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 more than 5 unique visits and paid claims with a date of service between 5/1/07 and 5/31/08, 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 |
80.2% |
N/A |
N/A |
N/A |
| PCPs Only-Receipt of Appropriate Documentation received from Hospitals |
82.8% |
N/A |
N/A |
N/A |
| PCPs Only-Receipt of Appropriate Documentation received from Skilled Nursing Facilities |
68.5% |
N/A |
N/A |
N/A |
| PCPs Only-Receipt of Appropriate Documentation received from Home Health Agencies |
93.1% |
N/A |
N/A |
N/A |
| Gateway Representative and Communication |
| Professionalism and Courtesy of your Gateway Provider Relations Representative |
97.3% |
90.6% |
100% |
93.7% |
| Timeliness of the Gateway Provider Relations Representative when responding to inquiries |
94.4% |
86.9% |
76.5% |
87.4% |
| Knowledge of the Provider Relations Representative regarding Gateway’s Policies and Procedures |
95.8% |
89.3% |
88.2% |
88.1% |
| Your Overall Satisfaction with the Quality of Service from your Gateway Provider Relations Representative |
94.2% |
87.8% |
94.1% |
88.9% |
| Quality of Written Communications, Policy Bulletins, and Manuals |
91.5% |
90.9% |
87.5% |
83.1% |
| Do you find written communications useful? |
98.0% |
90.8% |
100% |
86.9% |
| Provider Servicing and Claims |
| Consistency of Provider Servicing Representatives’ answers to inquiries. |
90.2% |
87.2% |
76.5% |
86.6% |
| Knowledge of the Provider Servicing Representative regarding Gateway’s Policies and Procedures. |
94.1% |
88.7% |
77.8% |
85.9% |
| The Professionalism and Courtesy of the Provider Servicing Representative |
95.2% |
93.0% |
94.4% |
91.8% |
| Timeliness of Provider Servicing Staff when Responding to Inquiries |
89.7% |
86.1% |
82.4% |
84.3% |
| Your Satisfaction with Clean Claims being Processed Consistently |
84.4% |
86.6% |
68.6% |
85.3% |
| Your Satisfaction with Clean Claims being Paid in a Timely Manner |
86.9% |
90.5% |
73.3% |
84.1% |
| Your Overall Satisfaction with the Claims Review Process |
82.4% |
84.5% |
70.6% |
70.8% |
| Utilization Management |
| Your Knowledge of which Services Require an Authorization |
93.3% |
87.5% |
93.3% |
82.8% |
| Timeliness of UM Staff when Responding to Inquiries |
90.4% |
89.7% |
85.7% |
85.1% |
| UM Staff’s Clinical Knowledge |
94.0% |
90.6% |
92.3% |
87.8% |
| UM Staff’s Consistency in the Authorization Process |
93.3% |
91.8% |
93.3% |
84.6% |
| Medical Appropriateness of Gateway’s Physician Reviewer Decisions |
78.6% |
84.5% |
69.2% |
75.5% |
| Professionalism/Courtesy of the UM Staff Representative |
96.4% |
95.6% |
100% |
92.7% |
| Your Overall Satisfaction with the UM Process |
93.3% |
90.7% |
100% |
86.4% |
| Pharmacy Authorization Process, Staff, and Drug Formulary |
| When Calling Gateway’s Pharmacy Department, Pharmacy Staff’s Professionalism and Courtesy |
94.9% |
93.7% |
100% |
100% |
| When Calling Gateway’s Pharmacy Department, Pharmacy Staff’s Consistency in Responses Regarding Formulary Procedures |
93.8% |
89.3% |
100% |
96.0% |
| When Calling Gateway’s Pharmacy Department, Pharmacy Staff’s Timeliness when Responding to Inquiries |
89.5% |
90.1% |
100% |
100% |
| Your Understanding of the Gateway Pharmacy Authorization Process |
92.2% |
87.0% |
100% |
80.8% |
| Your Overall Satisfaction with the Gateway Pharmacy Authorization Process |
79.0% |
86.0% |
100% |
90.9% |
| Ease of Using Gateway’s Web-based and Personal Digital Assistant (PDA) Drug Formulary |
80.3% |
90.4% |
0% |
84.2% |
| Variety of Drugs Available on Gateway’s Drug Formulary |
58.6% |
67.3% |
50.0% |
73.9% |
| Disease Management |
| Practice Benefits from the Asthma Disease Management Program |
84.3% |
69.0% |
N/A |
N/A |
| Practice Benefits from the Diabetes Disease Management Program |
86.3% |
82.3% |
N/A |
N/A |
| Practice Benefits from the Cardiac Disease Management Program |
84.5% |
77.8% |
N/A |
N/A |
| Practice Benefits from the MOM MattersSM High Risk Maternity Program |
76.7% |
72.1% |
N/A |
N/A |
| Practice Benefits from the Complex Case Management Program |
90.9% |
81.8% |
N/A |
N/A |
| Hours of Availability |
| Provider Relations Hours of Operation Meet Practice Needs |
95.0% |
96.2% |
93.8% |
94.6% |
| Provider Services Hours of Operation Meet Practice Needs |
94.7% |
97.1% |
94.1% |
94.2% |
| Utilization Management Hours of Operation Meet Practice Needs |
93.1% |
96.6% |
100% |
93.5% |
| Pharmacy Department Hours of Operation Meet Practice Needs |
89.9% |
95.0% |
66.7% |
94.4% |
| Overall Satisfaction and Loyalty |
| Consistency Across all Departments at Gateway |
99.0% |
97.6% |
92.3% |
97.5% |
| Would you Recommend Gateway Health Plan® to other Physicians’ Practices |
86.7% |
88.0% |
N/A |
N/A |
| Overall Satisfaction with Gateway Health Plan®? |
81.6% |
87.8% |
80.0% |
83.7% |