Strategies for Becoming a CAHPS-Focused Health Plan


Improving member experience through improved Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores continues to be top priority for health plans. The weighting changes over the past two years, the potential for additional weighting changes in the future, and the need to be the front runner in performance will require innovative thinking and thoughtful use of already stretched resources. With limited resources within most health plans, you must be strategic in the development of tactics for improvement.

To significantly improve CAHPS scores for Medicare, focus on three things:

  • Ensuring accurate member data, a key element to effective touchpoints and overcoming operational issues through effective communication that reaches the member. Plans need to ensure member addresses, phone numbers and communication preferences are accurate.
  • Building strong stratification of member experience by identifying personas and communications that speak to the member. Plans cannot continue to develop standard communication for each member and expect the outcome to change. We have to meet the member where they are and stand with them in a place they are comfortable. This begins with how messaging is built and how that messaging is delivered.
  • Ensuring the touchpoints for the member is a CAHPS push. Do not let interactions pass by that could dramatically improve the view the member has of the health plan. Improving member experience is a full-time job, so make the most of each interaction.

Embrace CAHPS Changes

From an industry trends perspective, we must be prepared for anything. When the CAHPS cut points arrived in 2022, no one was expecting to see cut point drops. Everyone was expecting the worst.  However, in planning for the upcoming CAHPS survey, plans must be prepared for the unexpected. Most in the industry expect there to be an upward shift in cut points, but the level of certainty is widely unknown. We believe we will see the focus on improving member experience continue and plans to begin moving more quickly into engaging their members via enhanced member portals, multiple paths to digitally engage their members, and ensure member issues are resolved quickly and in a way the member walks away knowing the plan truly cares.

All Medicare plans must ensure they are meeting members where they are and see the health plan experience from the member’s point of view. Plans must be swift in understanding both the racial and cultural make-up of their members. As yourself:

  • Are you creating communication in the language your member needs?
  • Do you represent the plan in a way that members, regardless of race or culture, feel like they belong?
  • Are you identifying disparities facing certain groups of membership or even lack of resources based on location within the market?

Unless you begin to understand your membership make-up, you will not be successful in meeting their needs and improving their experience with the plan.

Where to Focus Your Resources

CAHPS has always been challenging because we do not know who is responding. With HEDIS gaps, we know exactly who to target and can develop outreach with this information. To become a CAHPS-focused health plan, implement off-cycle surveys to gather proxy data that can be used as a measuring stick for potential official CAHPS survey respondents. Plans may need to survey key accounts to understand the needs of specific groups. We live in a world where we sometimes become overwhelmed with data, but for CAHPS, we can never have too much. The more you know about the population, the better able you will be to address their needs and improve their experience.

Health equity is becoming an area of intense focus for health plans. For plans to be successful, knowing their membership is going to be key. Without a full view of membership, ensuring equity is going to prove to be a hard mountain to climb. Now is the time to begin building out the framework for member personas and understanding what their needs are related to getting quality healthcare. Start by reflecting on two questions:

  • Have you built out race and ethnicity reporting for your plan and validated for accuracy?
  • What reporting have you created to ensure you understand the social determinants of health needs of your membership?

Lastly, to become a CAHPS-focused health plan you can’t forget about your provider network. With the number of measures related to care directly impacted by the provider, plans must be diligently working to build relationships with those providers, educating them about the importance of the care they provide related to member experience, and potentially incentivizing providers on their experience scores. As difficult as it may seem, the relationships the plan builds with their providers can and will improve member experience scores. We also must change our path as Star Ratings changes. In the past, focus on incentivizing HEDIS was important due to the weighting of the domain. As the Star Ratings program evolves, evaluate your incentive plans to focus on what must now improve.

At Healthmine, we have the tools ready to help you in improving you CAHPS scores through the implementation of mock-CAHPS surveys and Pulse Surveys. These surveys will assist you in understanding provider performance and what changes you can make quickly to ensure success for CAHPS season. The more you know about member experience, the more successful you will be. Reach out to me at to get started on improving your CAHPS strategies to better align with current needs.