2012 Provider Satisfaction Survey. Prepared by Carrie Schreiner Provider Network Manager - Quality

Transcription

1 2012 Provider Satisfaction Survey Prepared by Carrie Schreiner Provider Network Manager - Quality 1

2 CCCW Provider Satisfaction Survey Executive Summary Introduction The mission of Community Care of Central Wisconsin (CCCW) is to identify and support the strengths and preferences of members, create community connections, and coordinate quality, cost-effective, and individualized long-term care services available through Wisconsin s Family Care program. Positive, collaborative relationships with direct service providers are critical to achieving CCCW s mission. Feedback from providers assists CCCW staff to identify levels of satisfaction among providers; including specific areas where targeted quality improvement efforts may be warranted. CCCW sub-contracts with over 500 provider organizations who deliver long-term care services to CCCW members. This report is a summary of information obtained through an electronic survey of contracted providers administered in January and February, The survey was mailed to providers for whom CCCW did not have addresses. Methodology Contracted providers interact with many staff working in a variety of different departments within CCCW. Within the Provider Network Department, there are: Contract Managers who work to establish agreeable reimbursement rates and to negotiate annual contracts as well as maintain adequacy and review capacity of the network; Quality Managers who monitor and support the provision of high quality services; and, Residential Service Managers who work directly with residential providers to ensure members in need of residential services are referred to providers who have openings and are able to meet the member s unique residential service needs. Service Coordination staff work with providers to secure services for members and to coordinate services among a variety of providers. Good care management requires ongoing relationships between CCCW s Service Coordination staff and providers. CCCW s Long Term Care Functional Screen Specialists must re-determine functional eligibility for each member on at least an annual basis. This process frequently involves contact with care providers who are knowledgeable about a member s day to day abilities and assistance needs. Staff of CCCW s claims/business office works with providers to ensure services requested for a member have been appropriately authorized, and to resolve any issues that arise regarding provider billing and payment. In order to receive payment for services rendered, providers must also interact with staff of WPS, a third party administrator working under contract to process payments to providers for services authorized by CCCW. 2

3 The 2012 survey was constructed to obtain information specific to provider interaction with various CCCW staff (Provider Network, Claims/Business, Functional Screen Specialists, and Service Coordination) and staff of WPS. Additional survey elements focused on each respondent s overall level of satisfaction with CCCW, direct feedback regarding things CCCW is doing well, and suggestions for targeted improvement. Provider agencies often have multiple staff with different organizational functions. This makes it unlikely that a single organizational representative has sufficient experience with CCCW staff to respond to all questions on the survey. In recognition of this, provider organizations were invited to have more than one staff member complete the survey. Skip patterns were built into the survey to ensure each staff member was asked to respond only to questions appropriate to their work tasks and experience. Each sub-set of questions within the survey contained an open-ended comment field for providers to submit clarifying information or to provide additional information pertinent to that specific area of CCCW operations. With the exception of two open-ended questions at the end of the survey, What Does CCCW Do Best? and What Could CCCW Do Better?, detailed comments from open-ended fields were not coded for inclusion in the executive summary. Instead, the comments were compiled and shared directly with appropriate CCCW staff. All 547 provider organizations were invited to respond. Surveys show that 163 provider organizations were represented by those who responded. The response rate is 156/547 or 28.5%. Based on a 2009 white paper by Michael Braun Hamilton, an on-line survey analyst for Ipathia, Inc., a 28.5% response rate is below the average response rate of 41.21% for samples of less than (Paper available on-line at Demographics To determine whether information obtained through the survey is representative of providers in all areas of CCCW s service region, providers were asked to identify counties their organization currently serves. As indicated in the Table 1, the percentage of respondents serving Marathon, Portage, and Wood counties was very similar. A smaller percentage reported serving residents of Langlade and Lincoln County. Nearly twelve percent (12%) of respondents indicate their organization serves counties outside the CCCW region. This likely reflects provider organizations who serve counties bordering the service region as well as providers based in other areas who serve CCCW members with significant needs that cannot currently be met by providers within the service region. Table 1: Service Areas Answer Options Response Response Percent Count Langlade County 16.2% 33 Lincoln County 17.6% 36 Marathon County 40.7% 83 Portage County 37.3% 76 Wood County 37.3% 76 Other 11.8% 24 3

4 Respondents were also asked to identify the populations served by their organization. Table 2 shows that the percentage of respondents working for organizations that serve adults with developmental and physical disabilities is higher than the percentage serving frail elders. Table 2: Population Answer Options Response Percent Response Count Adults with Developmental Disabilities 72.4% 147 Adults with Physical Disabilities 70.0% 142 Frail Elders 52.7% 107 Adults with Mental Health Diagnoses 50.7% 103 Frail Elders/Dementia Specific Care 40.4% 82 Adults with Traumatic Brain Injury 36.9% 75 Skip patterns within the survey asked respondents to identify whether they had direct experience relevant to each subset of questions. Table 3 shows the number of respondents with experience relevant to contracting, residential services, quality management, billing, the coordination and delivery of services, and functional eligibility screening. The percentage of respondents with experience in claims/billing and service coordination is higher than those with experience with provider network functions. Table 3: Experience with CCCW Involved in billing WPS, receiving payment from WPS, or interacting with CCCW Claims Department Yes Response Response Count 77.4% 144 Work with CCCW IDT (Nurse and Social Work Service Coordinators) 72.1% 132 Involved in the process of contracting and contract negotiation with CCCW 55.8% 112 Experience with CCCW's Long Term Care Functional Screen Specialists 44.2% 80 Contacts or interactions with Provider Network Quality Managers 25.8% 48 Experience with CCCW's Residential Services staff in regard to respite and/or residential placement referrals 22.8% 43 4

5 CCCW Provider Satisfaction Survey Results Questions Related to Claims, Billing, and WPS Individuals who responded Yes to the question Are you involved in billing WPS, receiving payment from WPS, or interacting with CCCW Claims Department for services provided to CCCW members? were presented with a variety of statements pertinent to their experience with billing, claims processing, and reimbursement for services rendered. Two initial questions (see Table 4 below) were aimed at determining: (1) whether providers feel they received adequate training about the process for submitting claims, and (2) whether providers feel they received adequate information regarding the process to appeal the denial of a claim. Table 4: Survey Items Related to Claims Submission Training & Appeals Strongly Agree & Agree Neither Agree nor Disagree Disagree & Strongly Disagree I received adequate training about the process for submitting claims. 58% 21% 21% I received adequate information regarding the process to appeal the denial of a claim for reimbursement. 66% 22% 12% Twenty one percent (21%) of providers disagreed or strongly disagreed with the statement I received adequate training about the process for submitting claims. While CCCW added additional training in 2011 for new providers, perhaps some additional attention to the frequency or availability of such training by WPS may be warranted. Eighty-eight percent (88%) of respondents were satisfied with the information they received to appeal the denial of a claim for reimbursement. The information about the process to appeal the denial of a claim is included on each explanation of benefits and is incorporated in the CCCW Provider Handbook. Respondents with experience in billing and receipt of payment were also presented with a series of statements and asked to indicate whether each statement is true Always, Almost Always, Sometimes, Never, or Almost Never. Some of the statements pertain to provider experience with CCCW operations and others pertain to provider experience in contacts with WPS, the organization sub-contracted to process provider claim reimbursement. Table 5 on the next page shows each statement and the percentage of respondents indicating the statement is true Always or Most of The Time, Sometimes, and Never or Almost Never. 5

6 Always & Most of the Time Sometimes Almost Never & Never Table 5: Claims, Billing, and WPS Answer Options Service authorizations are timely. 67% 24% 9% Service authorizations are accurate. 80% 19% 1% When I call CCCW with questions regarding service authorizations, Claims staff are knowledgeable and helpful. 83% 13% 4% When I call CCCW with questions regarding service authorizations, Claims staff are courteous and respectful. 92% 7% 1% CCCW is responsive to provider appeals. 81% 15% 4% I receive reimbursement within 30 days. 82% 11% 7% The reimbursement I receive is accurate. 84% 15% 1% When I call WPS with billing or payment issues, I am readily directed to someone who can help me. 78% 15% 7% WPS staff is responsive to my needs as a provider. 77% 18% 5% WPS staff is courteous and respectful in their interactions with me. 89% 8% 2% For seven out of ten statements pertinent to the claims/billing and WPS process, more than eighty percent (80%) of respondents reported the statements to be true Always or Most of the Time. Ninety-two (92%) of providers felt the statement When I call CCCW with questions regarding service authorizations, Claims staff are courteous and respectful. to be true and eighty-nine percent (89%) of providers felt the statement WPS staff are courteous and respectful in their interactions with me. 6

7 Nine Percent (9%) of respondents indicate that the statement Service authorizations are timely is true Almost Never and Never. During the survey period, the CCCW Claims Department is experiencing a temporary delay in authorization processing due to contracts, state code changes, end of the month authorizations, and claims staffing. Typically they are able to process and print authorizations within one to two business days following service coordination s approval; this has increased to five to seven days. Claims staff is working diligently to reduce this time period hiring temporary staff, getting assistance from other departments, and offering over-time to current Claims staff. Seventy-eight percent (78%) and seventy-seven (77%) of providers felt that when calling WPS they were readily directed to someone who could help them and that WPS staff were responsive to their needs. Since both these areas are below eighty percent (80%), CCCW will be targeting these areas as an opportunity for improvement in 2012 and will work closely with WPS to create a performance improvement plan. Questions Related to Nurse and Social Work Service Coordinators Upon enrollment, each CCCW member becomes part of an interdisciplinary team that includes both a Social Work and Registered Nurse Service, Coordinator employed by CCCW. They are responsible for monitoring the quality of services to ensure the best possible outcomes for members. To that end, CCCW Service Coordination staff must establish and maintain good working relationships with staff of provider agencies. Respondents who answered Yes to the question Do you work with CCCW IDT (Nurse and Social Work Service Coordinators)? were presented with a variety of statements pertinent to their experience with CCCW s Service Coordination staff. For each statement, respondents were asked to indicate whether the statement is true Always, Almost Always, Sometimes, Never, or Almost Never. Table 6 shows each statement and the percentage of respondents indicating the statement is true Always or Most of The Time, Sometimes, and Never or Almost Never. Table 6: Service Coordination Answer Options The Social Work and RN Service Coordinator (or CCCW team) assigned to each member provide clear direction regarding expectations for member care and services. The information I receive regarding CCCW expectations or policies is clear and consistent, regardless of which CCCW team we are working with. CCCW teams are courteous and respectful in their interactions with MANAGEMENT staff of this organization. CCCW teams are courteous and respectful in their interactions with DIRECT CARE staff of this organization. CCCW teams demonstrate a positive attitude that encourages collaboration in addressing the needs of CCCW members. When I contact CCCW with concerns about a member, the team responds within 1 business day. Always & Most of The Time Sometimes Never & Almost never 75% 21% 4% 65% 29% 6% 82% 15% 3% 81% 17% 2% 81% 17% 5% 78% 14% 8% CCCW teams are responsive to my needs as a provider. 71% 25% 4% 7

8 For five of the seven items related to experience with Service Coordination staff, more than seventy-five percent of respondents reported the statement to be true Always or Most of The Time. Two statements had a smaller percentage of positive responses and may present opportunities for improvement. These statements are: (1) The information I receive regarding CCCW expectations or policies is clear and consistent, regardless of which CCCW team we are working with (65%) and (2) CCCW teams are responsive to my needs as a provider. (71%). In 2011, CCCW expanded into two counties, Lincoln and Langlade. This requires training a group of employees on CCCW s processes and procedures. In addition, in early 2011 CCCW distributed a Service Coordination Handbook. This handbook is designed to assist Service Coordinators in understanding the critical role they play in delivering publicly funded long-term care services to CCCW members via Wisconsin s Family Care Program. To that end, the handbook references Federal, State, and local requirements that CCCW must adhere to by contract. Service Coordinators will also find this a valuable tool for learning about guidelines, policies, and procedures that have been established to support them in their efforts to achieve CCCW s organizational mission as well as provide consistency in the expectations regardless of which team a provider may be working with. We hope that by the continued use of this resource more consistency between each location will continue to occur. In addition, CCCW s service coordination department will continue to focus on these two areas as targeted opportunities for improvement in Questions Related to Contracting and Service Agreements Individuals who responded Yes to the question Are you involved in the process of contracting and contract negotiation with CCCW and working with Becky Roble, Stacey Covi, Kelly Coyle, Jennifer Woitzcak, or Amy Tuskowski?? were presented with a variety of statements pertinent to their experience with CCCW s Provider Network Contract Managers. Two initial questions (see Table 7) were aimed at determining whether CCCW is conveying sufficient information about: (1) the Family Care program and (2) the process involved in becoming part of CCCW s provider network. At least eighty-nine percent (89%) and seventy-eight percent (78%) of providers who have contracted with CCCW within the last two years agreed or strongly agreed that sufficient information or direction was provided. Less than three percent (3%) of respondents Disagreed or Strongly Disagreed with the statements indicating that very few providers were dissatisfied with the amount of information they received in Table 7: Contracting and Service Agreements Strongly Agree & Agree Neither Agree or Disagree Disagree & Strongly Disagree I receive(d) an appropriate amount of information about the Family Care program 89% 9% 3% CCCW staff provide(d) clear direction in regard to the process involved in becoming a network provider. 78% 19% 3% 8

9 Respondents with contracting experience were also presented with a series of statements and asked to indicate whether each statement is true Always, Most of The Time, Sometimes, Never, or Almost Never. Table 8 shows that for four of the eight statements, at least seventy-five percent (75%) of respondents indicate the statements are true Always or Most of The Time. Most providers with contracting experience (90%) report that CCCW contracting staff are courteous and respectful in their interactions with providers Always or Most of The Time. Table 8 Contracting and Service Agreements Answer Options The CCCW Provider Handbook is easy to read and understand. Always & Most of The Time Sometimes Almost never & Never 76% 20% 4% The CCCW contract clearly details what CCCW expects from me as a network provider. CCCW provides adequate reimbursement for services their members receive. CCCW is transparent and fair when providing information on reimbursement for the services their members receive. I know who to contact within CCCW for questions related to my contract. 78% 18% 4% 42% 41% 17% 58% 27% 14% 77% 19% 5% I feel like a partner with CCCW contracting staff. 55% 28% 18% I receive a timely response to my telephone or communications. CCCW contracting staff are courteous and respectful in their interactions with me. 72% 18% 10% 90% 10% 1% On January 1, 2011, CCCW began administering Family Care for Langlade County and on April 1, 2011 CCCW expanded into Lincoln County. Our past experience in expansion into new counties has shown that conforming to CCCW s standardized rate-setting methodologies has, in some cases, reduced the rates providers have typically received through the county programs. This may have played a factor in the lower percentages in respondents feeling satisfied with their rates and with feeling like a partner with CCCW. Also in 2011, due to change in government officials, DHS decided not to proceed with a state-wide residential rate methodology at this time and is leaving it up to MCO s to determine their rate structure. It was at that time that CCCW began to make modifications to our current tool. We are anticipating that this new tool will result in more fair and equitable payments to providers based on information provided to us by DHS for our capitation rate development, as well as feedback from providers on what drives costs of care. 9

10 CCCW developed a residential rate setting work group which included many of our residential providers from all types of settings, from owner-occupied 1-2 bed adult family homes to corporate community-based residential facilities. Providers were actively engaged in providing their opinions on areas of the rate setting tool, performance incentives, and outlier criteria. In addition, CCCW worked with contracted, in-network, supported employment providers to create an outcome-based, tiered payment model for reimbursement of job coaching hours. During the project, CCCW s main objectives were to identify and share provider best practices, maintain or enhance the structures and definitions that are currently working, as well as supplement or change the structures and definitions that were not working. During the workgroups, CCCW strived to assure that we maintained a strong, and trusting relationship with our providers, as well as open, honest and transparent communication regarding how the process is working for them. Despite these efforts, low percentages of respondents still felt the statements CCCW provides adequate reimbursement for services their members receive and CCCW is transparent and fair when providing information on reimbursement for the services their members receive (42%) and (58%) were true Always or Most of the Time. CCCW will continue to focus on these areas in Questions Regarding Functional Screening Specialists Wisconsin s Long Term Care Functional Screen is a web-based application used to collect information about an individual s functional status, health, and need for assistance with activities of daily living. A member s functional eligibility must be re-evaluated on at least an annual basis and a new functional screen (or edit to a current screen) is to be completed whenever a member experiences a significant change in functional abilities. The Wisconsin Department of Health Services uses aggregate member acuity on the functional screen, for all CCCW member combined at a specified point in time, to determine the per member capitated payment to CCCW. In addition, CCCW uses functional screen acuity to establish acuity-based provider rates for some types of services. Respondents who answered Yes to the question Do you have experience with CCCW s Long Term Care Functional Screen Specialists? were presented with a variety of statements pertinent to that experience. For each statement, respondents were asked to indicate whether the statement is true Always, Most of The Time, Sometimes, Never, or Almost Never. Table 9 shows each statement and the percentage of respondents indicating the statement is true Always or Almost Always, Sometimes, and Never or Almost Never. 10

11 Table 9 Functional Screening Specialists Answer Options Always & Most of The Time Sometimes Almost Never & Never The Screen Specialists provide sufficient advance notice to ensure the availability of staff that is knowledgeable about the member's functional abilities and assistance needs. 88% 12% 0% The Screen Specialists are flexible in scheduling appointments. 96% 4% 0% The Screen Specialists value our input about the member's functional abilities and the types of assistance the member requires to perform specific activities. 75% 21% 4% The Screen Specialists are courteous and respectful in their interactions with MANAGEMENT staff of this organization. 95% 4% 1% The Screen Specialists are courteous and respectful in their interactions with DIRECT CARE staff of this organization. 94% 3% 3% More than 90% of providers with experience report that CCCW s Screen Specialists are: (1) courteous and respectful with management staff (95%); (2) courteous and respectful with direct care staff (94%), and (3) flexible in scheduling appointments (96%). Seventy-five percent (75%) of respondents indicate that Screen Specialists value their input about a member s functional abilities and assistance needs. This may be an area where opportunity exists for improvement or again may be due to factors beyond the control of the Screen Specialists as the functional screen instructions are quite specific about the coding of elements and there may be a perception that items should be coded at a higher level than instructions allow. In addition, the tool does not capture all types of assistance a member may need. Questions Regarding Provider Network Quality Management Survey respondents who reported experience with CCCW s Provider Network Quality Managers, Carrie Schreiner and Carolyn Schulein, were asked to review a list of seven statements pertinent to their experience with Provider Network Quality staff. For each statement, respondents were asked to report whether the statement is true Always, Most of The Time, Sometimes, Never, or Almost Never. Table 10 shows each statement and the percentage of respondents indicating the statement is true Always or Most of the Time, Sometimes, and Never or Almost Never. 11

12 Table 10 Quality Management Answer Options Always & Most of The Time Sometimes Almost Never & Never I feel heard and supported during my contacts with CCCW Provider Network Quality Managers. 88% 10% 2% Provider Network Quality Managers are responsive to my concerns. 92% 8% 0% Provider Network Quality Managers clearly identify expectations for resolution to reported provider quality concerns or member incidents. 83% 15% 2% Provider Network Quality Managers value my input as a provider. 85% 13% 2% I feel like a partner with Provider Network Quality staff. 77% 19% 4% I receive a timely response to my telephone or communications. 85% 13% 0% CCCW Provider Network Quality staff is courteous and respectful in their interactions with me. 98% 2% 0% For six of the seven statements, at least eighty percent (80%) of respondents report the statements are true Always or Most of The Time. A very high percentage of respondents (98%) indicate Provider Network Quality Managers are courteous and respectful Always or Most of The Time. Provider Network Quality Managers most often have contact with providers for the purpose of monitoring provider compliance with contractual expectations; many times in response to concerns reported by members or CCCW s Service Coordination staff. Seventy-seven percent (77%) report that they feel like partners with CCCW Provider Network Quality staff Always or Most of The Time. Overall, responses seem to indicate that provider interactions with CCCW Quality Managers are quite positive. Questions Regarding Residential Services Individuals who responded Yes to the question Have you had experience with CCCW s Residential Services staff, Colleen Seemann or Michelle Adamski, in regard to respite and/or residential placement referrals? were presented with a variety of statements pertinent to their experience with Residential Services staff. For each statement, respondents were prompted to indicate whether the statement is true Always, Most of The Time, Sometimes, Never, or Almost Never. Table11 shows each statement and the percentage of respondents indicating the statement is true Always or Most of The Time, Sometimes, and Never or Almost Never. 12

13 Table 11 Residential Services Answer Options Always & Most of The Time Sometimes Almost Never & Never The referral information I receive regarding a member is ADEQUATE. 88% 10% 2% The referral information I receive regarding a member is ACCURATE. 83% 12% 5% I feel like a partner with CCCW Residential Services staff. 74% 14% 12% I receive a timely response to my telephone or communications. 79% 12% 9% CCCW Residential Services staff is courteous and respectful in their interactions with me. 83% 12% 5% Eighty-eight percent (88%) of respondents indicate the referral information they receive is ACCURATE Always or Most of The Time. This is almost (10%) increase from A somewhat smaller percentage of respondents (83%) report the referral information they receive is ADEQUATE Always or Most of The Time, another (10%) increase from This seems to indicate the focus placed on the residential referral process in 2011 did improve the information provided to respondents. A relatively high percentage of respondents (83%) report that Residential Services staff is courteous and respectful in their interactions Always or Most of The Time. Based on survey results in 2010, the Residential Referral process was extensively reviewed and modified by both the Provider Network Managers and the Service Coordination staff. The process originally had the Residential Services manager contacting all available providers with a rate for a member prior to the Service Coordination team reviewing the facility for member choice and preference. Many times, after receiving initial contact from Residential Services, the provider was never contacted again regarding that particular member. The process was changed allowing the Service Coordinators to review the potential providers first and choose the providers that would be the best fit for the member. Residential Services then contacts only those providers identified by the IDT with the referral and rate. In a current pilot program, CCCW is experimenting with having several teams throughout the organization take a more active role in selecting the providers that they feel would best meet their members needs and outcomes. Teams create a list of providers based upon service information contained within our Provider Network Directory. This list is forwarded to Residential Services where the rate is calculated and any additional options are added if needed. Calls are then made to providers with the rate and referral information to determine whether they are able to proceed with an assessment. Handling referrals in this way will help to expedite the process and ensure better matches and may have been the reason for the increase in satisfaction with this process on the 2011 survey. 13

14 Overall, staff of this orgamization feel good about their relationship with CCCW. I, personally, feel good about my relationship with CCCW. I encourage other service providers to become part of CCCW's Provider Network. I would recommend to a family or friend to receive services from CCCW. Questions Related to Overall Satisfaction or Perception of CCCW All survey participants were asked to respond to four statements targeting their overall perception and level of satisfaction with Community Care of Central Wisconsin. Chart 1 below shows each statement and the percentage of respondents indicating the statement is true Always or Most of The Time, Sometimes, and Never or Almost Never. Chart 1 Related to Overall Satisfaction or Perception of CCCW 90% 80% 70% 77% 78% 70% 73% 60% 50% 40% 30% 20% 10% 0% 18% 16% 16% 14% 6% 6% 18% 8% Always & Most of The Time Sometimes Never & Almost Never Seventy-seven (77%) of respondents indicate staff of the organization they represent feel good about their relationship with CCCW Always or Most of The Time. A comparable percentage (78%) indicates the respondent, personally, feels good about their relationship with CCCW Always or Most of The Time. Seventy percent (73%) report that they Always or Most of The Time encourage people who may be eligible for Family Care to enroll and become CCCW members. The percentage who indicates they encourage other service providers to become part of CCCW s provider network Always or Most of The Time is somewhat smaller (70%); however, this number remains the same as last year. 14

15 In viewing responses related to overall satisfaction or perceptions of CCCW, it is important to note the broad array of service providers who responded to the survey. Provider agencies responding to the survey include, but are not limited to: small Adult Family Homes (certified by CCCW), corporate Adult Family Homes (both in and outside the service region), adult day services, supported employment providers, interpreters, physical therapists, transportation providers, community-based residential facilities, and Residential Care Apartment Complexes. The level of involvement and interaction with CCCW varies tremendously among providers, and by the type of service(s) the agency provides. In consideration of this, it appears that most providers are quite satisfied with the relationship they have with CCCW. What Does CCCW Do Best? All survey participants were asked to respond to the question, What does CCCW do Best? Sixty-seven (67) individuals, forty-one percent (41%) of respondents, submitted a comment pertaining to what they believe CCCW does best. Responses were coded to identify similar themes and lengthy responses were sometimes found to contain as many as four themes. Table 12 indicates various themes, in order of frequency, communicated by respondents. Table 12 Themes of What CCCW Does Best Themes that Appeared in Responses to Question: "What Does CCCW Do Best?" Number of Respondents Provide good and prompt customer service/communication in provider interactions. 19 Provide "member-centered" care; truly supporting member choice and independence to achieve the best quality of life possible. 15 Timely Authorizations 3 Hire and retain qualified professional staff is caring, understanding, respectful, and supportive. 2 Collaborate or partner with providers to ensure members receive high quality care. 2 They provide a good service to their community 2 Keep members in homes 2 It is good that they have an RN to support and monitor their health 2 15

16 Most commonly mentioned is CCCW s ability to provide good and prompt customer service/communication in provider interactions (n=19) and the provision of member-centered care that truly supports member choice and independence to achieve the best quality of life possible (n=15). Following are several comments that demonstrate these common themes: Work for the member. I feel that from what I have seen, the member's needs and desires are what come first whenever looking at placement, plan and finding the right people to work with each member. CCCW is always cooperative and helpful in any way they can. I work with a lot of managed care organizations and CCCW is the best by far. In my short time working with the CCCW program, I have been very impressed with everyone that I have dealt with. My questions are answered thoroughly and in a timely manner. I feel comfortable going to the CCCW staff if I or the member needs something. Provides alternative to NH placement adding to quality of life for clients needing these services. Staff in my case have good understanding of client needs and has always seen that I have all supplies etc needed to provide care. Case managers respond quickly to return calls and address issues as needed. I have no concerns regarding the services provided by CCCW and WPS. We are fortunate to have a wonderful relationship with both. We get the assistance we need when we need it and I truly believe the case managers and nursing staff have their members needs close to heart. They are great advocates. What Could CCCW Do Better? All survey participants were asked to respond to the question, What Can CCCW do Better? Sixty-nine (69) individuals, forty-two percent (42%) of respondents, submitted a comment pertaining to things they believe CCCW can do better. Responses were coded to identify similar themes and lengthy responses were sometimes found to contain multiple themes or suggestions. Table 13 shows common themes (ideas that appeared more than once,) in order of frequency. Table 13 Themes of What CCCW Could Do Better Themes that Appeared in Responses to Question: "What Can CCCW Do Better?" Respondents Ensure methods for determining provider reimbursement rates truly result in adequate reimbursement for the types of service and quality of services CCCW expects a member to receive. Either stream line the billing process with WPS or train providers on how to use the current process more efficiently and effectively to ensure more timely payment and less frustrating claim rejections. Improve the service authorization process (timeliness, accuracy, consider having stable authorization numbers for ongoing services) Improve staff response time to provider phone calls. 5 Include providers more in the Functional Screen process. 4 16

17 Ensure consistency among IDT staff, CCCW offices, and Departments within CCCW in the communication of policies, procedures, and organizational expectations. 3 Include providers more on decisions. 2 Make contracts easier to understand for smaller providers. 2 Improve communication with providers. 2 Develop quality standards for providers. 1 Educate service coordination staff better. 1 Empower service coordination staff to make their own decisions without have to consult management. 1 Use RNs for more than collecting paperwork. 1 Give my business more referrals. 1 Give me more respite days in a month. 1 The most common theme among provider responses continues to be Ensure methods for determining provider reimbursement rates truly result in adequate reimbursement for the types of service and quality of services CCCW expects a member to receive. (n=14) As stated earlier, CCCW is in the process of implementing a new rate-setting methodology for residential services. This process has been ongoing and implementation has been delayed by one quarter which may account for the continued concern over rates. In addition, many of our services are fee-for-service Medicaid rates which are not in CCCW s control to negotiate with providers. Service authorization and claims processing are also identified by a number of providers as areas where CCCW can focus on improving. In November of 2011 WPS changed how Excel claim files would be transmitted. The process was replaced with their MoveIT file transmission process. Many providers felt that the notice and training for the new process was lacking. The following are samples of comments regarding the top three ways CCCW could improve: Make it feasible for CBRF's to continue to operate and provide homes for their members. Some allocations are so low that if you had two or three of those people in a CBRF you would have to rethink providing services to these members. These types of members often live in the same place. 17

18 Communicate better with providers in regards to what is expected for the billing process (i.e. telling us to send notes versus EOB's). Communicate within CCCW so one item isn't approved by the care teams for payment, yet denied on the payment side. Improve the timeliness of the preauthorizations faxed back to our clinic, without requiring our clinic to have to re-contact CCCW to send it the first time. I think that communication about the claims process is the main thing that is at issue. From the start, we as providers were "sold" the entire WPS process, but there was never an appropriate training on entering claims. I also think that this latest snafu with the authorizations continues to add to the dissatisfaction with the process. I know that for me, the frustration is "hoping" that all is correct and done so I can get paid for the claim I am submitting that particular week. Comparative Results from 2011 and 2010 Provider Survey Provider surveys are used to obtain feedback for use in future planning efforts and, as a means to monitor planned quality improvement efforts. The Chart 3 compares the percentage of current respondents indicating the statement is true Always or Most of The Time, to the comparable percentage in the previous two surveys. The survey year is based on the year the survey was taken; therefore, the year the respondent is actually reviewing is the previous year. Example: The 2012 survey actually reviews the respondents experiences in 2011; the 2011 survey reviews the respondents experiences in 2010, etc. Chart 2 Claims and Billing Yearly Comparison CCCW Claims staff are curteous & respectful 92% 96% 93% The reimbursement I receive is accurate. 80% 84% 90% I receive reimbursement within 30 days. CCCW is responsive to provider appeals. 76% 82% 86% 83% 81% 84% Service authorizations are accurate. 76% 80% 83% Service authorizations are timely. 54% 67% 74% 18

19 Chart 3 Service Coordination Yearly Comparison The Social Work and RN Service Coordinator (or CCCW team) assigned to each member provide clear direction regarding expectations for member care and services. The information I receive regarding CCCW expectations or policies is clear and consistent, regardless of which CCCW team we are working with. 65% 75% 78% 77% 72% 70% CCCW teams are courteous and respectful in their interaction with MANAGEMENT staff of this organization. 82% 85% 89% CCCW teams are courteous and respectful in their interaction with DIRECT CARE staff of this organization. 81% 87% 90% CCCW teams demonstrate a positive attitude that encourages collaboration in addressing the needs of CCCW members. 76% 82% 84% When I contact CCCW with concerns about a member, the team responds within 1 business day. 71% 78% 84% CCCW teams are responsive to my needs as a provider. 71% 79% 85% 19

20 Chart 4 Contract and Service Agreement Yearly Comparison CCCW contracting staff are courteous and respectful in their interactions with me. 86% 89% 89% I know who to contact within CCCW for questions related to my contract. 77% 78% 80% CCCW provides adequate reimburement for services their members receive. 42% 48% 65% The CCCW contract clearly details what CCCW expects from me as a network provider. 78% 78% 80% The CCCW Provider Handbook is easy to read and understand. 76% 76% 78% 20

21 Chart 5 LTC Functional Screen Specialists Yearly Comparison The Screen Specialists provide sufficient advance notice to ensure the availability of staff who are knowledgeable about the member's functional abilities. The Screen Specialists are flexible in scheduling appointments. 88% 77% 96% 84% The Screen Specialists value our input about the member's functional abilities and the types of assistance the member requires. The Screen Specialists are courteous and respectful in their interactions with MANAGEMENT staff of this organization. The Screen Specialists are courteous and respectful in their interactions with DIRECT CARE staff of this organization. 75% 78% 95% 89% 94% 84% I receive a timely response to my telephone or communications. 77% 87% 21

22 The Provider Network Quality Managers and Residential Managers were newly created positions in 2011; therefore, the comparison data for those two areas are available for 2011 and 2012 only. Chart 6 Quality Management Yearly Comparison Provider Network Quality Managers clearly identify expectations for resolution to reported provider quality concerns or member incidents. 83% 78% Provider Network Quality Managers are responsive to my concerns. I feel heard and supported during my contacts with CCCW Provider Network Quality Managers. 92% 82% 88% 80% CCCW Provider Network Quality staff are courteous and respectful in their interactions with me. 91% 98% Chart 7 Residential Services Yearly Comparison I receive a timely response to my telephone or communications. 77% 87% CCCW Residential Services staff are courteous and respectful in their interactions with me. 69% 83% I receive a timely response to my telephone or communications. I feel like a partner with CCCW Residential Services staff. The referral information I receive regarding a member is ACCURATE. 79% 65% 74% 82% 83% 76% The referral information I receive regarding a member is ADEQUATE. 72% 88% 22

23 Overall, staff of this organization feel good about their relationship with CCCW. I encourage other service providers to become part of CCCW's Provider Network. I would recommend to a family or friend to receive services from CCCW. Chart 8 Overall Satisfaction or Perception of CCCW Yearly Comparison 77% 81% 76% 70% 70% 74% 78% 71% 58% The overall impressions of CCCW have remained fairly stable for the last three years. Throughout our expansion period, increasing attention has been focused on program costs and outcomes by a variety of the program s stakeholders. In response to upward cost pressures across its service region, related primarily to the care costs of incoming members who have relocated from nursing homes through the state s Community Relocation Initiative, CCCW hosted fifteen (15) Provider Forums across its service region in May The forums were attended by over 200 service provider representatives from a variety of service categories. The Provider Forum series was designed to address a number of key purposes: Engage providers in an ongoing process that demonstrates the organization s commitment to providing opportunities for input that influences decisions and outcomes in areas of mutual interest. Collaboration on the development of ideas that result in cost efficiencies for CCCW, providers, and the Family Care program. Prioritization of key cost effectiveness strategies that hold particular promise for implementation by CCCW and/or providers. By involving providers in such forums, CCCW showed our commitment to our contracted providers to involve them in the process and decisions on how to continue to provide quality care to our members while facing the necessary budget cuts. 23

24 Hopefully this type of partnering is one of the reasons that seventy-seven percent (77%) of respondents still feel good about their relationship with CCCW Always or Most of The Time. Conclusion By responding to the CCCW Provider Satisfaction Survey, providers have once again demonstrated their commitment to work collaboratively with staff of CCCW to maintain good working relationships that support high quality outcomes for members. Comparative results show CCCW has made improvements in the areas of Quality Management and Residential Services. CCCW can pride itself on providing great customer service that is prompt and member-centered. Areas where opportunities exist for improvement are the authorizations and billing processes and communicating rate-setting methodologies with providers. CCCW and network providers have faced many challenges over the past year. In 2012, Wisconsin s state budget crisis is likely to raise continued issues and concerns. Collaborative partnering between CCCW and its network of providers will be essential to the ongoing delivery of high quality services to members throughout the CCCW service region. 24