Strategies for Continuous CAHPS Improvements


Any opportunity to build trust with health plan members and foster positive experiences is a chance to support continuous plan performance. How members perceive their quality of care correlates to improved health outcomes. Members who report positive member experiences with providers are more likely to self-manage chronic diseases and adopt healthy behaviors.

Understanding what drives positive member experiences, how the Consumers Assessment of Healthcare Providers and Systems (CAHPS) surveys measure member sentiment and how to leverage digital solutions to improve plan performance is vital for plans looking to accelerate their quality improvement initiatives.

What Is CAHPS?

CAHPS surveys are a subset of surveys administered by the Centers for Medicare & Medicaid Services (CMS) every year from March through June to measure the experiences of patients and develop a reliable method of evaluating health plans and providers. These surveys are mailed to a random selection of members from eligible health plans. CMS follows up with calls to members who don’t respond to the survey.

CAHPS surveys follow the specific principles and guidelines developed by the CAHPS Consortium, a group of research organizations that conceives of, develops, tests and refines CAHPS surveys under the oversight of the Agency for Healthcare Research and Quality (AHRQ).

The current CMS CAHPS surveys include:

  • Medicare Advantage and Prescription Drug Plan CAHPS
  • Nationwide Adult Medicaid CAHPS
  • Hospital CAHPS
  • Home Health CAHPS
  • Home and Community Based Services CAHPS
  • Fee-for-Service CAHPS
  • In-Center Hemodialysis CAHPS
  • CAHPS Hospice
  • Outpatient and Ambulatory Surgery CAHPS
  • CAHPS for Merit-based Incentive Payment System
  • Emergency Department CAHPS

AHRQ compiles the responses to these surveys into CAHPS measures that are used to score the quality of care provided by health plans and providers.

Why Is CAHPS Important for Medicare Advantage Plans?

CMS has incorporated CAHPS responses into its public reporting and reimbursement programs to incentivize health plans to improve member experiences. For Medicare Advantage (MA) plans, CAHPS measures help calculate rankings in the Star Ratings program, which allows seniors to compare the quality of care provided by different MA plans based on a one to five ranking system.

Plans that achieve four or more Stars are rewarded with quality bonus payments, which are calculated based on the number of members enrolled in a plan and the cost of providing services to a member. Higher enrollment ranks are also linked to higher ranked plans: growing by just one star can increase enrollment by 8-12%. In 2022, CMS paid an estimated $10 billion in quality bonus payments to MA plans, making bonuses a powerful motivator for plans to improve member experiences.

When evaluating CAHPS performance to determine Star Ratings, CMS focuses on:

  • Getting needed care
  • Getting appointments and care quickly
  • Doctors who communicate well
  • Customer service
  • Getting needed prescription drugs
  • Care coordination
  • Rating of health plan
  • Rating of health care quality
  • Rating of drug plan
  • Annual flu vaccine
  • Pneumonia vaccine

CAHPS measures are quadruple weighted and account for roughly one-third of a plan’s Star Rating. Strong performance in CAHPS measures is vital for achieving four or more Stars, resulting in significant revenue growth and enabling plans to bolster member benefits for the following year.

How to Improve CAHPS Scores

CAHPS scores are directly related to how members feel about their experiences with a health plan, and continuously fostering positive member experiences will allow plans to reach the upper rankings of the Star Ratings program.

Achieving high marks in CAHPS relies on the ability to collect and action member feedback into scalable member experience improvements. In our experience helping plans achieve four or more Stars, here are three areas plans should focus on to boost CAHPS scores.

Capture Member Feedback with the Right Surveys

Keeping a pulse on member feedback with well-designed surveys enables you to develop interventions that convert negative member responses to positive scores. Plans can future-proof their CAHPS scores by sending mock-CAHPS surveys to members to gauge member sentiment prior to the official survey. While plans don’t know which members will end up being selected for the CAHPS survey, mock-CAHPS surveys do help inform overall strategies for maintaining, or gaining, member satisfaction.

CMS allows MA plans to administer surveys based on the AHRQ standards to collect feedback and make the necessary improvements to address member concerns, but plans cannot survey members during the official survey period from March to June. Outside of that period, plans are welcome to capture member feedback to inform strategies that resolve member concerns.

Implement Appropriate Interventions

Based on the data collected, plans can identify patterns. Whether there is a social determinant of health that specific communities are dealing with or challenges members face when contacting customer service, plans can zero in on the issues that contribute the most to negative feedback and implement solutions that deliver widespread change.

For members who need additional support and assistance in getting quality care, personalized interventions may be necessary. Reaching out directly to members through an outbound call campaign enables plans to provide individualized support that converts negative member experiences into positive CAHPS scores. This type of direct outreach may also help close care gaps, identify barriers to care and collect data to inform additional interventions.

Continuously Monitor and Address Feedback

Boosting CAHPS performance is not as simple as closing a single care gap or delivering a one-and-done intervention. Members will always need assistance in receiving the high-quality of care they deserve. Rather than focusing all plan efforts on individual interventions, proactively adjust throughout the organization to foster positive member experiences at every stage.

Routinely surveying member populations throughout the year allows for continuous feedback on common pain points and helps develop year-round strategies for improving member experiences. Healthmine’s Pulse Surveys can be surfaced throughout a member’s health journey to determine if interventions were successful or if additional assistance is necessary. 

Expand the CAHPS Improvement Toolbox

Rounding out CAHPS strategies with digital solutions improves operational efficiency, optimizes interventions and achieves a better return on investment. Employing a digital-first approach to survey administration reduces the cost of distributing mailers and the turnaround rate on receiving feedback. With responses available in real-time, plans can surface insights and develop interventions without performing unnecessary spreadsheet mathematics.

Building out the IT infrastructure internally to inform the specialized CAHPS improvements needed to achieve four or more Stars is a large ask for stakeholders and quality teams, but there is no reason to start from scratch. Healthmine’s suite of digital solutions empowers MA plans to implement scalable solutions to meet CAHPS needs.

Your Mock-CAHPS Guide


How Healthmine Supports CAHPS Improvements

To help plans rapidly evaluate member feedback, Healthmine’s CAHPS Pulse Surveys are tailored to evaluate your performance in specific CAHPS questions. These surveys can be incorporated into end-of-year quality improvement strategies to inform time-sensitive solutions to your members’ most pressing concerns. Our Pulse Surveys are the fastest method of capturing and analyzing member feedback. With an implementation time of less than two weeks, quickly begin collecting the right data to inform CAHPS interventions.

Plans looking to continuously monitor and improve CAHPS scores can access our mock-CAHPS survey. Modeled after the official CAHPS survey, our survey captures vital member feedback and displays results in real-time, allowing you to immediately develop data-driven interventions. When incentivized, our survey achieves a 33% response rate, equivalent to the official survey. Plans can administer the survey digitally through emails, text messages and secure messages, with the option of rounding out their survey capabilities with physical mailers for members who will not engage digitally or have limited internet access.

Leverage Healthmine’s member experience solutions to drill down into member pain points and drive continuous CAHPS improvements to boost Star Ratings. Contact us for a demo.

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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