Market Research Services

Case Study: Assessing Medicaid and CHIP MCP Network Adequacy

INTRODUCTION

An External Quality Review Organization (EQRO), is dedicated to evaluating and improving the quality of healthcare services provided to Medicaid beneficiaries in Indiana. As part of their ongoing efforts, they sought to assess the adequacy of Medicaid and Children's Health Insurance Program (CHIP) Managed Care Plans (MCPs) networks to ensure timely and accessible care for beneficiaries.

Challenge or Problem Statement

Medicaid and CHIP MCPs are mandated to maintain provider networks meeting quantitative standards, including time and distance requirements, provider-to-enrollee ratios, and appointment availability. However, accurately evaluating network adequacy and identifying gaps in access can be challenging. The EQRO contractor faced the task of conducting a Secret Shopper Survey, a critical component of the assessment process, to gather objective data from healthcare providers while minimizing bias.

Solution

To address this challenge, Axon Advisors collaborated with the EQRO to administer the Secret Shopper Survey. Leveraging our expertise in quantitative research methodologies, we designed a comprehensive survey protocol aligned with CMS guidelines and tailored to the specific requirements of the 2024 ANA protocol. Our solution ensured objective data collection by employing trained secret shoppers to evaluate the accuracy of provider information, MCO affiliations, and appointment availability.

Implementation

The implementation process involved meticulous planning and coordination between Axon Advisors, the prime contractor, and the relevant stakeh The implementation process involved close collaboration with the EQRO to understand the nuances of the ANA protocol and tailor the survey methodology accordingly. Axon Advisors meticulously trained secret shoppers to adhere to established protocols and maintain anonymity during survey interactions. Additionally, we developed customized survey instruments and data collection procedures to capture relevant metrics such as provider acceptance of new patients and average appointment wait times.

The quantitative research study yielded tangible outcomes that significantly informed the development and refinement of HCBS rate methodologies for the State of Indiana. Key benefits derived from the study include:

- Enhanced alignment and transparency: The survey data enabled the State to streamline and standardize rate methodologies across different HCBS waivers, promoting clarity and consistency for providers.

- Improved sustainability: By incorporating alternative sources of information and exploring tiered and bundled rate methodologies, the State achieved greater sustainability in rate setting, ensuring adequate participant access to services while aligning with budgetary constraints.

- Promotion of person-centeredness and value-based purchasing: Insights from the survey informed the adoption of value-based purchasing strategies, aligning financial incentives with HCBS outcomes and fostering person-centered practices within the Medicaid programs.

Overall, the quantitative research study conducted by Axon Advisors facilitated evidence-based decision-making and empowered the State of Indiana to enhance the effectiveness and efficiency of its HCBS rate setting processes.

Holders within the State of Indiana. Customizations were made to the survey instrument to ensure it resonated with the diverse provider landscape and accommodated the State's evolving priorities. Axon Advisors facilitated the administration of the survey, ensuring robust data collection from a representative sample of HCBS providers.

Results and Benefits

Through our Secret Shopper Survey, the EQRO gained valuable insights into the adequacy of Medicaid and CHIP MCP networks, enabling informed decision-making to improve healthcare access for beneficiaries. Key benefits of our approach included:

- Objective Data Collection: By utilizing trained secret shoppers, we minimized potential bias and ensured the reliability of survey findings.

- Identification of Gaps: The survey revealed areas of improvement, such as inaccuracies in provider information and challenges in accessing timely appointments, enabling targeted interventions.

- Compliance with Regulatory Standards: Our solution aligned with CMS guidelines, helping the EQRO fulfill its mandate of assessing network adequacy and supporting state-level quality improvement initiatives.

Overall, the collaboration between Axon Advisors and the EQRO facilitated a successful Secret Shopper Survey, contributing to the enhancement of Medicaid and CHIP healthcare delivery in Indiana.

Market Research Services

Case Study: Assessing Medicaid and CHIP MCP Network Adequacy

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