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Network Adequacy September 12, 2014
HSPRE
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Network Adequacy Overview
Network Growth GEO Access Provider Relations Outreach and Strategies Mystery Shopper Results
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Network Counts 2012 2013 2014 As of Sept % of Change CMAP PCPs 2,914
2012 2013 2014 As of Sept % of Change CMAP PCPs 2,914 3,339 3,534 21.27% CMAP Specialists (MDs, APRNs, PAs etc.) 18,305 18,727 22,562 23.25% CMAP Specialists (Other-DME, Physical Therapists, Podiatrists etc.) 1,663 1,854 11.48% CMAP Network Totals 21,219 23,729 27,950 31.72% Attested Providers N/A 3,266 3,503 OPR Providers Enrolled 1,890 2,408 In-State OPR Providers Confirmed Enrolled * Includes border and out-of-state providers 420 (216 CMAP OPR Enrolled) 24 CMAP Enrolled
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Provider Relations Outreach Results Dis-enrolled Providers
2012 2013 2014 Dis-enrolled Providers Outreached N/A 3,135 272 Dis-enrolled Providers Enrolled 1,028 (33%) 63 (23%)
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In State Network: Open and Closed Panels
Specialties Number of Providers 2012 As of Sept 2014 Open Panels Percent of Open Panels PCP 2,914 3,513 3,423 97.4% OB/GYN 506 1,016 971 95.5% Cardiology 441 492 454 92.9% General Surgery 440 402 365 90.7% Orthopedics 314 400 330 82.5% Gastroenterology 53 269 209 77.6% Oncology 32 163 159 97.5% Urology 135 160 137 85.6% Dermatology 112 164 88 53.6% Neurology 252 235 88.9% Otolaryngology (ENT) 138 156 129 82.6% Endocrinology 37 128 101 78.9% Rheumatology 21 82 64 78%
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GEO Access Results-Open Panels Adult HUSKY Program-wide:
Open Panels Only HUSKY 15 miles 20 miles 25 miles PCPs 100% OB/GYNs Cardiology 99.6% Dermatology 94.5% 98.4% Endocrinology 94.8% 99.2% 99.7% ENT 99.4% General Surgery 99.8% Gastroenterology Oncology 97% Orthopedic 99.5% Rheumatology 95.9% 97.9% 99.1% Urology 98.7% 99.9%
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GEO Access Results-Open Panels Child HUSKY Program-wide:
Open Panels Only HUSKY 15 miles 20 miles 25 miles Pediatricians 100% OB/GYNs (Age 10 to 18) Cardiology 99.6% Dermatology 94.5% 98.4% Endocrinology 95.1% 99.3% 99.7% ENT 99.4% General Surgery 99.8% Gastroenterology 99.5% Oncology 96.9% Orthopedic Rheumatology 97% Urology 98.7%
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GEO Access Results-Open Panels HUSKY Adult by LOB
HUSKY C HUSKY D Provider Within 15 miles 20 miles 25 miles PCPs 100% OB/GYNs Cardiology 99.5% 99.6% Dermatology 94.1% 98.4% 95.3% 98.5% 94.4% 98.3% Endocrinology 94.6% 99.2% 99.7% 95.2% 99.3% 94.9% ENT General Surgery 99.8% Gastroenterology Oncology 96.6% 97.4% 97.1% Orthopedic 99.4% Rheumatology 95.4% 97.6% 99.1% 96.4% 98.1% 96.2% 98% Urology 98.8% 99.9 98.7% 99.9%
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GEO Access Results-Open Panels HUSKY Child by LOB
HUSKY A HUSKY B HUSKY C HUSKY D Provider Within 15 miles 20 miles 25 miles Pediatricians 100% OB/GYNs 99.8% Cardiology 99.6% 99.4% Dermatology 94.5% 98.4% 93.1% 91.8% 96.6% 95.5% 97.3% Endocrinology 95.1% 99.3% 93.8% 98.8% 95.9% 96.4% ENT 99.2% General Surgery 99.7% Gastroenterology 99.5% Oncology 96.9% 99.9% 99.1% Orthopedic Rheumatology 97% 98.9% 98.6% 98.2% Urology 97.8%
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Mystery Shopper Study The Mystery Shopper survey included the following areas for investigation: Appointment availability Appointment flexibility Effects of insurance coverage on appointment setting Courteousness of office personnel Study approach was to target high volume providers (FQHCs, PCMH, Community providers and Clinics).
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Mystery Shopper Study GreatBlue® conducted 500 completed telephone appointment attempts. The split was 70% Primary Care /30% Specialty calls for appointments. The breakdown of appointments: 125 Urgent Care-not an emergency condition-within 48 hours 142 Non Urgent Care (sick) conditions - 48 to 72 hours 133 Routine Preventive Primary Care conditions - 6 weeks 100 Initial Obstetrics and Gynecology/Prenatal conditions-within 1 week to 6 weeks
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Mystery Shopper Survey
Type of Appointment Condition Timeliness Targets Urgent Care (non-emergency) High fever, cough Within 48 hours Non-Urgent sick visit Sinus infection, sore throat 48 to 72 hours Routine Preventative Primary Care Well child visit, adult physical 6 weeks Pre-natal visit Prenatal OBGYN Routine OBGYN complaint Within 1 Week Initial or well visit 6 Weeks
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Mystery Shopper Results
Available appointment times… 2013 Composite 2014 Composite Something available 33.6% 63.8% Nothing available at this time 66.3% 36.2%
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Mystery Shopper Results
Told your insurance affected availability of appointment times? 2013 Composite 2014 Yes 35.2% 14.6% No 47.1% 68.2% Don’t know/unable to determine 17.7% 17.2% Felt unwelcomed/discouraged from setting appointment 7.5% 7.0% 92.5% 93.0%
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Mystery Shopper Study Researchers were most likely offered an appointment within 2 weeks of the time of the call regardless of the condition about which they were calling. The largest areas of improvement exist regarding non-urgent appointments. Approximately one-quarter of researchers were unable to receive an appointment for this type of condition until 2-3 weeks from the call.
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Improving the Oral Health of HUSKY Members
Donna: Introduction.
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Participating Dental Practitioners as of August 29, 2014
County Endo General Dentists Oral Surgeons Ortho Pediatric Dentists Perio Hygienists Totals FAIRFIELD, CT 2 346 20 29 38 3 9 447 HARTFORD, CT 12 496 44 40 55 11 687 LITCHFIELD, CT 45 5 1 56 MIDDLESEX, CT 6 7 53 NEW HAVEN, CT 8 329 54 25 33 459 NEW LONDON, CT 69 97 TOLLAND, CT 34 42 WINDHAM, CT 31 35 Out of State 64 75 26 1452 134 116 156 15 52 1951
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Participating Dental Service Locations as of August 29, 2014
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Participating Dental Practitioners as of August 29, 2014
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Building Dental Access, Results
Contract Standard: one PCD in <=20 miles Results: all Clients have access to one PCD in <= 15 miles at minimum Green = Two Providers in 10 Miles Blue = Two Providers in 15 Miles Yellow = One Provider in 10 Miles Lee: Distribution of accessibility by zip code – another portrayal of the robustness of the CTDHP provider network. Zip codes with less than 2 providers in 10 miles due to lack of dentists located in those communities. Driven by population density/opportunity cost for dentists.
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