Primary care providers (PCPs) in the Neighborhood Health Plan of Rhode Island (Neighborhood) network must be available to members 24 hours a day, 7 days per week. To ensure twenty-four hour coverage, PCPs must have one of the following mechanisms in place to handle incoming member phone calls outside of normal business hours:
- Answering machine or answering service that directs the member to visit the closest Emergency Room.
- Answering machine that directs the member to contact the PCP or the designated on-call practitioner; or answering service that contacts the PCP or designated on-call practitioner on behalf of the member.
- The linguistic capabilities of the answering service representatives with whom the PCP is contracted and/or the outgoing message on the answering machine should represent the linguistic needs of the population serviced.
In order to ensure primary care providers are meeting the above standards, Neighborhood conducts a survey of after-hours access. In 2017, 80 primary care sites (representing 25% of Neighborhood’s membership) were randomly selected to be called after the scheduled hours of operation to understand the mechanisms used and information provided to members.
The survey evaluated the following:
- Whether each site uses an answering machine, answering service, or both;
- The number and type of languages available to callers;
- Whether or not emergency department instructions are mentioned first;
- The average wait time until a member is connected with an on-call provider.
The results demonstrated that 100% of the practices had a reliable mechanism (answering machine, answering service, or both) after business hours. 47% of the sites surveyed use both an answering machine and answering service, or the on-call provider answered the call directly. The average wait time for a call-back from an on-call provider increased from 16 minutes in 2016 to 20 minutes in 2017.
The results of the survey illustrate the dedication of the PCP network to Neighborhood’s standards, as well as, our member’s health and well-being. Neighborhood values the primary care practitioner’s participation in our provider network and appreciates the 24/7 commitment made to our members.