Contact: Jacquelyn Jans
Bakersfield, CA: In January 2020, the California Department of Managed Health Care (DMHC) released its Timely Access Report. Providing timely access to health care services is a health plan's fundamental duty to its enrollees. This report summarizes Measurement Year 2018 provider appointment availability data submitted by health plans to the DMHC. For 2018, the DMHC required health plans to utilize external vendors to validate the plans' timely access data.
Health plans are required to ensure that each of its providers has the capacity to offer enrollees appointments within the established timely access standard. Health plans must also ensure that appointments meet the clinical appropriateness standard, which requires that services be provided in a timely manner that is appropriate for the nature of the individual enrollee's condition, consistent with good professional practice.
DMHC's annual review and reporting of timely access data demonstrates the State's commitment to protect consumers' right to receiving health care and ensure a stable health care delivery system by increasing and providing comparable timely access data to the public and other interested parties.
Standards are established by the State and each health plan is ranked on how they perform to each standard. Access measures are taken for Primary Care, Specialty Care, non-physician mental health and ancillary services (Chiropractic, Podiatry, Physical Therapy, etc.) for both urgent and non-urgent appointments.
When comparing Kern Health Systems' (KHS) performance with all health plans statewide (37) and Medi-Cal only health plans (20), KHS's performance was ranked against both groups for the following categories:
- Full Service Health Plans combining urgent and non-urgent access to care
- Full Service Health Plans (Medi-Cal only) combining urgent and non-urgent access to care
- Full Service Health Plans measuring non-urgent appointments
- Full Service Health Plans (Medi-Cal only) measuring non-urgent appointments
- Full Service Health Plans measuring urgent appointments
- Full Service Health Plans (Medi-Cal only) measuring urgent appointments
In all 6 categories measuring service access, Kern Health Systems ranked 1st in the State.
Of note, with 89%, KHS was number one in the percentage of all surveyed providers who had appointments available within the wait time standards (urgent and non-urgent). For non-urgent appointments only, KHS was number one with 94% of providers surveyed showing appointment availability. For urgent appointments only, KHS was number one with 83% of providers surveyed showing appointment availability.
Doug Hayward, KHS Chief Executive Officer, says: "This accomplishment began several years ago with Kern Health Systems’ grant programs providing over $50 million, earmarked for improving clinical service access for Kern Family Health Care members. The Physician Retention and Recruitment Grants, Facility Expansion Grants, ER Diversion Grants and Health Homes Program Grants (among others), all provided funding to launch and support bringing new providers to our community, expanding professional and outpatient services and creating new specialty care programs. Without which, this survey could have shown very different results."
According to Emily Duran, KHS Chief Network Administration Officer, "It cannot be overstated that, if not for the commitment of our contracted providers to do what was necessary to expand their practices in the face of rapid growth, we would not have achieved this outstanding performance." This accomplishment would not be possible without the collaboration of KHS and contracted providers to deliver high quality health care to Kern County residents. "I appreciate the partnership between my practice and Kern Health Systems that has allowed me to expand timely access to care to all our patients", said Dr. Hasmukh Amin, MD, owner of Riverwalk Pediatrics and a longtime participating KHS provider.
The report is available using the following link: http://dmhc.ca.gov/Portals/0/Docs/OPM/2018TAR-accessible.pdf
The charts within the report display, at the health plan level, the percentage of provider responses to appointment availability requests that were within the timely access standards.