access to care training - · pdf fileafter today’s training you will be able to:...

Access to Care Training

Magellan of Virginia

June 30, 2016

After today’s training you will be able to:

• Define care accessibility and describe its relationship to appointment availability

• Understand why it is important for providers to meet accessibility standards

• Identify appointment access standards as described by the National Committee for Quality Assurance (NCQA) and required by the Virginia Department of Medical Assistance Services (DMAS)

• Summarize descriptions of the urgency categories used to structure the accessibility standards

• Have adequate knowledge of Magellan’s accessibility data collection methods

• Assess your agency to identify where you may be able to make changes to improve member access

• Use a resource to organize the assessment and initial ideas for your agency’s plan to improve member access to care

June 30, 2016 Accessibility Training 2

Overview

What is care accessibility?

Care is appropriately accessible when members can get:

The RIGHT care

at the RIGHT time

in the RIGHT place

June 30, 2016 3 Accessibility Training

Overview

Appointment Availability

One way Magellan tracks our members’ level of access to care is by collecting data on appointment availability from providers.

Magellan Network Providers must strive to meet the appointment availability standards described in the Network Provider Handbook to:

• Help members get the right care, at the right time, in the right place

• Give members the best chance for successful recovery

• Adhere to provider responsibilities as listed in Magellan credentialing contracts

• Conform to best practices as defined by NCQA

• Meet the expectations of DMAS


Standards of Care for Accessibility

NCQA Appointment Access Standards

Magellan measures adherence with accessibility standards across the Provider Network and takes steps to improve overall appointment accessibility to ensure optimal care for our members.

In addition, Magellan must conduct activities to improve access to care to meet NCQA accreditation requirements and to fulfill our commitment to DMAS.


Level of Urgency Appointment Access Standard

Non-Life Threatening Emergent 6 hours

Urgent 48 hours

Routine 10 business days



Non-Life Threatening Emergent

• Member requires rapid intervention to prevent acute deterioration which might compromise the patient’s safety.

• Appointment must be available within 6 hours of referral.

Urgent

• The clinical situation would likely deteriorate if patient not seen in a timely fashion.

• Appointment must be available within 48 hours of referral.

Routine

• The member is stable enough to remain safe, but requires treatment to diminish distressing symptoms of mental illness.

• Appointment must be available within 10 business days of referral.

Life-Threatening Emergency

Member requires immediate intervention to prevent death or serious harm to self or others. Requires immediate evaluation within a secure environment. Magellan does not conduct survey calls for this urgency level. Magellan expects that providers who become aware of a member with a life-threatening emergency will assist the member to access emergent care via 911 or an emergency room.



Non-Life Threatening Emergent

Member requires rapid intervention to prevent acute deterioration which might compromise the patient’s safety.

Urgent

The clinical situation would likely deteriorate if patient not seen in a timely fashion.

Routine

The member is stable enough to remain safe, but requires treatment to diminish distressing symptoms of mental illness.

EXAMPLE A member is currently safe with family members, but is experiencing rapidly intensifying psychotic symptoms that could lead to safety risks if escalation continues. The family would like Crisis Intervention services.

EXAMPLE A member with good insight has noticed an increase in his major depression symptoms. They seem similar to symptoms he had before his last hospitalization. He hopes a swift medication adjustment might help him avoid another hospital stay.

EXAMPLE A member with Bipolar Disorder is established with a psychiatrist for medication management. With current medications, she is not having thoughts of harming herself. However, she is still experiencing breakthrough depression symptoms and occasional hypo-manic symptoms. She’d like to see a therapist for more support.

Accessibility Data Collection

Anonymous Call Methodology

• Magellan makes anonymous phone calls to providers to request appointments for situations that fit within each urgency category.

• Magellan records the response and determines if the result of the call meets or does not meet the access standard appropriate for the urgency of the presented situation.

• Magellan selects providers randomly. Claim or authorization volume does not affect provider selection.

• Magellan attempts to minimize repeated calls to the same provider to avoid excessive inconvenience for any one agency.

• At the conclusion of each survey call, the caller will notify the provider that the call is from Magellan as part of the Accessibility Quality Improvement Activity.


Accessibility Data Analysis

Universal Minimum Expectations

Magellan compares the results of each survey call against the same NCQA standard for that level of urgency, regardless of provider characteristics such as urban vs. rural, public vs. private, or higher volume vs. lower volume.

AGGREGATE

LEVEL

ANALYSIS


Magellan uses the data to draw conclusions about appointment accessibility across the network as a whole.

The data is NOT used to evaluate the performance of any particular provider.

Magellan does not impose a penalty when providers are unable to offer an appointment that meets the standards during data collection.

How Can We Improve Member Access to Care?

Every provider can help improve access.

What are your strengths in access to care? Where can you take action?

Consider assessing your practice from multiple perspectives:

• Clinicians / Direct Care Staff

• Administrative Processes

• Systems Approach- working with other providers and Magellan

The Accessibility Self-Evaluation and Action Planning Tool can help you organize your assessment process. It may not be realistic for your agency to address every item, but cumulative changes made by many providers will improve access to care across the provider network.

A printable version of this tool can be located on www.magellanofvirginia.com.


http://www.magellanofvirginia.com/


Accessibility Self-Evaluation and Action Planning Tool (Page 1)


Strength or Action Area?

Accessibility Evaluation Question Actions / Solutions

Do all leaders at our agency understand the urgency categories and NCQA standards?

Do all clinical staff at our agency understand the urgency categories and NCQA standards?

Do all administrative staff at our agency understand the urgency categories and NCQA standards?

Are members able to speak directly with the person who can schedule their appointment the very first time they call?

Are members able to schedule the initial appointment without immediate access to their Medicaid information?

What percentage of the time are we able to offer appointments within NCQA timeframes?

Do our answering system messages for the general mailbox and for individual staff clearly identify our agency name, who to call in case of emergency, a specific time frame in which to expect a return call, and whether or not the line is confidential?






Is our staffing sufficient to allow us to offer timely appointments?

Are we doing everything we can to prevent staff burnout?

Have we checked to see if Magellan has the correct contact information on file, so members who use the online referral tool or who call Magellan for referrals can easily reach us?

Do we regularly update appointment availability information with Magellan, including whether or not we are taking new clients and any seasonal changes to office hours?

Do we have a point person who can track accessibility and coordinate improvements?

Is our accessibility tracking system adequate?

Are there any other agency policies, procedures, or tools we need to change to increase adherence with access standards?






Do we have procedures and resources in place for connecting members to alternative providers when we can’t offer a timely appointment?

Do all of our scheduling staff know how to use Magellan’s Online Provider Search Tool to find other Magellan network providers in our area members can see? If not, do they know about the “how to” guide for the search tool that can be accessed by clicking “Need help searching for providers?” on the search tool web page?

Do all of our scheduling staff know that members can call the Magellan Customer Service line at 1-800-424-4046, with our without our staff supporting them, to get referrals to providers in our area?

Do all of our scheduling staff know about tools that help individuals to find non-Medicaid resources in their communities, such as the Virginia Easy Access navigation website, 2-1-1 Virginia website, or the Magellan Peer and Family Recovery E-Guide? (See last slide for resource links.)

http://www.magellanofvirginia.com/find-a-provider-va/portable-provider-search.aspx



http://www.magellanofvirginia.com/media/1069132/magellan_provider_search_instructions_for_website_v1.pdf



Review

• When members can access appointments within an appropriate timeframe for their presenting situation, providers are helping them to get the right care, at the time, at the right place.

• When providers offer timely appointments, they are helping members to have the best chance for successful recovery, adhering to best practices as required by NCQA and DMAS.

• Magellan evaluates whether or not each anonymous survey call result meets or does not meet the NCQA standard for the urgency level of the call. Magellan does not apply different standards, though provider characteristics may vary.

• Magellan conducts analysis at the aggregate level only. No penalties apply to any individual provider.

• All providers can take action and make a difference to improve accessibility.

• Providers may use the Accessibility Self-Evaluation and Action Planning Tool to assess what actions may be needed for their agencies. Agencies may not be able to address every item on the tool. However, when each provider makes small improvements, the result is improved access to care across the network for the members we serve.


Resources

Magellan of Virginia, Provider Handbook Supplement:

https://www.magellanprovider.com/media/1697/supp.pdf

Magellan National Provider Handbook:

https://www.magellanprovider.com/media/11893/provider_handbook.pdf

www.magellanofvirginia.com

• Provider Search Tool (link is located on the “Welcome” page)

• “How to” guide for the Provider Search Tool (link is located on the search tool page)

Magellan Customer Service Line: 1-800-424-4046

Virginia Easy Access: http://easyaccess.virginia.gov/

2-1-1 Virginia: http://www.211virginia.org/consite/ or call 211

Magellan Peer and Family Recovery E-Guide: http://www.magellanofvirginia.com/media/1391216/approved_2016_recovery_and_resiliency_resources_virginia_v1.pdf






http://www.magellanofvirginia.com/

http://easyaccess.virginia.gov/



http://www.211virginia.org/consite/

http://www.211virginia.org/consite/

http://www.magellanofvirginia.com/media/1391216/approved_2016_recovery_and_resiliency_resources_virginia_v1.pdf



Confidentiality Statement for Providers


The information presented in this presentation is confidential and expected to be used solely in support of the delivery of services to Magellan members. By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc. *If the presentation includes legal information (e.g., an explanation of parity or HIPAA), add this: The information contained in this presentation is intended for educational purposes only and should not be considered legal advice. Recipients are encouraged to obtain legal guidance from their own legal advisors.

Thank You

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