The population sampled included primary care practitioners with a panel size of 100 members or greater who have been participating with Gateway for at least one year. The specialty care practitioners sample included high-volume specialists with 5 or more referrals who have been with the plan for more than one year. 100% of the hospital network, and a remaining sample of ancillary providers were surveyed
| Question |
2008
PCP |
2008
SCP |
2008
Hospital |
2008
Ancillary |
| Continuity and Coordination of Care |
| PCPs Only-Receipt of Appropriate Documentation received from Specialty Care Practitioners |
82.4% |
N/A |
N/A |
N/A |
| PCPs Only-Receipt of Appropriate Documentation received from Hospitals |
82.3% |
N/A |
N/A |
N/A |
| PCPs Only-Receipt of Appropriate Documentation received from Skilled Nursing Facilities |
70.4% |
N/A |
N/A |
N/A |
| PCPs Only-Receipt of Appropriate Documentation received from Home Health Agencies |
94.8% |
N/A |
N/A |
N/A |
| Gateway Representative and Communication |
| Professionalism and Courtesy of your Gateway Provider Relations Representative |
98.7% |
88.4% |
100.0% |
91.0% |
| Timeliness of the Gateway Provider Relations Representative when responding to inquiries |
94.7% |
86.2% |
77.8% |
85.6% |
| Knowledge of the Provider Relations Representative regarding Gateway’s Policies and Procedures |
95.7% |
86.4% |
89.5% |
87.8% |
| Your Overall Satisfaction with the Quality of Service from your Gateway Provider Relations Representative |
95.4% |
88.0% |
88.9% |
87.9% |
| Quality of Written Communications, Policy Bulletins, and Manuals |
93.5% |
89.6% |
94.1% |
84.1% |
| Do you find written communications useful? |
97.2% |
90.5% |
91.7% |
87.6% |
| Provider Services and Claims |
| Consistency of Provider Services Representatives’ Answers to Inquiries |
90.9% |
84.9% |
88.9% |
85.1% |
| The Knowledge of the Provider Services Representative regarding Gateway’s Policies and Procedures |
93.1% |
87.6% |
84.2% |
83.9% |
| The Professionalism and Courtesy of the Provider Servicing Representative |
94.3% |
92.9% |
90.0% |
89.9% |
| Timeliness of Provider Servicing Staff when Responding to Inquiries |
89.4% |
84.5% |
88.9% |
82.1% |
| Your Satisfaction with Clean Claims being Processed Consistently |
86.2% |
82.6% |
82.4% |
81.3% |
| Your Satisfaction with Clean Claims being Paid in a Timely Manner |
87.7% |
85.5% |
82.4% |
80.7% |
| Your Overall Satisfaction with the Claims Review Process |
83.7% |
79.9% |
70.6% |
66.7% |
| Utilization Management |
| Your Knowledge of which Services Require an Authorization |
94.8% |
86.9% |
94.1% |
84.0% |
| Timeliness of UM Staff when Responding to Inquiries |
92.6% |
88.5% |
81.3% |
84.1% |
| UM Staff’s Clinical Knowledge |
91.7% |
89.7% |
93.8% |
91.1% |
| UM Staff’s Consistency in the Authorization Process |
92.0% |
89.9% |
94.1% |
81.8% |
| Medical Appropriateness of Gateway’s Physician Reviewer Decisions |
81.0% |
82.6% |
50.0% |
71.6% |
| Professionalism/Courtesy of the UM Staff Representative |
96.1% |
93.4% |
100.0% |
92.4% |
| Your Overall Satisfaction with the UM Process |
92.0% |
87.7% |
93.8% |
82.6% |
| Your Knowledge of which Services Require a Referral |
96.1% |
86.6% |
83.3% |
77.3% |
| The Ease of Use/Completion of the Paper Referral Form |
93.0% |
83.2% |
N/A |
N/A |
| Pharmacy Authorization Process, Staff, and Drug Formulary |
| When Calling Gateway’s Pharmacy Department, Pharmacy Staff’s Professionalism and Courtesy |
92.1% |
93.3% |
100% |
100.0% |
| When Calling Gateway’s Pharmacy Department, Pharmacy Staff’s Consistency in Responses Regarding Formulary Procedures |
89.4% |
87.9% |
100.0% |
93.1% |
| When Calling Gateway’s Pharmacy Department, Pharmacy Staff’s Timeliness when Responding to Inquiries |
89.7% |
88.6% |
100.0% |
96.9% |
| Your Understanding of the Gateway Pharmacy Authorization Process |
93.2% |
85.5% |
100.0% |
82.1% |
| Your Overall Satisfaction with the Gateway Pharmacy Authorization Process |
81.5% |
84.7% |
100.0% |
90.3% |
| Ease of Using Gateway’s Web-based and Personal Digital Assistant (PDA) Drug Formulary |
79.0% |
90.1% |
0.0% |
82.4% |
| Variety of Drugs Available on Gateway’s Drug Formulary |
61.8% |
68.4% |
50.0% |
68.2% |
| Disease Management |
| Practice Benefits from the Asthma Disease Management Program |
85.8% |
78.1% |
N/A |
N/A |
| Practice Benefits from the Diabetes Disease Management Program |
84.9% |
86.8% |
N/A |
N/A |
| Practice Benefits from the Cardiac Disease Management Program |
83.5% |
75.7% |
N/A |
N/A |
| Practice Benefits from the MOM MattersSM High Risk Maternity Program |
82.9% |
73.2% |
N/A |
N/A |
| Practice Benefits from the Complex Case Management Program |
89.7% |
85.2% |
N/A |
N/A |
| EPSDT Services |
| If you Conduct EPSDT Screens in your Office, Your Overall Satisfaction with the EPSDT Screening Program |
86.0% |
75.0% |
N/A |
N/A |
| Accessibility |
| Routine Appointments Scheduled in less than 10 Business Days |
69.1% |
69.1% |
N/A |
N/A |
| Urgent Care Appointments Scheduled within 24 Hours |
98.7% |
82.9% |
N/A |
N/A |
| Wait Time in the Waiting Room no Longer than 15 Minutes |
56.0% |
50.9% |
N/A |
N/A |
| Hours of Availability |
| Provider Relations Hours of Operation Meet Practice Needs |
95.8% |
94.2% |
94.1% |
93.4% |
| Provider Services Hours of Operation Meet Practice Needs |
92.6% |
97.0% |
95.0% |
94.9% |
| Utilization Management Hours of Operation Meet Practice Needs |
94.5% |
95.5% |
100% |
94.2% |
| Pharmacy Department Hours of Operation Meet Practice Needs |
89.7% |
94.9% |
100% |
84.2% |
| Overall Satisfaction and Loyalty |
| Consistency Across all Departments at Gateway |
98.0% |
96.8% |
93.3% |
96.3% |
| Would you Recommend Gateway Health Plan® to other Physicians’ Practices |
86.7% |
88.0% |
N/A |
N/A |
| Overall Satisfaction with Gateway Health Plan® |
89.5% |
84.5% |
93.8% |
85.4% |