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 5/1/08 and 5/31/09. 100 % of the hospital network and a remaining sample of ancillary providers were also surveyed.
Gateway will continue to strive toward meeting the needs of our practitioner and provider network. Action plans are developed to improve those areas with deficiencies to assure ongoing improvement.
| Question |
2009
PCP |
2009
SCP |
2009
Hospital |
2009
Ancillary |
| Continuity and Coordination of Care |
| PCPs Only-Receipt of Appropriate Documentation received from Specialty Care Practitioners |
83.5% |
N/A |
N/A |
N/A |
| PCPs Only-Receipt of Appropriate Documentation received from Hospitals |
87.5% |
N/A |
N/A |
N/A |
| PCPs Only-Receipt of Appropriate Documentation received from Skilled Nursing Facilities |
79.5% |
N/A |
N/A |
N/A |
| PCPs Only-Receipt of Appropriate Documentation received from Home Health Agencies |
93.6% |
N/A |
N/A |
N/A |
| Gateway Representative and Communication |
| Professionalism and Courtesy of your Gateway Provider Relations Representative |
95.2% |
91.9% |
82.2% |
90.8% |
| Timeliness of the Gateway Provider Relations Representative when responding to inquiries |
93.6% |
88.2% |
70.6% |
88.5% |
| Knowledge of the Provider Relations Representative regarding Gateway’s Policies and Procedures |
96.6% |
91.9% |
81.3% |
91.7% |
| Your Overall Satisfaction with the Quality of Service from your Gateway Provider Relations Representative |
95.9% |
87.8% |
82.4% |
89.5% |
| Quality of Written Communications, Policy Bulletins, and Manuals |
94.6% |
92.8% |
82.4% |
83.3% |
| Do you find written communications useful? |
92.2% |
91.6% |
100% |
89.8% |
| Provider Servicing and Claims |
| Consistency of Provider Servicing Representatives’ answers to inquiries. |
98.5% |
85.2% |
75.0% |
91.3% |
| Knowledge of the Provider Servicing Representative regarding Gateway’s Policies and Procedures. |
98.5% |
89.4% |
85.0% |
91.7% |
| The Professionalism and Courtesy of the Provider Servicing Representative |
95.5% |
91.8% |
90.0% |
94.3% |
| Timeliness of Provider Servicing Staff when Responding to Inquiries |
93.8% |
87.0% |
82.6% |
88.7% |
| Your Satisfaction with Clean Claims being Processed Consistently |
96.1% |
88.7% |
94.4% |
84.1% |
| Your Satisfaction with Clean Claims being Paid in a Timely Manner |
92.7% |
86.9% |
94.7% |
85.8% |
| Your Overall Satisfaction with the Claims Review Process |
89.4% |
83.5% |
90.0% |
82.0% |
| Utilization Management |
| Your Knowledge of which Services Require an Authorization |
95.4% |
91.8% |
90.9% |
85.7% |
| Timeliness of UM Staff when Responding to Inquiries |
89.0% |
89.4% |
87.0% |
88.9% |
| UM Staff’s Clinical Knowledge |
94.4% |
91.1% |
91.3% |
92.1% |
| UM Staff’s Consistency in the Authorization Process |
94.6% |
91.2% |
90.5% |
90.4% |
| Medical Appropriateness of Gateway’s Physician Reviewer Decisions |
87.5% |
82.1% |
66.7% |
88.1% |
| Professionalism/Courtesy of the UM Staff Representative |
97.1% |
93.5% |
91.3% |
93.7% |
| Your Overall Satisfaction with the UM Process |
93.0% |
88.0% |
78.3% |
92.7% |
| Pharmacy Authorization Process, Staff, and Drug Formulary |
| When Calling Gateway’s Pharmacy Department, Pharmacy Staff’s Professionalism and Courtesy |
96.1% |
90.9% |
100% |
96.0% |
| When Calling Gateway’s Pharmacy Department, Pharmacy Staff’s Consistency in Responses Regarding Formulary Procedures |
96.2% |
89.8% |
100% |
76.5% |
| When Calling Gateway’s Pharmacy Department, Pharmacy Staff’s Timeliness when Responding to Inquiries |
92.2% |
89.4% |
100% |
78.9% |
| Your Understanding of the Gateway Pharmacy Authorization Process |
94.6% |
85.8% |
100% |
78.3% |
| Your Overall Satisfaction with the Gateway Pharmacy Authorization Process |
87.6% |
85.3% |
100% |
82.6% |
| Ease of Using Gateway’s Web-based and Personal Digital Assistant (PDA) Drug Formulary |
87.3% |
88.0% |
0% |
81.3% |
| Variety of Drugs Available on Gateway’s Drug Formulary |
68.8% |
72.2% |
50.0% |
68.4% |
| Disease Management |
| Practice Benefits from the Asthma Disease Management Program |
87.6% |
65.2% |
N/A |
N/A |
| Practice Benefits from the Diabetes Disease Management Program |
89.9% |
67.7% |
N/A |
N/A |
| Practice Benefits from the Cardiac Disease Management Program |
87.6% |
80.4% |
N/A |
N/A |
| Practice Benefits from the MOM MattersSM High Risk Maternity Program |
86.5% |
79.7% |
N/A |
N/A |
| Practice Benefits from the Complex Case Management Program |
83.3% |
73.3% |
N/A |
N/A |
| Accessibility |
| Urgent Care Appointments Scheduled within 24 Hours |
93.8% |
77.8% |
N/A |
N/A |
| Wait Time in the Waiting Room no Longer than 15 Minutes |
64.9% |
55.7% |
N/A |
N/A |
| Hours of Availability |
| Provider Relations Hours of Operation Meet Practice Needs |
96.6% |
96.8% |
93.3% |
93.8% |
| Provider Services Hours of Operation Meet Practice Needs |
96.9% |
96.5% |
95.0% |
97.0% |
| Utilization Management Hours of Operation Meet Practice Needs |
94.2% |
96.1% |
100% |
93.3% |
| Pharmacy Department Hours of Operation Meet Practice Needs |
95.4% |
95.9% |
100% |
88.9% |
| Overall Satisfaction and Loyalty |
| Consistency Across all Departments at Gateway |
98.6% |
95.4% |
88.2% |
98.5% |
| Would you Recommend Gateway Health Plan® to other Physicians’ Practices |
92.0% |
89.6% |
N/A |
N/A |
| Overall Satisfaction with Gateway Health Plan®? |
93.8% |
90.0% |
77.8% |
86.4% |