Monitoring Access Standards Compliance

Health Net measures participating physician group (PPG) performance with timely access standards through the Provider Appointment Access survey and the Provider After-Hours Access survey. Overall member satisfaction is measured through the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey process. 

Providers not meeting these standards are required to submit and follow a corrective action plan (CAP), which the Quality Improvement (QI) Department monitors. Refer to the Service and Quality Requirements discussion under the Provider Oversight topic for detailed information on access standards.

Health Net identifies a random representative sample of members each year and engages with an independent quality assurance entity to conduct interviews, using a semi-structured interview tool provided by the Department of Health Care Services (DHCS), with each member in the sample to:

• Determine background and causes for emergency room visits, including the use or failure of long-term services and supports (LTSS) or if there was a lack of appropriate LTSS to adequately support the member in his or her environment
• Determine whether the member experienced any barriers to accessing health care and understand the nature of those barriers, including, but not limited to, inadequate access to language support services, alternative format materials, and physical accessibility for disabled members

Health Net analyzes results in order to identify issues within its system of care that require improvement to promote appropriate utilization of both LTSS and emergency room services, appropriate and timely access to care, and Americans with Disabilities Act (ADA) and language assistance program compliance. Health Net reports results as required to the Centers for Medicare and Medicaid Services (CMS) and DHCS.