Testing physician practice protocols to ensure member access

Measuring Provider Access involves determining both appointment availability and after-hours access for members. One way to accurately gauge these factors is to contact providers’ offices during office hours to determine their appointment availability. In addition, the offices are contacted after-hours to audit the availability of services or referrals when the practice is closed.

As a result of this study, the health plan gains valuable information, which ensures that the plan is meeting internal performance measures regarding Access standards. In addition, this information helps the plan monitor how effectively the network meets the needs and preferences of its membership, which satisfies QI 4 and supports QI 5.

Another option for measuring Provider Access is to survey the members directly to measure their perception of their providers’ appointment availability and after-hours care. The sample consists of members who have recently visited their doctors.