Accessibility of Services

Community Care continually evaluates accessibility of behavioral health services. Performance measures related to the ability to access services have inherent member safety implications, and we monitor that members obtain timely behavioral health appointments and have quick access to Community Care by telephone.

Community Care measures how quickly we answer the telephone and the percentage of callers who hang up before their call is answered. From 2020 to 2022, Community Care exceeded our goals, which are more stringent than industry standards, for both measures, with an average speed of answer of 13 seconds and 1.1% abandonment rate in 2022. However, we continually strive to improve our telephone responsiveness, particularly as our membership grows and call volume increases.

Emergent and urgent access to services is measured through member calls to Community Care that require triage and referral. When a member calls seeking care, a Customer Service Representative routinely asks the member a series of questions to determine the urgency. If the responses indicate that the member needs to be seen right away, the call is transferred to a Care Manager who assesses the member’s level of acuity and works with a facility/practitioner to ensure the member has an appointment within the appropriate timeframe. Community Care has adopted related appointment access standards that meet or exceed state and national guidelines. Community Care members are entitled to:

• Appointments offered for urgent needs within 24 hours

• Appointments offered for emergent needs within one hour

From 2020 to 2022, Community Care members were able to obtain appointments within the standards for urgent and emergency needs 100% of the time in all contracts.

Access to routine behavioral health appointments is also measured by two questions on the annual Member Satisfaction Survey. The 2022 Member Satisfaction Survey access questions and results, which are based on experiences in 2021, were as follows:

• “In the last 12 months, if you/your child needed a routine appointment for counseling or treatment, how often did you get an appointment for counseling or treatment as soon as you wanted (usually, always)?” The 2022 survey results reflect an aggregate adult score of 80.8% and a child score of 81.2%.

• “How long did you have to wait for an appointment (same day – seven days)?” The 2022 survey results show an adult score of 74.2% and a child rate of 74.1%.

Completed and ongoing interventions to increase these rates include:

• In 2021, Community Care developed an internal Network Accessibility Workgroup tasked with capturing access related to network data that reflects diverse inputs including, but not limited to, member complaints, non-participating provider utilization metrics, and provider reports. This workgroup includes network, clinical, and quality staff so that the information can be synthesized to recommend contract-specific and company-wide interventions designed to increase access in areas of need. This workgroup is piloting projects related to network expansion, including innovation around the recruitment and retention of providers, conducting financial analysis of various incentive programs/rate increases, and exploring opportunities around the use of integrated, virtual and nontraditional care models. Provider recruitment has been a key aspect of this work group, which developed a brochure about joining the provider network (CCBH-Recruitment-Brochure.pdf). Moving forward, this group will continue to meet and evaluate access and associated interventions.

• Community Care faced many ongoing challenges beginning in 2020 and continuing through 2022, most notably the COVID-19 pandemic and its impact on access for both members and network providers. Community Care has implemented several ongoing interventions (e.g., bridge payments, website resources, and telehealth) to ensure that providers continued to offer members access to essential behavioral health services throughout the pandemic and that members could more easily access these services. An overarching theme to the decline of overall penetration of services may be the current workforce crisis experienced by contracted providers. Providers have been reporting substantial issues with recruitment and retainment of staff, which has impacted their ability to accept new members and/or provide timely appointments. Community Care has been closely collaborating with providers about this issue and moving forward will consider additional interventions to support providers with workforce stability.

• Customer Service and Care Management staff are available to help members schedule appointments. Community Care maintains a “Contact Us” link on the Community Care member webpage, so that members may easily contact Customer Service at any time.

• Access standards are shared at the Member and Family Advisory Meetings, with reminders that Community Care can be contacted if help is needed in scheduling appointments.

• Access standards are also shared during provider meetings as a reminder of the expectations and to encourage providers to contact Community Care if they cannot accommodate a member for an appointment, as Community Care will assist the provider and/or member.

• All new members are given a handbook that details how to access Community Care, providers, and other resources; this handbook was recently updated. Additionally, Community Care initiated a new process of making Welcome Calls to inform new members of Community Care, review our website, offer referrals, and educate that Community Care may assist them 24/7, 365 days a year.

• Community Care publishes Access standards annually. The most recent member newsletter, “Foundations,” from Fall 2022 (Volume 10, Issue 2) contained the article “Getting Treatment When You Need It,” which outlined access standards as well as actions to take if members have problems getting an appointment when needed (Foundations Fall 2022).

• Community Care maintains a webpage that outlines Access standards. This webpage also details Care Management interventions related to ensuring Access as well as how to contact Community Care if members are having problems getting an appointment soon enough to meet their needs (Getting an Appointment on Time - Member Webpage).

Community Care thanks network providers for ensuring HealthChoices members are offered timely access to services. Community Care looks forward to continued collaboration in meeting our members’ needs.