Build Member-Centric Strategies With a Guided CAHPS Playbook

August 3, 2023


The increased focus on the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey from federal and state agencies has made one thing clear for health plans: quality and financial performance is intricately tied to member experiences.

Plans that prioritize member experiences in their annual strategies will secure strong scores year-over-year, while those that delay will struggle to overcome the impact of negative plan perception. Wherever a plan is in its CAHPS journey, there is no time like the present to start designing member-centric strategies.

Get ahead of the pack by reviewing the details of the CAHPS program and discover how to build the right CAHPS tools, resources and interventions into annual strategies and daily operations with a guided playbook.

What is CAHPS?

CAHPS is a series of surveys designed by CMS and the Agency for Healthcare Research and Quality (AHRQ) to measure patient experiences within healthcare settings. These surveys are conducted by a certified survey vendor every year from March through June to a select number of patients. Surveys are conducted through the mail. Starting in Measurement Year 2024, the survey will also be conducted by email. Survey vendors also contact non-responders by phone.

What is the Purpose of CAHPS?

The surveys generally include questions about how well providers communicate, patients’ ability to get appointments and needed care, patient ratings of health plans and customer service interactions. Exact questions vary depending on the healthcare setting and services provided. For example, a Medicare Advantage CAHPS survey asks plan-specific questions, whereas the Hospital CAHPS (HCAHPS) survey asks about a patient’s experience with hospital services.

The broad goal of CAHPS is to evaluate patient experiences and quality of care, and CMS notes that patient experiences differ from patient satisfaction in important ways. While patient satisfaction is based upon whether a patient’s expectations are met during a health care interaction, patient experience focuses on what actually happened in the interaction. Through the CAHPS survey, CMS evaluates these interactions to confirm if a patient received appropriate care and review the quality of that care.

How are CAHPS Scores Calculated?

CAHPS survey questions are assigned to specific or composite quality measures. Each response to these measures is quantified into a CAHPS score using complex mathematical formulas within the CAHPS Analytics Program. These formulas take the standard questions within the survey and assign them a number on a scale from 0 to 100, with higher scores representing stronger performance.

Who Uses the CAHPS Survey?

The various CAHPS surveys are used by CMS and AHRQ to evaluate patient care and experiences within different healthcare settings, including:

  • Health plans
  • Hospitals
  • In-home care services
  • Hospice facilities
  • Nursing homes
  • Hemodialysis centers
  • Outpatient and ambulatory facilities
  • Emergency rooms

Among health plans, CAHPS is used to evaluate member experiences within Medicare Advantage, Medicaid Managed Care, Children’s Health Insurance Program (CHIP) and Commercial health plans. However, the survey impacts these plans in different ways.

What Do CAHPS Scores Mean for Health Plans?

CAHPS scoring is a scientific method of evaluating member experiences within health plans. Higher scores mean that members experience positive interactions with health care services, while lower scores reflect negative experiences.

By analyzing survey results, plans may identify opportunities to improve quality of care, access to care, patient-provider relationships or care coordination, all of which contribute to better member engagement and health outcomes. CAHPS scores may also highlight the effectiveness of different care programs, such as behavioral health services.

But CAHPS scores go beyond individual measure performance and program effectiveness by impacting the financial outcomes of health plans.

What is the Financial Impact of CAHPS Scores?

The CAHPS survey is directly tied to quality incentive and health plan accreditation programs in several marketplaces.

The CAHPS Medicare Advantage surveys uses member experiences measures to calculate Star Ratings, and strong performance can play a major role in determining if a plan is eligible for quality bonus payments. Individual states may incorporate CAHPS measures into Medicaid and CHIP quality incentive programs. In these marketplaces, improving CAHPS performance is vital to increasing revenue.

Commercial health plans are also ranked publicly on the National Committee of Quality Assurance (NCQA) Report Card. These rankings can influence an employer’s decision to partner with a plan. CAHPS scores also determine NCQA Health Plan Accreditation, which may be required by state health agencies or employers. As of July 2023, 26 states require Medicaid plans to receive Health Plan Accreditation. Failure to receive appropriate accreditation will bar a plan from working in certain marketplaces.

Beyond quality programs and accreditation, CAHPS scores play a role in member retention and re-enrollment. Poor experiences receiving care often drive members to consider other health plans for coverage, and even members who have neutral perceptions of plans may change coverage if another plan provides them with better benefits or cost-sharing.

For Medicare Advantage plans, stronger CAHPS and Star Ratings can increase enrollment rates by 8-12%.  By improving member experiences, plans can improve retention rates and market share.

How can Health Plans Improve CAHPS Scores?

Achieving CAHPS goals relies on long-term, continuous strategies to improve results. Any interaction between a member and a health plan is an opportunity to improve experiences and responses on the official survey, but the reverse is also true. Negative interactions can occur at any stage of a member’s health journey, and the more time goes by without it being resolved, the harder it will be to rectify.

Paving a way to continuous CAHPS improvements starts with three key areas:

Engage Leadership

Health plans should begin by educating leadership about the importance of member experiences on plan performance. CMS and the AHRQ routinely update CAHPS with new questions, methodologies, and measure weights, and leadership should be prepared to make swift decisions to help plan operators achieve success.

Recently, CMS finalized efforts to add web based CAHPS surveys and email outreach. This regulatory update challenges plans to capture more accurate contact information, including email addresses, to improve response rates. Securing the appropriate resources and staff to address this challenge will require the support of leadership teams. Keeping leadership up to date on the latest CAHPS changes accelerates this process.

Educate and Train Staff

With the right training and knowledge, every team member has the opportunity to improve member experiences. Just as leadership should be aware of the impact of CAHPS scores on plan performance, so too should team members have a general understanding about common CAHPS questions and challenges. Anyone who has direct interaction with a member, such as customer service and care coordinators, should be prepared to ask CAHPS-related questions to gauge member sentiments.

In addition, plans should also train staff to follow the appropriate steps to resolve negative feedback. For example, if a member reports issues finding a provider in their neighborhood, staff may help members use their transportation benefits or search for providers who are closer to their home. More complex issues may require strong coordination between departments and team members, but it ensures that no CAHPS opportunity is missed.

By mobilizing teams to monitor and resolve CAHPS pain points as they arise, plans shift from point-to-point solutions to CAHPS-focused organizations that continuously improve scores.

Move From Data to Action

The two biggest challenges with CAHPS are a lack of awareness about member experiences and the inability to resolve challenges in meaningful timeframe.

Surveying members throughout their health journeys enables plans to monitor member sentiment and collect feedback in near real-time. This can be as simple as customer service teams asking members how they feel about their plan experience or using more coordinated strategies, such as surveys.

CMS forbids plans from asking CAHPS-related questions outside of the blackout period, meaning plans can only conduct surveys from July to January. This grace period is the perfect opportunity to mobilize CAHPS strategies. Plans can use this time to leverage mock-CAHPS surveys or Pulse Surveys to collect feedback that directly relates to specific CAHPS measures.

Based on these responses, plans should coordinate appropriate outreach to resolve pain points. Some complaints will require high-touch phone outreach with live agents, while others can be addressed with low-cost digital outreach like text messages or emails that educate and engage members in the right ways.

Omnichannel outreach tools that leverage multiple touchpoints give plans the ability to quickly organize scalable CAHPS improvements without dividing their strategies between two many systems. Leveraging a single platform for administering surveys and initiating outreach also allows plans to minimize spend, improve efficiency and increase their speed to action.

Choose the Right CAHPS Partner

The complexities of CAHPS require organization-wide efforts to improve scores, secure incentives and improve financial performance, but plans do not have to do it all alone. Healthmine partners with plans in all markets to design targeted and cost-effective CAHPS strategies that survey, engage and delight members throughout their health journeys.

Through our member experience tools, plans can administer robust mock-CAHPS surveys to gauge overall CAHPS responses or drill down into specific pain points with Pulse Surveys. Member feedback is actively ingested into comprehensive records for review and analysis with dedicated account managers, as well as the CAHPS experts on our Expert Advisory Services team. Designed to quickly move plans from insights to outreach, this data can be immediately funneled into omnichannel outreach campaigns to engage the right members in the right ways to accelerate CAHPS performance.

If you need help improving member experiences to secure quality incentives, download our CAHPS playbook to lay the groundwork for continuous CAHPS success. We’ll guide you step-by-step through the best practices for collecting member data, analyzing responses, prioritizing next steps and initiating outreach. Leverage this guide to build year-round CAHPS strategies and contact us to talk one-on-one about how to make them a reality with the member-centric digital tools.

Healthmine is the leading member engagement and rewards solution focused on empowering people to take the right actions to improve their health.

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