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There are numerous options for reducing the provider burden associated with the PAAS

• Centralized sampling with no other changes to the methodology could reduce outreach attempts by 60 percent for primary care providers (PCPs) and by 72 percent for specialists.
• Centralized sampling with a sampling strategy designed to leverage overlap between health plans could reduce outreach attempts by 60 percent for PCPs in Los Angeles County.
• Sampling office locations rather than specific providers could reduce outreach attempts by 70 percent for PCPs.
• Improving contact list data could reduce the number of ineligibles by approximately 50 percent.
• Updating the target sample size to reflect ineligibles could reduce the number of outreach attempts to reach target sample sizes.
• Making greater use of nonsurvey methods of data collection could reduce provider burden if there is a move to other modes of data collection and reporting.
• Improving communication and outreach to providers could improve providers' likelihood of responding.

There are several options for providing broader measures of timely access

• These include surveying office locations, incorporating the DMHC's binomial probability calculation, reporting more nuanced access data, and incorporating nurse practitioners and physician's assistants into the sampling frame.

Timely access to care is an important element of a high-performing health care system. There is, however, very little evidence to inform metrics and appropriate benchmarks. Given the limitations of the literature, the state of California has taken the lead in developing metrics, standards, and a methodology for collecting the needed data for monitoring timely access to care in the state. The California Department of Managed Health Care (DMHC) has developed the Provider Appointment Availability Survey (PAAS), which health plans that offer products regulated by the department are required to implement. The PAAS methodology has changed over time to address issues with the data collection and reporting process, but the methodology is set to be finalized in January 2020. Health plans have faced numerous challenges in collecting and reporting this information.

In this report, the authors focus on two specific concerns with the methodology that have been raised by health plans and other stakeholders: the burden associated with the PAAS (particularly on providers) and a change in methodology between measurement years (MYs) 2017 and 2018 that removed a question from the survey script and changed the way compliance is measured. Having conducted an environmental scan of timely access issues, undertaken discussions with stakeholders, and analyzed MY 2017 PAAS data for a subset of health plans, the authors use a multipronged approach to describe and document each of these issues and identify and assess potential solutions.

• Chapter One

  Introduction

• Chapter Two

  The Timely Access Data Collection and Reporting Burden

• Chapter Three

  The Removal of the Alternate Provider Question from the Provider Appointment Availability Survey

• Chapter Four

  Discussion