Accessibility of Services

Community Care continually evaluates accessibility of behavioral health services. Assessing access entails the synthesis of various data measures, which includes objective measures related to telephone statistics as well as subjective measures related to a member’s perception of access. Performance measures related to service access have inherent member safety implications, and these measures enable Community Care to 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 (known as the average speed of answer) and the percentage of callers who hang up before their call is answered (known as the abandonment rate). Community Care’s goals related to these two measurements, which are more stringent than industry standards, are 5% or less for the abandonment rate and 30 seconds or less for average speed of answer. From 2021 to 2023, Community Care continued to exceed the goal for the abandonment rates; however, in 2023, the average speed of answer increased to 21 seconds, and was slightly above the goal. Community Care continually strives 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 2021 to 2023, Community Care members were able to obtain appointments within the standards for urgent and emergency needs 100% of the time in all contracts. Furthermore, complaints related to access time standards (emergent and urgent complaints) are used as a supplemental data source to evaluate appointment accessibility. Community Care received no complaints related to Emergent and Urgent calls in 2021, 2022, and 2023.

Access to routine behavioral health appointments is also measured by two questions on the annual Member Satisfaction Survey. The 2023 Member Satisfaction Survey access questions and results, which are based on experiences in 2022, 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 2023 survey results reflect aggregate scores of 80.2% for both children and adults.
  • “How long did you have to wait for an appointment (same day – seven days)?” The 2023 survey results show an adult score of 73.7% and a child rate of 71.5%.

Completed and ongoing interventions to increase these rates include:

  • In 2021, Community Care developed an internal Network Accessibility Workgroup that has focused on becoming an innovator in access and a payor of choice. The group has also worked on capturing reliable data surrounding access, which includes the review of capacity, availability, and utilization. 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, such as the following:
    • Provider recruitment has been a key aspect of this work group, which developed a brochure about joining the provider network (CCBH-Recruitment-Brochure.pdf).
    • Community Care has implemented rate increases for providers to encourage providers to join or remain within the network to help ensure members have ease of access to services.
    • Community Care will send letters to in-network providers to acknowledge their value to the network, thank them for delivering needed services, and ask for feedback.
    • An innovative, evidence-based intervention is being piloted within one Community Care contract with single session psychotherapy to reduce wait lists. As of Quarter 3, 2023, this contract had five providers participating.
    • In 2023, the workgroup activities included collaboration with the Primary Contractors regarding development of the monthly Child MH Service ePortal 30-day availability reporting and how this data may be linked to the Provider Directory for rollout in December 2023.
  • Community Care implemented several interventions 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. These interventions included financially stabilizing the provider workforce via ambulatory bridge payments, adjusting pre-certification and authorization requirements (per the 1135 waiver), and loosening of regulations surrounding telehealth. Due to the efficiency and ease of access associated with the waiver, some of the pre-certification and authorization changes were permanently implemented within Community Care’s processes, even with the ending of the waiver on May 11, 2023.
  • To address workforce shortages created by the lingering effects of the pandemic, Community Care has been closely collaborating with the Primary Contractors on workforce stabilization initiatives.
  • Community Care’s Network Department implemented the Council for Affordable Quality Healthcare (CAQH) standard credentialing application. Providers were previously required to complete different forms with different managed care organizations to enter Community Care’s network. Community Care required paper forms (not online) and other information to be credentialed within the network. The CAQH is a universally accepted credentialing application that is of no cost to providers and prevents the practitioner from needing to complete multiple credentialing applications. The ease of this process should encourage providers to join or remain in the network, which would improve access.
  • Providers are required to notify Community Care if they are unable to see members within specified timeframes depending on acuity, as specified in the Community Care Provider Manual. Community Care also understands that providers at times cannot serve a member within expected access times, which are listed in Community Care’s Provider Manual, and may offer to place that member on a referral list so that members waiting to receive services are scheduled for appointments promptly as they become available. Community Care has developed a “Referral List and Wait Time Management Best Practices” document that offers guidance to providers related to referral list management. The goal of this guidance is to ensure that members waiting for behavioral health services are appropriately assisted, that resources are efficiently utilized and coordinated, that the roles and responsibilities of involved entities are understood and transparent, and that relevant data is collected so that it can be shared and utilized to identify service gaps within the behavioral health continuum. Additionally, Community Care developed a “What You Can Do if Waiting for Services: Tips for Members” sheet that reminds members to call Community Care to get an appointment as well as offers several other options to ensure that members are receiving needed services. Finally, Community Care offered a training (Orientation to Wait Time Management) to assist providers in managing wait times. While these processes may not directly impact the access data, each does help ensure that members are receiving necessary services for urgent, emergent, and routine needs if a wait time is necessary. The links to these resources may be found on the website as well as a related provider alert (Referral List and Wait Time Management Best Practices: HealthChoices Providers and Provider Alert 11: Referral List and Wait Time Management Best Practice).
  • Care Management ensures that members receive urgent, emergent, and/or routine services as part of their daily activities. For urgent levels of care, Care Managers will actively perform bed searches across the state for both inpatient and PRTF levels of care to ensure that members have rapid access to these categories of care.
  • Clinical Operations committees comprised of representatives from network, clinical, and program operations in each contract review all requests from prospective providers wishing to join the network. These committees consider geographic location and areas of provider specialization when expanding the network. Program descriptions are also reviewed to determine if any priority or special populations are served, or unique services exist to meet the needs of the membership. The committees also review providers who have left the network to address any resulting gaps in coverage. From August 2022 to August 2023, a net total of over 1,500 new providers were added to the network.
  • Community Care reviews non-participating provider activity to target providers for network inclusion.
  • Member cards are distributed in the new member packets. These cards contain information regarding Community Care as well as how to access behavioral health services.
  • Customer Service Representatives make Welcome Calls to outreach to all new members. During these calls, the representative will assist members to ensure they have access to care.
  • Access expectations for emergent, urgent, and routine appointments are detailed for providers within the Provider Manual, which may be found on Community Care’s website (Community Care Provider Manual (ccbh.com)).
  • Community Care maintains a webpage that outlines Access standards for members. 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: HealthChoices Members - Community Care (ccbh.com).

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.