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The American Journal of Managed Care July 2019
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Physician Satisfaction With Health Plans: Results From a National Survey
Natasha Parekh, MD, MS; Sheryl Savage; Amy Helwig, MD, MS; Patrick Alger, BS; Ilinca D. Metes, BS; Sandra McAnallen, MA, BSN; and William H. Shrank, MD, MSHS

Physician Satisfaction With Health Plans: Results From a National Survey

Natasha Parekh, MD, MS; Sheryl Savage; Amy Helwig, MD, MS; Patrick Alger, BS; Ilinca D. Metes, BS; Sandra McAnallen, MA, BSN; and William H. Shrank, MD, MSHS
Several physician and payer characteristics are associated with physician satisfaction with health plans. There is opportunity to improve physician satisfaction with payers, specifically in pharmacy.
ABSTRACT

Objectives: Physician satisfaction is associated with patient satisfaction, adherence to treatment recommendations, and quality. However, burnout is prevalent, and physician experience with health plans is likely a key contributor. We explored physician satisfaction with health plans and assessed physician and plan characteristics associated with greater satisfaction.

Study Design: Cross-sectional analysis of physician satisfaction surveys for US health plans in 2016.

Methods: We assessed the association between health plan/physician characteristics and physician satisfaction domains using multivariable linear regression. The following satisfaction domains were outcomes of interest, measured by 5-point Likert scales: overall health plan rating, finance, utilization/quality management, network/care coordination, pharmacy, call center, provider relations, and recommendation of the plan to others’ practices.

Results: We analyzed surveys from 3158 physicians on 74 health plans, representing a 12.6% response rate. We observed highest satisfaction in overall plan rating, finance, and call center domains (adjusted means = 3.25) and lowest satisfaction in the pharmacy domain (adjusted mean = 3.02). The largest and smallest plans and vertically integrated plans had the highest satisfaction; 76% and 66% of physicians recommended vertically integrated plans and non–vertically integrated plans, respectively, to others (P <.001). Solo practitioners rated overall plan rating, finance, utilization/quality management, and pharmacy domains more favorably than did physicians in larger practices, whereas primary care physicians rated overall plan rating, finance, and utilization/quality management more favorably than did specialists.

Conclusions: Our findings demonstrate opportunity to improve physician satisfaction with health plans, specifically in pharmacy/formulary management. As provider satisfaction is increasingly recognized as a critical outcome, our findings highlight intervention targets.

Am J Manag Care. 2019;25(7):e211-e218
Takeaway Points
  • Significant opportunity exists to improve physician satisfaction with health plans, specifically in pharmacy/formulary management.
  • Vertically integrated health plans and the largest and smallest plans had the highest physician satisfaction.
  • Solo practitioners rated overall health plan ratings, finance, utilization/quality management, and pharmacy domains more favorably than did physicians in larger practices, whereas primary care physicians rated overall health plan ratings, finance, and utilization/quality management domains more favorably than did specialists.
  • As provider satisfaction is becoming increasingly recognized as a critical outcome of its own, our findings highlight potential intervention targets.
Studies have demonstrated that physician satisfaction is associated with patient satisfaction, adherence to chronic disease management recommendations, and quality of care.1-5 However, physician burnout is a growing concern; the majority of physicians in the United States experience burnout symptoms, and between 2011 and 2014, the prevalence of burnout among physicians increased by 9% while remaining stable in other fields.6 Given the importance of physician satisfaction, some have suggested that the Triple Aim (representing patient experience, quality of care, and cost reduction) be expanded to the Quadruple Aim, which adds provider satisfaction as the fourth key tenet.7

A key source of physicians’ frustration is related to their relationships with payers. Challenges include administrative burden, documentation pressures, payment and delivery changes, and publicly reported quality metrics,6,8,9 and they represent central causes of physician burnout. It is therefore important to better understand the associations between physician satisfaction and characteristics of the health plan, provider, and practice.

Our existing knowledge of physician satisfaction with health plans is limited, mixed, and outdated. Studies from the 1990s that focused on managed care found contradictory results regarding the association between managed care and physician satisfaction.9-11 More recent studies note that increased administrative burden and productivity requirements are associated with reduced satisfaction, but limited evidence is focused on physician satisfaction with health plans specifically.6,8,9 Moreover, little is known about what provider and plan characteristics are associated with greater provider satisfaction with health plans. Considering the rapid evolution of new payment models and the emergence of vertically integrated health plans (ie, plans in which healthcare providers and payers are integrated), we need to refresh our understanding of key provider and payer relationships and their association with physician satisfaction. Accordingly, we sought to explore physician satisfaction with health plans and assess the physician and plan characteristics that are associated with greater satisfaction.

METHODS

In partnership with SPH Analytics, a provider of patient/member experience and population health solutions charged with measuring, analyzing, and interpreting patient and provider satisfaction for US health plans, we conducted a cross-sectional analysis of provider satisfaction surveys from 2016. As a requirement for National Committee for Quality Assurance (NCQA) accreditation, all health plans solicit feedback from their providers with the goal of improving care coordination and quality. Unlike patient satisfaction surveys, NCQA does not specify which questions are asked of providers about health plans. SPH Analytics therefore developed its Provider Satisfaction Benchmark Survey Tool to help health plans assess provider satisfaction. The tool is administered by SPH Analytics on behalf of health plans to providers, including physicians, nurses, office managers, and behavioral health clinicians. Our study used results from the 2016 SPH Analytics Provider Satisfaction Benchmark Survey Tool, which was completed by providers for 130 health plans, representing approximately 30% of health plans across the United States. Of the 130 health plans, 54 had customized surveys with customized questions/responses. Because responses to these questions could not be compared among health plans, we excluded plans with customized surveys from our analyses. We included only physician responses in this analysis (ie, we excluded office staff responses) to simplify result interpretation because our specific focus was the intersection between health plan practices and physician satisfaction, and as a group, physicians may have different responses compared with other provider types.

Survey Design and Development

SPH Analytics developed its original Provider Satisfaction survey in 2001 based on the reporting, regulatory, and accreditation requirements of its health plan clients. In 2012-2013, SPH Analytics re-evaluated the utility of this existing survey, seeking to ensure that it covered meaningful topics and provided valuable results by which health plans could measure and compare their performance and identify areas of opportunity. The organization therefore conducted focus groups with 10 physicians and interviews with 12 office managers from diverse practice settings (representing a combination of primary care and specialist offices and large and small groups) to obtain feedback on the survey, key domains, administration methods and frequency, and result sharing. SPH Analytics then used focus group and interview feedback to revise its original tool. It specifically reordered the domains by most important to least important according to the focus groups and, to reduce respondent burden, removed follow-up questions asking providers to rate other plans they encounter for each domain.

The final survey included 7 demographic questions, 33 five-point Likert scale questions (with response options of well above average, somewhat above average, average, somewhat below average, and well below average), 1 yes/no question about whether the provider would recommend the sponsor plan to other physicians, and 1 free-text question where responders could leave comments. Key domains included (1) overall health plan rating, which reflected general satisfaction with the respective health plan compared with all other plans they work with; (2) financial issues, which included questions on provider reimbursement, fee consistency, and claims processing and resolution; (3) utilization and quality management, which included questions on access to knowledgeable staff, procedures and timeliness of preauthorization information, facilitation of appropriate clinical care, access to care managers, and preventive care and wellness coverage; (4) network/coordination of care, which included questions on number, quality, and timeliness of reports from specialists and behavioral health clinicians in the plan’s provider network; (5) pharmacy issues, which included questions on formulary consistency over time, reflection of current care standards, variety of branded drugs, ease of prescribing preferred medications, and availability of substitutions; (6) call center experiences, which included questions on ease of reaching the call center, helpfulness in referrals, and overall satisfaction with call center staff; (7) provider relations, which included questions on availability and capacity of provider relations representatives, quality of provider orientation, and value of written communications; and (8) whether providers would recommend the respective health plan to other practices.


 
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