There were two satisfaction surveys conducted in 2007 for Medicare providers. One survey was conducted in the Spring and the second survey was conducted in the Fall of 2007. The survey population included PCPs with a panel greater than 100, high-volume Specialists including Obstetrics and Gynecology, Cardiology, Ophthalmology, Orthopedics, Otolaryngology, Podiatry and Surgery with more than 5 unique visits and paid claims and Hospital/Ancillary providers. Results are as follows:
| Question |
2007(1)
PCP |
2007(2)
PCP |
2007(1)
SCP |
2007(2)
SCP |
2007(1)
Hospital/
Ancillary |
2007(2)
Hospital/
Ancillary |
| Gateway Representative and Communication |
| Professionalism and courtesy of your Gateway Representative |
93.3% |
94.1% |
89.6% |
84.5% |
87.7% |
87.6% |
| Timeliness of the Gateway Representative when responding to inquiries |
91.2% |
86.3% |
83.6% |
83.3% |
81.5% |
88.4% |
| Knowledge of the Representative regarding Gateway’s Policies and Procedures |
94.4% |
95.9% |
89.3% |
85.5% |
84.0% |
88.3% |
| Your Overall satisfaction with the quality of service from your Gateway Representative |
92.2% |
88.5% |
86.7% |
84.6% |
82.6% |
88.2% |
| Quality of written communications, policy bulletins and manuals received from Gateway. |
94.1% |
96.1% |
90.2% |
87.0% |
83.3% |
84.5% |
| When calling your Provider Relations Representative, the hours of availability meet your practice’s needs. |
94.6% |
90.3% |
95.1% |
92.9% |
94.2% |
95.4% |
| Provider Servicing and Claims |
| Consistency of Provider Servicing Representatives’ answers to inquiries. |
94.8% |
89.9% |
85.8% |
79.3% |
83.5% |
81.4% |
| Knowledge of the Provider Servicing Representative regarding Gateway’s policies and procedures. |
93.0% |
96.8% |
87.8% |
84.0% |
83.1% |
84.2% |
| Professionalism and courtesy of the Provider Servicing Representative. |
96.5% |
95.8% |
92.1% |
89.8% |
92.7% |
89.8% |
| Timeliness of Provider Servicing Staff when responding to inquiries. |
87.7% |
90.6% |
87.0% |
81.5% |
83.3% |
86.0% |
| Your satisfaction with clean claims being processed consistently. |
86.7% |
89.0% |
80.6% |
83.0% |
78.9% |
83.3% |
| Your satisfaction with clean claims being paid in a timely manner. |
88.8% |
89.9% |
80.5% |
83.8% |
83.7% |
83.0% |
| Your overall satisfaction with the claims review process. |
80.0% |
78.4% |
77.5% |
79.7% |
75.7% |
80.5% |
| When calling the Provider Services Department, the hours of availability meet your practice’s needs. |
98.2% |
94.5% |
96.4% |
94.8% |
94.3% |
94.5% |
| Utilization Management |
| Your knowledge of which services require an authorization. |
89.1% |
90.3% |
87.3% |
84.4% |
83.6% |
86.4% |
| Your knowledge of how to obtain an authorization for a Gateway member. |
N/A |
N/A |
N/A |
N/A |
88.3% |
89.8% |
| Timeliness of UM staff when responding to inquiries. |
86.4% |
89.8% |
88.6% |
89.3% |
82.2% |
86.5% |
| UM staff’s clinical knowledge. |
88.6% |
91.8% |
91.0% |
92.2% |
86.7% |
88.3% |
| UM staff’s consistency in the authorization process. |
87.9% |
85.0% |
91.5% |
91.1% |
87.1% |
85.8% |
| Medical appropriateness of Gateway’s physician reviewer decisions. |
81.1% |
73.7% |
82.3% |
85.0% |
82.0% |
84.5% |
| Professionalism/courtesy of the UM staff representative. |
93.1% |
90.1% |
95.1% |
94.3% |
92.2% |
95.5% |
| Your overall satisfaction with the UM process. |
88.7% |
84.7% |
89.0% |
90.0% |
86.8% |
88.8% |
| When calling the Utilization Management Department, the hours of availability meet your practice’s needs. |
95.7% |
92.6% |
96.5% |
94.2% |
92.0% |
96.0% |
| Pharmacy Authorization Process, Staff, and Drug Formulary |
| When calling Gateway’s Pharmacy Department, Pharmacy staff’s professionalism and courtesy. |
89.1% |
91.0% |
90.3% |
87.5% |
88.9% |
92.0% |
| When calling Gateway’s Pharmacy Department, Pharmacy staff’s consistency in responses regarding formulary procedures. |
88.1% |
88.9% |
87.5% |
91.0% |
88.5% |
65.6% |
| When calling Gateway’s Pharmacy Department, Pharmacy staff’s timeliness when responding to inquiries. |
83.2% |
87.5% |
86.8% |
85.0% |
84.6% |
84.0% |
| Your understanding of the Gateway pharmacy authorization process. |
86.4% |
88.0% |
83.9% |
75.2% |
81.5% |
80.0% |
| Your overall satisfaction with the Gateway pharmacy authorization process. |
78.6% |
78.2% |
80.4% |
77.9% |
80.8% |
72.7% |
| Ease of using Gateway’s Web-based and Personal Digital Assistant (PDA) Drug Formulary. |
86.4% |
75.0% |
73.6% |
87.0% |
78.9% |
88.9% |
| Variety of drugs available on Gateway’s Drug Formulary. |
63.6% |
63.8% |
59.0% |
62.1% |
53.8% |
66.7% |
| When calling the Pharmacy Department, the hours of availability meet our practice’s needs. |
97.1% |
94.1% |
90.7% |
94.9% |
90.9% |
84.0% |
| Disease Management |
| If your patients have utilized the Asthma Disease Management Program, do you feel your patients benefit from the program? |
97.0% |
N/A |
84.3% |
N/A |
N/A |
N/A |
| If your patients have utilized the Asthma Disease Management Program, do you feel your practice benefits from the program? |
85.1% |
80.0% |
76.8% |
76.9% |
N/A |
N/A |
| If your patients have utilized the Diabetes Disease Management Program, do you feel your patients benefit from the program? |
97.1% |
N/A |
89.5% |
N/A |
N/A |
N/A |
| If your patients have utilized the Diabetes Disease Management Program, do you feel your practice benefits from the program? |
84.1% |
86.8% |
84.8% |
86.8% |
N/A |
N/A |
| If your patients have utilized the Cardiac Disease Management Program, do you feel your patients benefit from the program? |
97.9% |
N/A |
86.1% |
N/A |
N/A |
N/A |
| If your patients have utilized the Cardiac Disease Management Program, do you feel your practice benefits from the program? |
87.0% |
83.3% |
81.4% |
82.6% |
N/A |
N/A |
| If your patients have utilized the MOM MattersSM High Risk Maternity Program, do you feel your patients benefit from the program? |
100% |
N/A |
75.9% |
N/A |
N/A |
N/A |
| If your patients have utilized the MOM MattersSM High Risk Maternity Program, do you feel your practice benefits from the program? |
93.3% |
86.2% |
73.7% |
78.4% |
N/A |
N/A |
| Overall Satisfaction and Loyalty |
| Consistency across all departments at Gateway is: |
99.2% |
97.8% |
96.3% |
96.1% |
94.9% |
96.3% |
| Would you recommend Gateway Health Plan® to other physicians’ practices? |
87.1% |
90.0% |
87.3% |
87.2% |
N/A |
N/A |
| Overall satisfaction with Gateway Health Plan®? |
81.1% |
86.2% |
82.3% |
86.6% |
84.4% |
88.7% |
Gateway has set thresholds for results less than 75% to a proposed goal of 80% for 2008 as opposed to the 75% goal set for the initial 2007 survey. Those results between 75% and 92% will have a goal 5% higher than the current rate, unless the goal reaches or exceeds the upper threshold of 92%. Those results meeting or exceeding 92% will be placed in “maintenance”; if the results drop below the 92% threshold the above criteria will apply.
Opportunities and actions were developed after the first 2007(1) survey and those goals that did not meet the required goals during the 2007(2) survey remain as opportunities or actions.