How to Use Data to Drive CAHPS Improvements

December 7, 2023


Performance on the Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey is a powerful predictor for member retention, quality ratings and health plan revenue. Health plans must prioritize member experiences in all decisions to improve plan performance.

But with increasingly limited resources and tight budgets, delivering personalized member experiences at scale is extremely difficult. Improving CAHPS scores amidst these challenges requires the right data to make cost-effective and impactful member engagement decisions that make the most of every touchpoint. Understand how to overcome data gaps in member experiences to support targeted and cost-effective CAHPS improvement strategies.

Identifying CAHPS Challenges

Organizing tactics to address CAHPS performance starts by understanding why health plan contracts receive specific scores, but there are several challenges to accessing this information.

First, the official survey does not provide insights into member-level experiences. The official CAHPS survey only shows contract-level performance and prevents plans from determining which members need assistance. In addition, it is also difficult to pinpoint members who would positively impact CAHPS scores and motivate them to share feedback. 

The lack of insight also speaks to two additional, interconnected challenges: declining response rates and disparities in care. The National Committee for Quality Assurance (NCQA) reports that response rates have declined below 40% for Medicare Advantage plans and 20% for Medicaid and Commercial health plans. In addition, the Agency for Healthcare Research and Quality (AHRQ), which designs that CAHPS survey, acknowledges that response rates for underserved groups are lower than national averages.

As a result, current CAHPS scores do not accurately reflect the experiences of diverse communities and limit the ability for plans to deliver equitable quality of care. Plans with high populations of low-income and diverse members, such as Medicaid and Children’s Health Insurance Programs, are especially impacted by these issues. Increased pressure on Medicare Advantage plans to reduce health disparities and improve member experiences also makes this a major challenge for Star Ratings teams.

How Data Guides Member Experience Improvements

As regulators push for better access to social determinants of health (SDOH) data and equitable care, plans in all markets need to develop a well-rounded, whole-person view of member experiences to guide improvements in CAHPS scores. To overcome this challenge, plans need to actively monitor member experiences and address negative encounters before they impact the official survey results. Conducting routine patient experience surveys enables plans to capture high-value metrics to guide CAHPS improvement strategies.

Key data to collect includes:

  • Demographic data
  • Access to care
  • Interactions with doctors
  • Customer service performance
  • Survey performance, including completion and response rates
  • Likelihood to complete surveys
  • Predictive responses to official surveys

Avoid These Surveying Mistakes

As powerful as surveys are for assessing member experiences, there are several risks plans need to avoid to ensure they can access reliable and usable data.

Members may receive surveys from a variety of healthcare services, including providers and pharmacies, alongside other retail services. Adding mock-CAHPS surveys or short questionnaires on top of these communications may contribute to lower response rates. The Centers for Medicare &Medicaid Services (CMS) and AHRQ advise against over-surveying, especially during the blackout period, to prevent survey fatigue and member abrasion.

Instead, plans should carefully select sample sizes to eliminate repeat communications and make the survey process as simple as possible for selected members. Communicating through preferred communication channels and providing members with a variety of options for completing surveys is vital for preventing abrasion.

Keeping in mind the timeliness of survey is also important. Conducting surveys too far after a healthcare event makes it difficult for members to provide accurate information, but plans must abide by the CAHPS blackout period, which typically runs from February 1 to June 30. Major holidays and trends in survey completion should be incorporated in CAHPS strategies to maximize response rates.

Optimize CAHPS Performance with Four Digital Tools

Creating data driven CAHPS strategies is difficult without a strong foundation in survey administration and digital engagement. As plans search for cost-effective and targeted tactics for improving performance, consider incorporating three digital tools into your CAHPS playbook:

  • Web-based surveys: Conducting short surveys in pulses allow health plans to ask questions about specific member experience challenges to support targeted interventions. To rapidly field useful feedback, use web-based surveys to allow members to easily share responses with as little abrasion as possible. By engaging members through text messages or emails, plans can minimize the cost of paper outreach on survey administration while streamlining data collection and analysis.
  • Digital mock-CAHPS surveys: Fully replicating the CAHPS survey allows plans to fill major data gaps with a single questionnaire, but administering it through the mail is costly. Implementing a digital mock-CAHPS survey instead provides plans with instant access to member responses, reduces survey costs and helps plans develop a high-level understanding of future CAHPS performance.
  • Predictive analytics: Predicting how members will respond to the official survey and identifying which members will impact results enables plans to develop strategic and effective CAHPS interventions. When supported by predictive analytics, plans can shift from reacting to historical CAHPS performance to proactive improving scores at a member-level with targeted solutions. Whether a plan needs to bolster response rates for members with positive perceptions or resolve negative responders before CAHPS season, predictive analytics will play a role in success.
  • Data stratification: Consolidating member health statuses, non-clinical information and survey responses into a single profile enables health plans to efficiently stratify data to guide personalized, equitable interventions. Centralizing member data prevents it from becoming siloed in divided systems and allows plans to rapidly create outreach lists based on similar characteristics, such as negative feedback, demographic data and SDOH.

Healthmine’s comprehensive member experience solutions equip health plans with all of these tools to ensure they are fully prepared to maximize CAHPS scores. Supported by our personalized omnichannel outreach capabilities, health plans can accelerate performance in member experiences measures by rapidly identifying challenges and implementing targeted interventions.

Expand your understanding of member challenges and initiate meaningful improvements with our member experience solution. Contact us for a demo

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