CenCal Health has ranked fourth among the 36 health plans in the State of California in providing timely access to health care services for its membership, as reported by the state Department of Managed Health Care (DMHC) for calendar year 2016. DMHC, which regulates health plans in California, measures and releases a report on patient access to care on an annual basis as it believes it is a fundamental priority for health plans to provide for their members.
“When our members can get in to see their doctor in a timely manner, it’s a good thing for the patient and the community as health concerns or sickness can be addressed early on”, said Bob Freeman, CEO of CenCal Health. “We are grateful to the providers in our community who make our members a priority.”
In addition to ranking fourth in the State in the comprehensive access measurement, CenCal Health also ranked second in the State in relation to wait times to see a specialist physician.
The referenced report measures different appointment types, including Urgent Care (with and without prior authorization requirements), non-urgent appointments for primary, specialty and ancillary care, as well as non-urgent mental health appointments. DMHC, along with consultation from various stakeholders, developed standardized methodologies for measuring compliance with timely access standards. By utilizing accurate and comparable data from health plans in the state of California, they have been able to achieve an acceptable rate of compliance in meeting appointment wait time standards.
Health plans must also meet specific requirements including patient’s access to a primary care provider within 15 miles or 30 minutes from where they live or work, and the availability of telephone triage or screening services on a 24/7 basis. CenCal Health takes pride in offering a vast network of contracted providers in its service area and a 24/7 Nurse Advice Line for its members. Additionally, during normal business hours, a patient must not wait more than 10 minutes to speak with a health plan customer service representative. Finally, interpreter services must be coordinated for scheduled appointments to ensure health plan members are able to interact with their providers and receive information in their preferred language.