QMetrics has been a trusted administrator of healthcare surveys in California since 2017, conducting Provider Surveys and, more recently, Enrollee Surveys since 2023. These surveys are designed to fulfill key regulatory and accreditation requirements for health plans, including mandates from the California Department of Managed Health Care and the National Committee for Quality Assurance.
Surveys targeting the fulfillment of regulatory requirements that we offer include:
Required by the DMHC, this survey assesses timely access to urgent, non-urgent, and behavioral health follow-up appointments. Outreach is performed by contacting provider offices via fax, email/online, and telephone to assess urgent and non-urgent provider availability. This survey targets PCPs, 10 types of Specialists, Psychiatrists, Non-Physician Mental Health Providers, and Ancillary service providers (Mammography and Physical Therapy). In addition to administering the survey, QMetrics also serves as a required validator, ensuring that the survey process and results meet all applicable regulatory standards and validation requirements.
QMetrics understands the critical importance of accurate contact data and has developed the prevalidation process to ensure quality and minimize errors before survey fielding begins. This proactive approach involves reviewing and reconciling the Health Plan Network File with associated documents, in close collaboration with the Health Plan. By identifying potential issues early, the prevalidation process reduces errors during survey administration and lightens the post-survey quality assurance workload. Additionally, it identifies high-volume providers in advance, allowing us to strategically plan for maximum survey completion, adding exceptional value and efficiency to the process.
QMetrics expertly administers the Provider Appointment Availability Survey in full compliance with the PAAS Manual, DMHC guidelines, FAQs, and All Plan Letters for the current measurement year. Our survey administration spans fax, email, and telephonic modalities, with a strong focus on minimizing provider abrasion and maximizing response rates. To ensure smooth survey completion, we’ve developed the White Glove process, specifically designed for high-volume provider offices. In partnership with the Health Plan, we proactively manage these offices to optimize response rates, minimize errors, and meet the required sample size outlined in the DMHC Survey Methodology.
Additionally, our Operations and Programming Analytics team provides real-time interim reporting through a convenient dashboard, offering valuable insights into survey progress. This dashboard tracks survey response rates, compliance thresholds, and provides a breakdown by provider type, including Primary Care Providers, Specialists, Ancillary providers, and more, ensuring the Health Plan stays informed and on track throughout the survey process.
The Department of Managed Health Care mandates that health plans partner with an external vendor to validate their Timely Access Compliance Reports and submit a Quality Assurance Report. QMetrics provides expert validation based on the rigorous Quality Assurance process outlined in the current Provider Appointment Availability Survey Manual, along with supplemental DMHC documents and FAQs. Our team ensures that the Health Plan’s PAAS Report Forms are thoroughly validated for accuracy, validity, and completeness. We reconcile Contact Lists with the Plan’s Network Filing and cross-check Raw Data to ensure that survey results reflect the true provider network. Any discrepancies are promptly identified and submitted to the Plan for correction, validation, or feedback, ensuring full compliance and accurate reporting.
Starting in RY 2024/MY 2023, the Department of Managed Healthcare requires Primary Plans to report all required data for PAAS providers made available through Plan-to-Plan contracts in their Timely Access Compliance Report. QMetrics offers a contracted service to perform a comprehensive Quality Assurance Review and deliver consolidated results for the Primary Plan’s Plan-to-Plan arrangement, ensuring full compliance with DMHC requirements. Our review includes algorithmic verification of calculations, accuracy checks of network/counties represented, and final tabulations to guarantee that the health plan meets all necessary standards.
The Provider Satisfaction Language Assistance Program Survey meets DMHC requirements by evaluating provider satisfaction with timely access to care across various service types, while also assessing their knowledge, usage, and satisfaction with the health plan’s Language Assistance and Interpreter Services. Administered via fax with an online completion option, the survey targets Primary Care Providers, Specialist Care Providers, Psychiatrists, and Non-Physician Mental Health Providers. By gathering insights from these key provider groups, the effort supports both regulatory compliance and improvements in language access service delivery.
In alignment with DMHC requirements, the After-Hours Survey ensures that contracted primary care and mental health providers have appropriate protocols in place for timely triage or screening of enrollee telephone calls received outside of regular business hours. Conducted via telephone, the survey targets Primary Care Providers, Psychiatrists, and Non-Physician Mental Health Providers, verifying the presence and adequacy of after-hours procedures to support timely access to care and safeguard patient well-being.
The Emergency Instructions Survey supports compliance with DMHC requirements by confirming that contracted primary care and mental health providers have established procedures to appropriately triage or screen enrollee telephone calls received during regular business hours. Conducted via telephone, the survey is administered to Primary Care Providers, Psychiatrists, and Non-Physician Mental Health Providers. When expanded to include high-volume or high-impact specialists, the survey also fulfills NCQA Net 2B Accreditation requirements, making it a dual-purpose tool for both regulatory and accreditation alignment.
The Enrollee Experience Survey fulfills DMHC requirements by employing a statistically valid and reliable methodology to capture member perspectives on key access and service domains. It gathers feedback on the ability to obtain timely appointments, awareness of enrollee rights related to timely care, and the experiences of limited English proficient individuals in accessing interpreter services. Administered via mail with an online completion option, the survey supports health plans in identifying barriers to care and enhancing the overall enrollee experience.
Conducted via telephone, the Data Accuracy Survey aims to validate and update provider contact information to improve response rates—particularly for the Provider Appointment Availability Survey. QMetrics verifies the accuracy of health plan-submitted contact details and collects missing or corrected information, such as fax numbers and email addresses. These updates enhance the efficiency of subsequent survey administration by reducing the need for follow-up phone calls, thereby minimizing the burden on provider offices and supporting more effective outreach.
This telephone-based survey serves a dual purpose: validating provider contact information to support improved response rates—particularly for PAAS—and identifying Primary Care Providers who offer Advanced Access scheduling. Advanced Access PCPs, once identified, are exempt from PAAS participation and considered compliant with DMHC appointment timeliness standards for a period of three years. In addition to verifying contact details, the survey assesses whether providers offer same or next-day appointments, how these are scheduled, and whether the scheduling process aligns with regulatory expectations for timely access to care.
The Expanded Appointment Set Survey evaluates the timeliness of routine care appointments, including Well-Woman Preventive Visits, Annual Physical Exams, Prenatal visits, and Initial Health Assessments offered by Primary Care Providers and OB/GYNs, for both in-person and telehealth modalities. Administered annually via fax with an online completion option, the survey supports compliance with timely access standards established by the DMHC and DHCS. Telehealth method(s) of administration, and barriers to offering telehealth visits are also assessed.
