2024 Annual Provider Accessibility Audit Results

Highmark Wholecare conducted the 2024 Annual Accessibility Audit of Medicaid and Medicare primary care providers, medical specialists, and behavioral health specialists during the second quarter of this year. The audit determined if participating practice sites were adhering to established access standards related to the timeliness of member care. Practice sites that failed one or more standards have received a letter indicating required next steps.

Overall, the audit results were positive and identified the following achievements:

Medicaid

• Primary care practice sites see patients for routine care within 10 days, urgent care within 24 hours, and provide timely access to after-hours care.

• Obstetrician-gynecologist specialist practice sites provide timely access to urgent care within 24 hours.

• Oncology specialist practice sites see patients within 30 minutes of their scheduled appointment for routine care and make three attempts to reach patients for missed appointments, with at least one attempt by phone.

• Compliance increased for all provider types across most standards, most significantly for urgent care and routine care in 2024.

Medicare

• Primary care practice sites see patients for routine care within 30 days, urgent care within 24 hours, and provide timely access to after-hours care. Primary care sites also see patients within 30 minutes of their scheduled appointment for routine care and make three attempts to reach patients for missed appointments, with at least one attempt by phone.

• Oncology specialist practice sites see patients for urgent care within 24 hours and see patients within 30 minutes of their scheduled appointment for routine care.

• Compliance increased for all provider types across most standards, most significantly for urgent care and routine care in 2024.

• Behavioral health practice sites see patients for urgent care within 48 hours. Additionally, they showed significant improvements for seeing patients with non-life-threatening emergencies within 6 hours, initial routine care within 10 days, and follow-up routine care within 15 days.

To promote continued access improvement, Highmark Wholecare is focusing on the continuous education of our provider network through the Accessibility Standards. Please use the resources found here to provide continued education for your office staff that schedule member appointments, including central scheduling and call center staff.

The next annual accessibility audit will be launched in the second quarter of 2025. Thank you for your participation in the audit and ensuring patients have timely access to care!