2016 Patient Engagement Satisfaction Survey Results

ARKANSAS MEDICAID PATIENT ENGAGEMENT SURVEY

2016 Patient Engagement Satisfaction Survey Results

TABLE OF CONTENTS

Contents

Executive Summary ........................................................................................................................ 3 Beneficiary Survey Results........................................................................................................... 11

Beneficiary Survey Overview and Methodology ..................................................................... 13 Demographics of Beneficiary Survey Sample and Population................................................. 15 Patient Portal Access and Use by Beneficiaries ....................................................................... 17 Reported Uses of the Patient Portal .......................................................................................... 19 Frequency, Ease of Use and Satisfaction with Internet and Portals ......................................... 21 Does Use of Patient Portals Correlate with Internet Access and Use? ..................................... 23 Beneficiaries Inclination and/or Barriers to Use....................................................................... 25 Demographic Analysis.............................................................................................................. 27 Internet- and Health-Related Information................................................................................. 31 Beneficiary Survey ? Frequency Tables ................................................................................... 33 Appendix A - Letters and postcard ............................................................................................... 51 Appendix B - Beneficiary Survey tools ........................................................................................ 57 Provider Survey Results................................................................................................................ 79 Provider Survey Overview and Methodology .......................................................................... 81 Provider / Practice Characteristics and Portal Use ................................................................... 83 Provider / Practice Experiences with the Portal........................................................................ 85 Provider Survey - Frequency Tables......................................................................................... 91 Appendix C - Provider Survey Tool ............................................................................................. 95

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Executive Summary

The Arkansas Department of Human Services' (DHS) Division of Medical Services (DMS)

contracted with AFMC, a National Committee for Quality Assurance (NCQA) certified Healthcare

Effectiveness

Data

and

Information

Set

(HEDIS

?

0F

1)

survey

vendor,

to

conduct

its

2016

Patient

Engagement Satisfaction Survey. The Arkansas Medicaid program plans to develop patient

engagement strategies to increase the use of health informational technology (HIT) and patient

portals by the state's Medicaid population. A patient portal is a secure online website that gives the

consumer convenient 24-hour access to their personal health information from anywhere with an

internet connection. These technologies, particularly when integrated with an electronic health record

(EHR), have the potential to improve both quality and access to care through features that enable

patients to communicate electronically and securely with their provider, access their medical records,

schedule appointments, pay bills, and refill prescriptions.

The 2016 Patient Engagement Satisfaction Survey included two parts: a patient survey and a provider survey. The patient satisfaction beneficiary survey was mailed to 8,007 beneficiaries with equal representation from ConnectCare, ARKids First A and B, and the private option health plans. The provider satisfaction survey was emailed to 1,190 health care providers via SurveyMonkey. This report provides a summary of the 2016 survey results and will assist DMS in developing strategies to improve health care through technology.

Background

As part of its contract with DMS, AFMC regularly surveys Medicaid beneficiaries about their health care experiences. This survey regarding access and use of health care technology by Medicaid beneficiaries and Arkansas health care providers is the first survey of its kind conducted by AFMC.

The beneficiary survey asked questions about access to patient portals, frequency of use and experience. For individuals who responded that their health care provider offered a patient portal but they have never tried to access it, the survey asked about the reasons for not doing so. The survey also collected information about the general availability and use of technology other than patient portals (whether or not they had access to the internet and what type of internet connection). Furthermore, the survey inquired about the use of internet by Arkansas Medicaid beneficiaries to search for health care-related information.

Since it is equally important to understand patient portal use by health care providers and barriers to use if any, an online survey via Survey Monkey was sent to 1,190 providers for their input regarding their use of and experience with this technology.

Response rate

Per NCQA guidelines, 8,007 beneficiaries were selected from Arkansas Medicaid Management Information System (MMIS) data. The final sample size included 2,000 ConnectCare, 1,995 ARKids First A, 2,003 ARKids First B and 2,009 Private Option beneficiaries. A total of 1,357 surveys was received, resulting in a cooperation rate of 16.9 percent. After further exclusion of bad addresses and survey recipients who no longer met eligibility criteria, the analyzable sample size was 6,639.

1 HEDIS? is a registered trademark of the National Committee for Quality Assurance (NCQA)

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Analyzable surveys were considered complete and valid if they were received and the beneficiary had answered at least one question on the survey. A total of 1,354 complete and valid surveys were available for analysis resulting in an analyzable rate of 20.4 percent.

On March 22, AFMC sent out an email to invite 1,190 provider contacts to take the survey via SurveyMonkey on behalf of providers whose name was listed on the accompanying email. The survey consisted of 17 questions and as of April 12, 230 contacts had responded. The cooperation rate was 19.3 percent. Fifty provider contacts (4.2%) opted out of receiving surveys via SurveyMonkey. Excluding email addresses that bounced, the analyzable sample size was 1,145. A total of 215 surveys were complete and valid resulting in an analyzable rate of 18.8 percent.

Table 1: Sample size and response rates

PES16 Survey Survey sample size Total surveys returned Cooperation rate Analyzable sample size* Analyzable surveys Analyzable rate * also excludes bad addresses/bad emails

Beneficiary Survey Provider Survey

2016

2016

8,007

1,190

1,357

230

16.9%

19.3%

6,639

1,145

1,354

215

20.4%

18.8%

Key findings

The following is a summary of the results for the beneficiary survey:

Demographics

Demographically, the survey sample was significantly different from the population in most categories. This was a result of using a minimum required sample size of 2,000 from four distinct populations that varied significantly in size.

The analyzable survey sample was not demographically very different from the survey sample. The respondents of the patient engagement survey were predominantly female (54.7%) and

white (56.6%). Differences between survey sample and the population by age, although statistically

significant, are not very substantial, with the largest difference of 3.6 percent noted in the age category of "18?24" and the smallest difference of 0.3 percent in the "55 or older" age category among the adult beneficiaries. Comparing the child population (ARKids First A and B) with the child sample, the largest difference is in the age category of "13?18," with a significantly larger representation of this age group in the sample as compared to the population.

Patient portal access and use by beneficiaries

Regardless of Medicaid plan type, the majority of respondents indicated that their provider did not offer patient portals or that they were unaware.

While exploring by Medicaid plan type, no statistically significant differences were noted for patient portal access or use.

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 51.3 percent of 158 respondents indicated that they access the portal via a home computer or laptop and more than a third access it via a personal mobile device.

When comparing by demographics of respondent, survey respondents ages 18 and under constituted 7.4 percent of the total respondents, with only 4.8 percent of those having access to and only 1.1 percent of those using the patient portal. While respondents ages 18?34 constituted 28.3 percent of the total survey respondents, that age group made up over a third of the number of respondents that have used the portal.

Females are more likely to report using the patient portal but less frequently than males. Similarly, whites and respondents who indicated their education level as "Some college" were most likely to report using a portal.

Reported uses for the patient portal

62.7 percent of respondents use the patient portal for office visit summaries and for viewing lab tests and results

Less than 10 percent of the respondents use patient portals for making payments, asking billing questions and educational materials

38.6 percent indicated viewing lab tests and results was the most valuable use of the portal, followed by 17.5 percent selecting office visit summaries as the most valuable use

Less than five percent selected "ask billing questions," "request referrals" and "make payments" as the most valuable use of the portal

Frequency, ease of use and satisfaction with internet and portals

More than half of the 47 private option respondents reported using the portal at least once a month or more, while only 26.8 percent of the ARKids First B parents reported using the portal as frequently

A larger proportion of the child Medicaid and CHIP respondents have access to internet all/most of the time compared with the ConnectCare and private option adults

The respondents for the child plans (ARKids First A and B) were also more likely to have email addresses and go online at least once every week

More than 75.0 percent of respondents representing beneficiaries from each Medicaid plan type seem to be "Very satisfied" or "Somewhat satisfied" with using the portal

54.2 percent of the 24 respondents who indicated that they were "Somewhat dissatisfied" or "Dissatisfied" with using the portal feel the portal is not very user friendly, and 16.7 percent indicated they would need help or education on using it

Beneficiaries' inclination to use the portal if they could have access

518 out of 770 (67.3%) responded that they would be inclined to use it if they were able to access medical records, immunization records, check lab results, make appointments, request refills, make payments or address medical concerns

The adult beneficiaries covered under the traditional Medicaid program were the least inclined, with only 58.5 percent showing an inclination to use patient portals

Beneficiaries' barriers to use even though they have access to portal through provider

31.4 percent of 242 respondents are not interested in accessing their records electronically 25.6 percent do not have access to the internet or a computer 22.7 percent are concerned about online privacy and security

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Internet and health-related information

Less than a quarter of all respondents (21%) use the internet to research health care information for the beneficiary

Of the 276 who use the internet for health care information, 185 (67.0 percent) indicated that they discuss that information with the health care provider of the beneficiary

The following summarize the results for the provider survey:

Provider/practice background

67.0 percent of respondents describe their practice as a solo practice or a small group practice (2? 7 physicians)

71.2 percent of respondents say the majority of the care they provide is primary care 67.0 percent of respondents practice in communities of more than 10,000 people 69.3 percent of respondents see fewer than 301 patients each week 86.0 percent of respondents have achieved Meaningful Use (MU) or are working on achieving

MU of certified EHR technology

Portal use by practice characteristics

Smaller practices with no more than seven physicians (66.0%) are less likely to use a patient portal than large groups or hospital-affiliated groups (90.1%)

79.7 percent of primary care respondents use a patient portal in their practice Practices that see more than 100 patients per week (82.0%) are more likely to use a patient portal

than practices that see fewer than 100 per week (50.0%)

Provider/practice experiences with the portal

47.1 percent of respondents use an outside support vender to support their portal 73.9 percent of respondents indicated using their patient portal for clinical summaries 64.1 percent of respondents selected "Ease of sharing information with patients in a timely

manner" as being useful/beneficial 49.7 percent of respondents say they have measured improvements in the "Access to clinical

summary" from the use of the patient portal 45.0 percent of respondents say their clinicians have access to the portal through their mobile

devices

Patients' education regarding the portal

68.6 percent of respondents indicated that clerical/front desk staff recommend the use of their patient portal to patients

86.9 percent of respondents offer verbal instructions on educating patients about their patient portal

83.0 percent of respondents offer assistance in registering patients on their patient portal

Obstacles for current users

80.1 percent of respondents indicated their patients' not using technology was an obstacle in their use of a patient portal

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