Question

A health plan is required to have a mechanism for members to submit complaints. Which of the following actions must be included in the complaint analysis to ensure the plan makes full use of this type of information?

a. Total each complaint category at least on an annual basis.
b. Calculate the average number of complaints per office site.
c. Review complaints to find system problems that can be improved.
d. Determine the date/time the complaint occurred and the person responsible.

Answer 1

A health plan must analyze complaints by reviewing them for systemic problems, totaling complaint categories annually, and determining the specific details of each complaint to improve services and member satisfaction.

Step-by-step explanation:

To ensure a health plan makes full use of the information obtained from member complaints, specific actions must be included in the complaint analysis. It is important to:

1. Review complaints to find system problems that can be improved. This involves looking for patterns or recurring issues that indicate underlying problems with the health plan's processes or services.
2. Total each complaint category at least on an annual basis. This helps to identify which areas are receiving the most complaints and may require additional attention or changes to reduce future complaints.
3. Determine the date/time the complaint occurred and the person responsible. This information helps to track down specific incidents and ensure accountability within the health plan's operations.

Analyzing complaints in this manner enables a health plan to take preemptive measures to improve their services, which can lead to higher member satisfaction and better overall performance of the plan.