
| Pharmacy Authorization Process, Staff, and Drug Formulary |
| When Calling Gateway’s Pharmacy Department, Pharmacy Staff’s Professionalism and Courtesy |
89.7% |
93.1% |
100% |
90.0% |
| When Calling Gateway’s Pharmacy Department, Pharmacy Staff’s Consistency in Responses Regarding Formulary Procedures |
90.5% |
89.2% |
0.0% |
85.0% |
| When Calling Gateway’s Pharmacy Department, Pharmacy Staff’s Timeliness when Responding to Inquiries |
88.6% |
91.0% |
0.0% |
85.0% |
| Your Understanding of the Gateway Pharmacy Authorization Process |
92.8% |
85.0% |
0.0% |
85.7% |
| Your Overall Satisfaction with the Gateway Pharmacy Authorization Process |
85.6% |
86.6% |
100% |
90.0% |
| Ease of Using Gateway’s Web-based and Personal Digital Assistant (PDA) Drug Formulary |
83.8% |
79.6% |
0.0% |
90.0% |
| Variety of Drugs Available on Gateway’s Drug Formulary |
74.5% |
67.2% |
50.0% |
61.1% |
| Disease Management |
| Practice Benefits from the Asthma Disease Management Program |
83.0% |
54.5% |
N/A |
N/A |
| Practice Benefits from the Diabetes Disease Management Program |
87.2% |
76.9% |
N/A |
N/A |
| Practice Benefits from the Cardiac Disease Management Program |
82.5% |
86.4% |
N/A |
N/A |
| Practice Benefits from the MOM MattersSM High Risk Maternity Program |
81.4% |
87.0% |
N/A |
N/A |
| Practice Benefits from the Complex Case Management Program |
86.7% |
65.0% |
N/A |
N/A |
| EPSDT Services |
| If you Conduct EPSDT Screens in your Office, Your Overall Satisfaction with the EPSDT Screening Program |
83.5% |
N/A |
N/A |
N/A |
| Accessibility |
| Routine Appointments Scheduled in less than 10 Business Days |
72.3% |
71.1% |
N/A |
N/A |
| Urgent Care Appointments Scheduled within 24 Hours |
98.1% |
74.6% |
N/A |
N/A |
| Wait Time in the Waiting Room no Longer than 30 Minutes |
65.8% |
62.5% |
N/A |
N/A |
| Hours of Availability |
| Provider Relations Hours of Operation Meet Practice Needs |
95.3% |
95.9% |
88.9% |
86.9% |
| Provider Services Hours of Operation Meet Practice Needs |
92.4% |
97.0% |
94.4% |
93.8% |
| Utilization Management Hours of Operation Meet Practice Needs |
93.5% |
95.6% |
77.8% |
93.8% |
| Pharmacy Department Hours of Operation Meet Practice Needs |
92.5% |
96.4% |
100% |
89.5% |
| Overall Satisfaction and Loyalty |
| Consistency Across all Departments at Gateway |
96.6% |
96.7% |
80.0% |
94.8% |
| Would you Recommend Gateway Health Plan® to other Physicians’ Practices |
95.4% |
92.4% |
N/A |
N/A |
| Overall Satisfaction with Gateway Health Plan® |
93.8% |
86.2% |
87.5% |
83.2% |