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How Healthcare Payers Measure Patient Experience, Use CAHPS Surveys

Healthcare payers use the CAHPS Health Plans Survey to assess patient experience and fulfill other quality reporting requirements.

Just as hospitals and clinics place high priority on understanding the patient experience of care, as do healthcare payers looking to offer high-quality and satisfactory plans to beneficiaries.

While different health payers may have their own unique methods for assessing patient experience, the Consumer Assessment of Health Plans Survey (CAHPS) is a universal tool used to better understand the patient perspective with a health plan.

The survey, which is separate from the Consumer Assessment of Healthcare Providers and Systems, looks at various care quality indicators and asks patients about the level of care they received.

“The CAHPS Health Plan Survey is a tool for collecting standardized information on enrollees' experiences with health plans and their services,” the Agency for Healthcare Research and Quality (AHRQ) explains on its website. “It was designed to support consumers in assessing the performance of health plans and choosing the plans that best meet their needs. Health plans can also use the survey results to identify their strengths and weaknesses and target areas for improvement.”

And as noted above, the CAHPS Health Plan Survey is nearly universal. Survey sponsors include individual health plans, any state agencies that purchase and regulate health care such as Medicaid, the Department of Defense, and CMS.

The CAHPS Health Plan Survey measures five different categories, including:

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

There are also supplements for children with chronic illness, health literacy, or individuals with mobility impairments.

They key to gleaning actionable data from these surveys is selecting a viable survey implementation process. Per AHRQ, health plans may consider the following to ensure effective survey data:

  • Constructing the sampling frame
  • Choosing the sample
  • Maintaining confidentiality
  • Collecting the data
  • Tracking returned questionnaires
  • Calculating the response rate

As noted above, numerous different entities leverage the CAHPS Health Plan Surveys to analyze their plan quality, although some have different parameters. For example, commercial health plans look at a 12-month retrospective to assess patient experiences, while Medicaid traditionally looks at six months of patient data.

Other entities use CAHPS Health Plan Surveys to fulfill other care quality measures. Specifically, the National Committee for Quality Assurance (NCQA) HEDIS measures leverage CAHPS Health Plan Surveys to satisfy one of their measure sets. For CMS, the CAHPS Health Plan Survey helps bring more transparency to the enrollment process.

How does HEDIS use the CAHPS Health Plan Survey?

The fundamental purpose for the CAHPS Health Plan Surveys for NCQA is to fulfill the patient experience measure set for their HEDIS measures. The HEDIS measures create an internal ranking of health plans, informs health plan accreditation, and helps NCQA set new measure standards.

While HEDIS measures are not a patient-facing tool, the patient experience of care plays a critical role.

NCQA uses a modified version of the CAHPS Health Plan Survey to fulfill that patient experience measure. The subtle differences that distinguish the NCQA CAHPS survey from the AHRQ survey include some supplemental items and different implementation protocol. Specifically, NCQA requires a different sample size, data collection method, and definition for child.

How does CMS use the CAHPS Health Plan Survey?

CMS also uses the CAHPS Health Plan Survey to inform its own rankings. Specifically, the agency uses the survey to create its Medicare Star Ratings, which are consumer-facing tools that help beneficiaries and their family members make informed decisions about which Medicare Plan they choose.

CMS purposely uses simple and familiar ranking scales to ensure this data is usable and actionable for patients.

The agency looks at six measure sets as a part of its CAHPS Health Plan Survey and patient experience measures:

  • Getting Needed Care
  • Getting Appointments and Care Quickly
  • Doctors Who Communicate Well
  • Customer Service
  • Getting Needed Prescription Drugs
  • Care Coordination

CMS also asks patients to provide an overall rating for the health plan, for care quality, and for their Medicare Advantage or Part D drug plans.

Medicare publishes this data in the Medicare and You handbook issued to beneficiaries for each plan year. This patient-facing tool allows members and their families understand their health plan quality. Consumers may also view the Medicare Plan Star Ratings online.

However, very few patients actually use these ratings to make health plan decisions, according to 2018 data from HealthMine.

Currently, only about one in five patients have used the CMS Health Plan Star Ratings. Limited patient use can largely be credited to lack of consumer awareness about the rating system. Seventy-five percent of respondents said they would be interested in using the star ratings if they learned more about them.

As more healthcare payers continue to analyze the beneficiary experience, it will be essential that they make this information actionable. While some payers use patient experience data internally to make plan improvements, others use that data to create patient-facing tools that help patients make care decisions.

Driving patient education about these tools and make these tools usable and understandable will be essential to yield more meaningful for patient experience measures.

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