Using Mock-CAHPS to Improve Medicaid Performance

October 31, 2023


As state health agencies develop new quality strategies and initiatives to address healthcare challenges, the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys will continue to play a vital role in guiding Medicaid plan performance. Data captured in these surveys allow Medicaid plans to understand member-level challenges for diverse populations, operational inefficiencies with healthcare programs and opportunities to improve member experiences.

To accelerate CAHPS improvements, Medicaid plans need to ingest member feedback and address low-performing quality areas throughout the year. Explore how the CAHPS survey provides insights into Medicaid plan performance and strategies for using digital surveys to improve quality scores with our downloadable mock-CAHPS guide.

CAHPS’ Role in Medicaid Plan Performance

The CAHPS Health Plan Survey includes two standardized surveys for measuring member experiences for adult and child populations. Like CAHPS surveys for Medicare and Commercial plans, these surveys compile responses into several quality measures, including:

  • Getting needed care
  • Getting care quickly
  • How well doctors communicate
  • Health plan customer service
  • How people rated their health plan

The Centers for Medicare & Medicaid Services (CMS) include CAHPS measures in the core quality measures for Medicaid adults and children, but states health agencies have the final decision on how to use these measures in quality programs. Some may choose to calculate quality withholding payments and pay-for-performance bonuses based on these measures, while others may consider them for accreditation.

Even in states like Arizona and California where the measures are not used to establish revenue or accreditation, states may conduct surveys to gauge member experiences against national averages, identify areas to improve quality and evaluate health equity initiatives. This feedback can also inform future Medicaid quality strategies and motivate health agencies to add CAHPS to pay-for-performance and quality withholding programs.

How do States Conduct CAHPS Surveys?

Typically, state Medicaid programs will work through an experienced survey vendor to administer surveys in accordance with Agency for Healthcare Research and Quality (AHRQ) guidelines. The AHRQ guidelines include procedures for determining respective sample sizes for adult and child populations, recommended data collection methods, training protocols for interviewers and analyzing results.

However, states and vendors may work together to develop their own survey methodology. AHRQ allows states to make slight modifications to the survey by adding supplemental items, such as behavioral health questions, but states cannot remove, reorder or reword questions. To better understand how Medicaid member experiences are being evaluated, plans should carefully review the standards and procedures outlined by their state’s quality program.

The Value of Medicaid Mock-CAHPS Surveys

CAHPS surveys offer valuable insights into contract-level performance in comparison to regional and national benchmarks. Through the CAHPS Health Plan Survey Database, Medicaid plans can view where they rank among their competitors and develop strategies to maintain or improve scores before the next survey. However, there are limitations to relying solely on the official CAHPS surveys for member experience data.

While the official results may tell plans which quality areas need improvement, this information is relayed to them months after the fact. By the time plans receive results, member experiences may have worsened to the point where they impact other elements of plan performance, such as member retention and care gap closures. To effectively improve CAHPS responses before the end of the year, Medicaid plans need to access member-level and real-time data.

Mock-CAHPS surveys are one of the most popular and effective tools for proactively improving CAHPS responses before the official survey. Designed to mimic the official adult and child questionnaires, mock-CAHPS surveys enable Medicaid plans to capture meaningful data with enough time to resolve issues before the next survey. Based on the data they collected, plans can:

  • Segment responders based on positive and negative plan perceptions
  • Determine which quality measures are near state or national benchmarks
  • Compare results against historic data to identify improvements and deteriorations
  • Direct staff and resources to high-value measures to improve performance
  • Focus high-touch outreach on negative responders to resolve issues

Your Mock-CAHPS Guide

Improve Medicaid CAHPS Data with Digital Surveys

To get the most out of a mock-CAHPS survey, Medicaid plans need to employ the right digital tools to maximize response rates, streamline survey administration and optimize follow-up interventions. Digital-first surveys allow plans to move from reacting to the CAHPS survey to proactively improving member experiences with data-driven interventions. Here’s how to get started:

Administer Surveys Digitally

Surveying members with paper surveys or over the phone with live agents comes at a high price tag that does not always yield the highest return on investment. These services are often less convenient to members who need translation services, experience housing instability or are too busy to talk to an agent or mail a survey.

Instead, plans should leverage secure webpages and mobile applications to distribute mock-CAHPS surveys. These channels allow members to share feedback at any time of the day and at their own pace. On the plan’s side, this comes at a lower cost and enables plan operators to easily process and analyze digital responses without manual or inefficient processes.

Educate Members Through Preferred Channels

The diverse populations served by Medicaid plans engage with their healthcare in different ways. Members who experience housing insecurity may rely more heavily on mobile apps, text messages and websites to connect with their health plans. In contrast, rural communities with limited internet access will prefer direct mail and phone calls.

Plans should leverage omnichannel outreach and member preferences to educate them about the value of completing a mock-CAHPS survey. This will not only maximize response rates, but also build member trust. Where possible, digital engagement should be employed first, with phone calls and direct mail serving as wrap-around support for non-digital members. This allows for more equitable and cost-effective outreach.

Monitor Performance in Real Time

Allowing members to share feedback digitally provides plans with near instant access to responses. By using real-time dashboards to monitor mock-CAHPS surveys, plans can quickly analyze completion rates and responses to guide best next steps. Integrating dashboards with omnichannel engagement tools further enables plans to nudge members to complete surveys and provide the right assistance to resolve negative feedback.

Synchronize CAHPS and Clinical Data

One of the major benefits of digital surveys is the ability to integrate responses with member records. By pairing member feedback with provider data, care gaps, pharmacy records and other self-reported experiences, plans can efficiently contextualize responses to understand the root causes of negative sentiment.

For example, if members are reporting negative experiences with their primary care providers, plans may determine that the main cause of poor health outcomes is a lack of consistent care coordination. These insights can help plans determine where to focus resources to improve health outcomes and CAHPS performance.

Accelerate Medicaid CAHPS Performance with Healthmine

Wherever a Medicaid plan is in its CAHPS strategy, Healthmine can streamline performance improvements with a comprehensive member experience tool kit. Partnered health plans have achieved 71% higher response rates with our digital mock-CAHPS survey at 40% of the cost of paper surveys. When implemented from our member engagement solutions, plans gain access to real-time dashboards, detailed member profiles and customizable smart lists to help them respond quickly to member feedback.

Download a guide for optimizing Medicaid mock-CAHPS strategies with digital survey capabilities and discover how you can accelerate quality scores with Healthmine’s solutions. 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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