By now, most of us are well aware of the big news in Star Ratings: The next Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey will make up 33% of the Star Ratings calculation for Medicare Advantage (MA) plans in the 2023 Star Ratings, a doubling of their weighting from 2x to 4x. 

As the metric for determining quality bonuses, changes to the formula for Star Ratings have a big impact: MA quality bonuses were worth a total of $6 billion in fiscal 2019, according to the Medicare Payment Advisory Commission, or about 5 percent of plan revenue.  

While you are awaiting your latest CAHPS results, you can and should start working to improve your plan’s performance on future CAHPS surveys, says Melissa Smith, HealthMine’s EVP of Consulting and Professional Services. To improve CAHPS performance, according to Melissa, an MA plan has to operate differently. This requires tearing down a lot of silos internally—and focusing significant effort outside of your organization—to personalize the care members receive and how they experience care. 

Focus Areas for Improving CAHPS Performance 

The Centers for Medicare & Medicaid Services (CMS) doubled the weighting of CAHPS surveys precisely to force this behavior change by MA plans, Melissa says. It’s a well-planned feature, not a bug (to put it in technology terms). 

Melissa recommends MA plans focus on three areas to improve their CAHPS performance: 

  • Use data to identify unmet member needs and drive more personalized benefit designs
  • Add human and digital touchpoints with members that go beyond the transactional aspects of the plan-member relationship
  • Engage with providers, pharmacies, hospitals, biometric screening providers, durable medical equipment (DME) suppliers, and others who care for your members 

Collect Member Feedback & Use Data to Drive “Mass Personalization” 

Digital tools enable MA plans to receive and act on feedback from members on an individualized basis, at full-population scale, while there is still time to improve the situation. One of the best ways to accomplish this is through a mock CAHPS survey,  Melissa says. 

Using mail-in surveys often means a significant time lag. And because mail-in surveys are often anonymous, they identify needs but do not tell plans which members have those needs. Digital surveys are much timelier and more user-friendly than traditional mail-in surveys, and easier to sustain continuously and afford at scale. They provide useful directional guidance on needs not currently being met and/or areas that could generally use more attention, such as members struggling to get appointments with their doctor or the medications their doctor has prescribed. 

Conducting surveys digitally shrinks the time lag, uncovers individual member needs in real time, and connects those needs to the context of the member’s overall health profile. Digital surveys also allow plans to collect valuable self-reported information to incorporate into the dataset they have about each member. With more current and relevant data built in to the health record for each member, plans can create hyper-personalized programs that close care gaps and improve overall member experience. 

More Touchpoints with Members 

The pandemic has changed the expectations of members in ways, and at speeds, that we did not expect. From restaurants to hair salons, businesses are providing digital tools for their customers to use to confirm reservations, learn about new products or services, and manage their relationship with the business. In MA, we’ve seen use of telehealth explode in 2020, affirming digital skills and connectivity works well with our MA members. 

Health plans have traditionally relied on call centers to reach out to members. But telephone outreach is dying—Melissa says call center outreach has historically yielded no more than 30% answer rates, which has dropped dramatically during the pandemic. 

Using a digital platform to connect with members meets these new consumer expectations, she says. It also allows us to reallocate call center resources to more challenging member needs problems that truly require human intervention. And it gives us a hub connecting member engagement information with member health and claims data. 

For more on this topic, check out a recent webinar Melissa co-presented with Kent Holdcroft, EVP of Growth, on how health plans can harness digital engagement technology to address whole-person care and create a positive member experience. 

Engage Those Who Care for Members 

Most responses to CAHPS questions involve members’ interactions with people and organizations that are not “part of” the health plan, per se: providers, DME suppliers, biometric or other screening providers, pharmacies, and others. 

MA plans can harness the data they have today, including responses to mock CAHPS surveys, to give these collaborators information about their patients/consumers—information that they can use to better serve people, and perhaps, improve their own performance on satisfaction surveys. That data exchange should also go both ways by ingesting data from external vendors and third parties to paint a full picture of the member’s health, and then health plans can use that data to initiate relevant interventions. 

Final Thought

The past year and a half have demonstrated how quickly people can adapt and incorporate new digital solutions across all industries – including healthcare. It’s become increasingly clear that plans must shift their member engagement strategy in order to keep pace. The new wave of digital healthcare coupled with a new weighting of CAHPS scores gives health plans two options: evolve or decline. By focusing on the right type of data, engagement and community relationships, health plans can feel confident that they are set up for future CAHPS success.  

If you need help reaching your CAHPS or Star Ratings goals, our team of experts can support your success. Contact us to learn more.