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By Monica E. Oss

The time that consumers are waiting for health care services appears to be getting longer. The average wait time for consumers seeking a new appointment with a physician increased 30% (24.1 days) since 2014 (see the Merritt Hawkins survey results in Physician Appointment Wait Times & Medicaid and Medicare Acceptance Rates). For mental health services this wait time can be up to 25 days (see Long Wait Times Typical for Psychiatry Appointments). Thirty-eight percent of consumers have had to wait longer than one week for mental health services (see America’s Mental Health 2018).

And a survey out of Massachusetts found that on average, provider organizations there reported seeing 81% percent of new consumers within two weeks of first contact, 93% within one month, 7% in five weeks more (see Quantifying Wait Times for Outpatient Mental Health Services in Massachusetts: Provider And Organizational Characteristics Associated With Access). For 3% of new consumers, access took over eight weeks.

Once consumers have an appointment, the on-time performance of most health care systems for those appointments isn’t great. These wait times in-office vary widely, with the average wait time for consumers to see their doctor at about 18 minutes (see Vitals Annual Wait Time Report – 2017). Patient Engagement HIT reports that the average in-office wait times for an appointment at a hospital range from 13 to 29 minutes—with 30% of consumers reporting that they had left the appointment because the wait was too long. (see Long Appointment Wait Time a Detriment to High Patient Satisfaction). Not surprisingly, in-person wait times in the emergency room are much longer, with average wait times before seeing a physician ranging from 53 minutes in Maryland, to 13 minutes in Colorado (see ER Wait Watcher).

The reasons for long times to appointments and long in-office waiting times are many. Possible reasons include the increase in consumers needing services due to expanded insurance coverage; staff shortages; and administrative burdens due to electronic health records (EHR) (see Why Appointment Wait Times Are Rising And What You Can Do About It). Scheduling is also to blame when it comes to in-office wait times, with many offices booking as many consumer appointments as possible to increase productivity, maximize revenue potential, and account for consumer no-shows.

The consumer access issue is a big one if you’re either a manager of a provider organization or a manager of a health plan. On the provider organization side, consumers with long wait times are generally consumers with low satisfaction scores. Health care consumer engagement group Vitals found that hospitals that achieved the highest satisfaction rating (5 stars) have a 13-minute in office wait time, compared to the lowest rated hospitals (1 star), which had a 33-minute wait time (see Patient Wait Times Show Notable Impact On Satisfaction Scores, Vitals Study Shows). And, consumers with long wait times to make an appointment are more likely to “no show”—or to leave an appointment. Thirty percent of consumers who have long wait times leave before seeing a clinical professional, and 20% will change provider organizations after experiencing a long wait time (see Long Appointment Wait Time a Detriment to High Patient Satisfaction). Both scenarios are very costly for a provider organization.

Health plan managers are focused on timely access for similar reasons—lower wait times produce better consumer engagement and more positive consumer satisfaction scores when it comes to CMS STARS and HEDIS scores (see HEDIS Measures and Technical Resources). Longer wait times to get appointments also can prove to be costly for health plans, as long wait times can result in increased emergency room and inpatient utilization. One study found that at Geisinger, among consumers waiting for specialty appointment, the 30-day rate of emergency room or inpatient utilization was 8.7 times higher than those consumers who were not waiting for appointments (see The Waiting Game — Why Providers May Fail to Reduce Wait Times).

Deb Adler

Therefore, health plan managers are now paying more attention to access. For more, I reached out to OPEN MINDS Senior Associate Deb Adler, who noted:

Studies show that the more quickly a consumer can access an appointment from the point of deciding to seek treatment, the more likely the consumer will engage in treatment. Research shows that “no show” rates rose from 12% when the appointment was delivered the same day, to 26% when the appointment was available the second day. No show rates rose up to 44% when the service was delayed for 13 days (see Impact Of The Wait For An Initial Appointment On The Rate Of Kept Appointments At A Mental Health Center).

This has resulted in payers implementing rapid access or quick access networks as a means to improve the consumer experience and promoting engagement and positive outcomes. For example, Optum has an “express access” network-a narrow network of providers that offers appointments to members within five days of request compared to the industry standard of 10 days. These fast access providers are transparently displayed to consumers with a “stopwatch” symbol to help guide members to this option. More information is available on their provider portal——including the ability to apply to this program, sign the require addendum, and other frequently asked questions.

The question I have for any service delivery system—what is the wait time for an appointment at your organization? And, with an appointment, how long do consumers wait for services? The answers to these questions are important for being a “preferred provider”—both with consumers and their health plans.

For more on speeding access to care and access issues, check out these OPEN MINDS Industry Library resources:

  1. Untangling The Access Issues For Addiction Treatment
  2. Health Insurance Coverage Vs. Access To Care—The Gap Between Them
  3. If There Are Enough Psychiatrists, Why Is Access Such A Problem?
  4. Is Tech The Solution For The Behavioral Health Access Issues?
  5. Is 2019 The Year Of The Telehealth Tipping Point?
  6. Network Adequacy Doesn’t Equal Consumer Access
  7. For Health Plans, Technology = Improved Consumer Access

And, for even more, join Ms. Adler and Matt Miller, Senior Vice President, Public Sector, Magellan Healthcare, on February 13 at The OPEN MINDS Health Plan Partnership Summit: A Guide To Developing & Negotiating Partnership Agreements With Health Plans, when they help attendees understand the needs of payers, reframe the services of typical provider organizations into “solutions” for health plans, negotiate agreements with payers and build mutually beneficial partnerships with payers in their market.



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