One of the critical criteria used by purchasers of healthcare services to evaluate health plans and providers is the availability of and access to appropriate care. Indeed, access to health services relates directly to client satisfaction and is one of the five major criteria of the NCQA HEDIS standards.
In general, accessibility and availability refer to the ease with which a patient can avail themselves of the programs and services at a specific facility, individual provider or network of providers. It includes the ability of a patient to contact the provider, schedule an appointment, arrange for transportation, obtain assistance with finding financial aid, the availability of appropriate personnel and services, etc. Some of the measures that will provide an index of accessibility include:
- Number of phone calls required to make contact with intake personnel
- Length of time between initial contact and intake interview
- Length of time required for emergency services
- Length of time required for an inpatient admission
- Length of time on waiting list for outpatient services
- Length of time between appointments
- Zip code analysis comparing residence of patient with location of facility
- Percent of patients seen by temporary therapist
- Number of clinicians on the panel
- Number of referrals to outside organizations
- Number of referrals out of network providers
- Number of patients discharged from inpatient facility that does not receive service within a specified period of time.
- Number of persons on waiting list for residential facilities
- Number of persons on waiting list for specialized services, e.g. substance abuse, etc.
In order to answer these questions it may be necessary to expand your patient database and to develop custom reports to track the appropriate information. These measures can also be developed into quality improvement indicators as described below.
Some sample reports that are useful in evaluating the above accessibility/availability criteria include:
- Applicant Latency Report - It is a cross tabulation report (2 dimensional table) used to evaluate the latency between the patients' initial contact and the first appointment. It lists the time frame required for the first appointment along the x-axis and risk level along the y-axis with the number and percentage of clients for each cell.
- Contact Frequency Report - It is a cross tabulation report used to monitor frequency of contacts by level of risk. It lists the contact frequency along the x-axis and risk level along the y-axis with the number and percentage of occurrences for each cell.
A good information system is essential to the collection and reporting of this information. In addition, it is helpful to be able to search and sort the data by a variety of demographic, financial and clinical variables, e.g. age, sex, financial class, program, services received, diagnosis, etc. These data will help the provider determine patterns of service and identify gaps in the service delivery system. Simple analyses can be conducted to determine accessibility and the availability of specific types of resources.
These data can be used to coordinate the development of the network and improve the continuity of care. This will make the provider or network more attractive to MCO's and will improve the overall quality of care.
"No Wrong Door" Central Access Systems:
State and county agencies increasingly are partnering with providers to improve access to all levels and forms of care. In some recent projects the authors have assisted regional public-private partnerships developing "no wrong door" central access systems. These systems are "central" in the sense that a single phone call is all it takes to help a consumer connect with the right service.
Staffed 24 hours a day, 7 days a week, this service greatly increases the efficiency and accuracy for consumers trying to find their way through a plethora of public and private health and social services. Through careful planning and automation, any service "portal" can route callers to the right service: emergency services, mental health, mental retardation, substance abuse treatment, aging, child welfare, juvenile justice, corrections, housing, healthcare, etc.
For individuals with co-occurring disorders, for example, substance abuse and mental illness and co-occurring life domain issues: housing, legal issues, health problems, child care, a "No Wrong Door" access system can provide care givers and support agencies the opportunity to quickly network toward more complete solutions.
The process of planning this capability is itself productive since it helps break down traditional barriers between human service, health and welfare, and other disciplines.
About The Authors:
Bruce Johnson, M.S., is President of Johnson Consulting Services, Inc., an information management consulting firm that specializes in working with healthcare, social service and managed care organizations. He can be reached at (800) 988-0934, www.jcsconsultants.com or by e-mail at jcs@eos.net. Mr. Schafer is a clinical records and operations management consultant. He specializes in working with managed care, behvavioral healthcare and child welfare organizations. He can be reached at (800) 661-2435, www.schaferconsulting.com or by e-mail at steve@schaferconsulting.com.
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