Special Needs Survey

1. How satisfied are you with [care manager]’s availability to speak with you? 0 1 2 3 4 5 6 7 8 9 10

2. How satisfied are you with [care manager]’s ability to provide you useful information to help manage your health? 0 1 2 3 4 5 6 7 8 9 10

3. How satisfied are you with how [care manager] helped you understand the doctor’s treatment plan? 0 1 2 3 4 5 6 7 8 9 10

4. How satisfied are you with how [care manager] helped you get the care you needed? 0 1 2 3 4 5 6 7 8 9 10

5. How satisfied are you with the courtesy and respect [care manager] treated you with? 0 1 2 3 4 5 6 7 8 9 10

6. How satisfied were you with the care management services that you have received to help you achieve your health goals outlined in your individualized care plan (ICP)? 0 1 2 3 4 5 6 7 8 9 10

7. How satisfied are you with the care you have received from your interdisciplinary care team (ICT) while being in care management? 0 1 2 3 4 5 6 7 8 9 10

8. How satisfied are you with the care management program as a whole? 0 1 2 3 4 5 6 7 8 9 10

9. How satisfied are you with your health care this year? 0 1 2 3 4 5 6 7 8 9 10

10. How satisfied are you with your prescription drug plan this year? 0 1 2 3 4 5 6 7 8 9 10

11. How satisfied are you with your health plan this year? 0 1 2 3 4 5 6 7 8 9 10

12. What current Martin’s Point plan benefits do you value?

13. What else would you like to see or change in your Martin’s Point benefits?