We are working with the Quality Improvement Committee to improve our ability to effectively analyze member data related to health care equity. Better analysis will lead us to design more targeted interventions to improve equity among the various language and ethnic groups represented in membership.
• Strategy #1: Self‐efficacy/communication for members: expand advertising and outreach and increase capacity of existing self‐management workshops to increase members’ health‐related self‐efficacy.
• Strategy #2: Health education materials development and dissemination: continue to increase outreach and promote culturally‐matched educational materials regarding well‐baby visits, overweight/obesity, heart health, and member use of ER for acute symptoms.
• Strategy #3: Training and outreach to providers: training to contracted health care providers, practitioners, and allied personnel regarding these findings to increase understanding of member needs; in addition, we will partner with our provider network to identify strategies for addressing gaps.
3. Measuring and Improving the Member Experience
One of SFHP’s top four organizational goals is to offer “exemplary service” to our members, participants, and providers. The Customer Service Department helps members understand and take full advantage of their health plan benefits. Members can contact SFHP Customer Service by phone, fax, TDD/TTY, email, mail, or in person. By contacting Customer Service, members can get assistance with ID cards, PCP changes, covered benefits, medical bills, grievances, access to doctors, enrollment, renewal, dis‐
enrollment, etc. We represent a safety net for any member who needs help.
3.1. Providing Excellent Telephone Service
Our members find it easiest to reach us by telephone. Therefore, we are committed to ensuring that we provide excellent customer service over the phone. One way we do this is by tracking and monitoring calls. Real time performance is displayed in the call center area so that Customer Service Representatives are aware of the performance and call traffic. We monitor our performance in several ways and continue to work on improving our processes.
3.1.1. Call Center Performance
We received 70,072 incoming calls through our telephone automated distribution system in 2011. We met or exceeded our performance standards on the following metrics.
• Our service level, which measures efficiency and speed of service, was 93.8%, exceeding our goal of 90% by 3.8%. We continuously improve in this area.
• The industry benchmark for call abandonment is 5%; SFHP’s average abandonment rate in 2011 was 1.4%.
• We maintained language coverage in our four threshold languages, English, Chinese, Spanish, and Vietnamese. Our Customer Service team speaks additional languages such as Russian and Burmese.
Our Customer Service metrics electronic wallboard displays real time information throughout the day to remind us of our performance standards and to allow up‐to‐the‐moment tracking.
The metrics we track are:
• Service level
• Total call volume handled
• Abandonment rate
• Total abandoned calls
• Calls waiting in different language queues
• Number of agents available at each language queue
SFHP adopted a new electronic telephone system in 2011, to allow continued operational efficiency and improvement in our service to members. The phone system provides the following benefits to improve customer service:
• Customer Service staff can be assigned to different queues by the supervisor based on the volume of calls and calls waiting in queues in real time so that members’ calls can be answered promptly.
• Provide current queue status information to staff members so that they can take action appropriately to handle calls.
• Different levels of alerts are set with assigned colors. Staff can be informed easily about the status, which motivates staff to handle incoming calls more efficiently and promptly.
• Management can react to unusual situations and assign customer service staff based on skill level to take care of calls effectively.
3.2. New Enterprise Information Management Platform
In 2011, SFHP acquired a new managed care platform, QNXT. Effective December 1, 2011, Customer Service staff can provide information of benefits, and claims and authorization status to members and providers immediately without transferring calls to other departments. Benefits information
provided to members is more accurate and specific to the member. More member inquiries can be handled with a single call.
3.3. Member Satisfaction with Customer Service
The Customer Services Department conducted its tenth annual member satisfaction survey in the last quarter of 2011. The purpose of this survey is to assess the level of satisfaction with the services provided by the Customer Service Department and to improve our services based on feedback from members.
The survey was conducted in English, Spanish and Chinese. The format was the same as in previous surveys: members provided responses to the following statements regarding recent interactions and experience with SFHP Customer Service staff.
• My call to SFHP Customer Service Call Center was answered quickly.
• I received polite service from the Call Center Representative.
• I received the information that I needed.
8,403 survey cards were sent to members who contacted Customer Service by phone during the months of October through December 2011. 34% more members were surveyed in 2011 than in 2010.
The response rate for the survey cards was 14.1%. Chinese‐speaking members had the highest response rate at 19.11%.
An average of 95.5% of our members reported satisfaction with the services provided by Customer Service team, 94.7% for quick service, 96.6% for polite service, and 95.2% for receiving needed information. The results were consistent with those achieved in previous years. We have been getting excellent results from this survey through the years. These very positive responses from our members indicated that they were highly satisfied with the services they received from the SFHP Customer Services team in 2011.
94.73% 96.61% 95.20%
20.00%
40.00%
60.00%
80.00%
100.00%
Quickly Polite Information
Satisfaction Rate
Member Satisfaction: Telephone Service
3.4. Monitoring Member Grievances
SFHP monitors grievances on a quarterly basis to identify trends and identify ways to improve service to our members. In addition to looking for trends in our grievances, we also monitor the way we handle grievances for timeliness and regulatory compliance. Our goal is to provide excellent service and, at a minimum, meet DMHC standards for responding to and resolving grievances (response within 30 days). Below is an overview of the grievances received in 2011 and key indicators showing our compliance with regulatory standards:
• 211 member grievances were processed by SFHP and Kaiser.
• 161 of these grievances were non‐delegated and handled directly by SFHP, all which were resolved within the 30‐day period mandated by DMHC.
• 18 grievances (11%) handled by SFHP were resolved by the next business day.
• 149 grievances (89%) handled by SFHP were resolved within 30 days.
• 100% of non‐exempt grievances met state regulatory requirements for timeliness of resolution letters sent within 30 days.
• Four grievances (2%) handled by SFHP had a Cultural and Linguistic Component.
3.4.1. Tracking and Trending Grievances
In order to identify patterns and changes in our grievances, we report grievance rates by line of business, medical group, and grievance category. Looking at the comparison of SFHP annual rates below, Medi‐Cal has the highest rate per 1000 members per month, with an increased rate in 2011 from 2010, which is attributed to the transition of SPD Medi‐Cal recipients into SFHP.
Healthy Kids saw an increase in the grievance rate, while Healthy Families decreased. Healthy Workers grievances decreased by 10%. The top three categories were Denials/Refusals, Quality of Service, and Enrollment. Below are the grievance statistics for 2011 and the highlights from our analysis.
Lines of Business ranked by grievances per 1000 members per month:
Line of Business 2010 Grievance Rates 2011 Grievance Rates
Medi‐Cal 0.16 0.23
Healthy Kids 0.16 0.23
Healthy Workers 0.21 0.19
Healthy Families 0.06 0.05
Medical Groups (SFHP & Kaiser) ranked by grievances per 1000 members per month:
Medical Groups
2010 Grievance Rates
2011 Grievance Rates
University of California San Francisco 0.4 0.48
Brown and Toland Physicians N/A 0.47
Hills Physicians 0.21 0.35
Community Health Network 0.16 0.25
Chinese Community Health Care Association 0.12 0.09
Kaiser Permanente 1.93 0.06
North East Medical Services 0.08 0.05
Grievances handled by SFHP by grievance category:
Category
2010 Grievances
2010
% of Total
2011 Grievances
2011
% of Total
Denials/Refusals 54 49% 64 40%
Quality of Service 26 23% 53 33%
Enrollment 5 5% 13 8%
Access 9 8% 10 6%
Quality of Medical Care 7 6% 9 6%
Benefits/Coverage 2 2% 6 4%
Billing 6 5% 5 3%
Cultural and Linguistic 1 1% 1 1%
Other 1 1% 0 0%
Total 111 100% 161 100%
Important Findings of 2011
• Denials/Refusals remained the top category and increased by 19% from 2010.
• Quality of Service issues increased by 104% from 2010.
o Of the 53 grievances filed, 35 were regarding poor communication with providers, medical office staff, and SFHP staff.
3.5. Ensuring Member Satisfaction
Experience surveys assist us in evaluating the quality of service our members receive from SFHP and from our provider network. In 2011, SFHP implemented strategies to improve health plan services and provider‐level care, using SFHP’s scores on the Medi‐Cal member experience survey in 2010 as our guide. Specifically, as a result of the 2010 survey results, SFHP was requested to address three target areas for improvement: rating of all health care, customer service, and getting needed care.
Our interventions to address this survey feedback are described below.
3.5.1. Improvement Initiatives based on 2010 MediCal CAHPS Results
Our trended member satisfaction results, as measured by the CAHPS survey, indicate that there is room for improvement, particularly in the areas of provider‐patient communication, shared decision‐making, and access to appointments.
As reported previously, San Francisco Health Plan launched two year‐long collaboratives in 2010 aimed at improving two key dimensions of the patient experience: access to care and patient‐
centered communication. These pilots ended successfully in April 2011.
The access collaborative, Optimizing the Primary Care Experience (OPCE), focused on improving access to appointments and office efficiency during appointments. Four clinics participated in the program. National expert Dr. Mark Murray provided content expertise; a SFHP staff practice coach trained in performance improvement provided ongoing project support. The goals of the OPCE project were to: 1) Reduce waiting times both for and at appointment services, and 2) Optimize health outcomes by improving clinical care delivery.
The results of the project as of April 2011 included each clinic achieving at least a 50% reduction in their patients’ wait time to see his or her own primary provider or primary care team member, as measured by the Third‐Next Available Appointment (TNAA) measure. Two clinics saw their delays shortened to within one week for regular return appointments. All clinics continued tracking their progress on delay reduction through 2011, with less frequent reporting to SFHP after the project’s end. All clinics shared successes with one another and other clinic sites in a series of improvement meetings.
The second collaborative, Patient‐Centered Communication (PCC), focused on targeted changes
to improve the provider‐patient and staff‐patient relationships so that patients feel their most important concerns are addressed during their visit. Five clinics participated. Communication technique trainings were led by the Institute for Healthcare Communication. These clinics were also supported by a SFHP practice coach. The goals of the PCC project were to: 1) Optimize health outcomes by improving communication and shared decision‐making, and 2) Improve provider, staff and patient satisfaction.
The CAHPS visit‐based survey was administered using a standardized methodology at three points in time during the project – baseline, 3 months post intervention, and 6 months post intervention. Highlights include the following results:
• The five clinics showed improvement from baseline in all provider communication and composite measures, staff communication and composite measures, and in global measures such as overall rating of provider and recommending clinic to family and friends. All five clinics improved at least 5% in two measures.
• There were four statistically significant improvements (p<.10): doctor spends enough time, doctor’s explanations are understandable, doctor provides easy to understand instructions, and clerks and receptionists are helpful.
• Four out of the five clinics improved in more than 50% of the measures from baseline; one clinic improved in all measures; followed by two clinics that improved in 75% of the measures.
The table below shows final project results. The final 10‐month post‐intervention surveys were fielded in December 2010, with data aggregated in January 2011 to report at the project’s completion in March 2011. Doctor knows important medical history 90.3% 91.9% 1.5%
Doctor explanations easy to understand 94.8% 95.0% 0.2%
Doctor shows respect 96.6% 96.9% 0.3%
Office Staff (composite) 94.1% 95.9% 1.8%
Rating of provider 86.1% 89.0% 2.9%
Patient recommends clinic 89.7% 92.7% 3.0%
Clerks and receptionists respectful 96.0% 96.9% 0.9%
Clerks and receptionists helpful 92.3% 94.8% 2.5%
PIP. See section 1.4.3 for more information on PIP. As part of PIP, the Clinician and Group version of the CAHPS survey was administered in October through December via an automated telephone response system. For the first time, following data analysis underway in 2012, SFHP and its providers will have statistically valid survey data at the practice level to guide improvement.
Data analysis and survey results were finalized outside the scope of the period covered in this report. However, preliminary results available at this writing show valuable information that will help SFHP and our providers continue our partnership in the Practice Improvement Program to improve patient experience. For example, the highest performance across respondents in Medi‐
Cal (704 total valid responses), Healthy Families (411 total valid responses) and Healthy Kids (120 total valid responses) was on the question of overall rating of providers, with 86% of respondents in all three groups giving their providers the highest scores. This value was comparable to a benchmark survey conducted across the Massachusetts state Medicaid program in 2008, where the score was 85%. SFHP will use the data from this provider‐level CAHPS survey in its improvement work with clinics and medical groups in 2012, as the pay‐for‐
performance program PIP requires all participating organizations to complete plans based on their CAHPS scores and SFHP’s recommendations for improvements.