The State of Maryland Department of Health (MDH) contracts with the Center for Study of Services (CSS), a National Committee for Quality Assurance (NCQA)-certified survey vendor. The purpose of the survey is to assess provider’s experience with MedStar Family Choice.
MedStar Family Choice reviews the survey results annually. Based on MedStar Family Choice's results, the Quality Improvement Department recommends the following interventions to improve provider experience.
Interventions for 2019 Based on Provider Survey Results
- MFC will continue to use the dedicated claims issue intake process through which all relevant concerns are funneled, assessed for root cause determination, and remediation plans developed. Related tracking mechanisms have been implemented through which issue resolution milestones are highlighted, and when appropriate, issues requiring claims system configuration will be tracked through the necessary load and testing protocol. Formal and scheduled tracker review meetings are held weekly to ensure claims system integrity.
- Explore options for a claims ticketing system that will allow MFC to enhance claim tracking issues to ensure timely resolution of all problems.
- Throughout the year when MFC Provider Relations Representatives performs site visits, they will take this opportunity to educate the provider and staff regarding the authorization process for claims and authorization on medications.
- Provider Relations will schedule webinars for the MFC Medical groups and all other participating providers regarding MFC operations, so that the providers are aware of our processes. They will update and educate the providers regarding claims and use of the MFC formulary and the process of obtaining formulary updates.
- Provider Relations, Community Relations, Case Management, Outreach and Quality Improvement will attend quarterly MMG POD meetings to build a better relationship with our MMG Providers, share quality data and address any issues offices may be having in real time.
- All departments will continue to work on improving the quality of written communications, policy bulletins, and manuals that are distributed to the provider offices.
- Educate providers about our Pharmacy & Therapeutics protocols available on the MFC web-site that will allow offices to efficiently obtain information necessary for many prior authorizations. An article in the provider newsletter will be written regarding the MFC drug formulary, which will give additional details related to the accuracy and accessibility of drug formulary updates.
- Provider Relations/Customer Service will work with the MFC staff to improve the responsiveness and courtesy of Provider Relations staff, Claims and Appeals staff, and the Customer Service staff at the Vestica Call Center.
- In an effort to obtain a more satisfactory outcome with the survey, MFC will inquire as to whom in the practice is responsible for completing the Provider Satisfaction Survey.
- Continue to participate in Call Calibration meetings between Vestica and MFC to deliver world class customer service to all provider calls.
- MFC will continue to work on implementing a call recording system at MFC to evaluate customer service of provider calls and to identify any areas of opportunities for improvement.
- Develop and implement a meaningful Provider Incentive Program.
If you would like a copy of the State of Maryland's 2018 HealthChoice Satisfaction Survey, please visit MMCP.Health.Maryland.gov/Healthchoice/Documents/State%20of%20Maryland%20Executive%20summary.pdf