Working together to improve health care experience.

Working together to improve health care experience.

Learning from CAHPS results

The Consumer Assessment of Healthcare Providers and Systems Survey (CAHPS) is the gold standard used by the Center for Medicare and Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA) for determining member experience with their health plan and health care providers. CAHPS results contribute to NCQA’s Health Plan Rating and Medicare Star rating. In fact, CMS now weighs CAHPS experience measures more heavily than process measures like cancer screenings in its overall Star ratings for Medicare Advantage plans.

Many CAHPS questions relate to a member’s experience with routine and non-routine care and care coordination. We know that we continue to have opportunities to improve health care experience across these areas that your work directly impacts.

As CAHPS responses are anonymous, we have implemented various methods to gain deeper insights into our members’ experiences and expectations, including pulse surveys, annual drill-down surveys, and group sessions. We will continue to share our findings to develop actionable items that improve our shared members’ and patients' experiences.

Communication: Tips to improve experience

We’ve shared that member education and expectation-setting may help decrease some negative responses. We believe this continues to be true. Communicating with members/patients in the following areas may be particularly helpful:

• Referrals: Set and communicate a reasonable timeframe to hear from the specialty office, and explain steps to take if a condition worsens or time elapses.
• Test Results: Communicate to members how test results will be shared (normal vs. abnormal findings). Ensure portals are accessible if this is the method your office uses, or provide an alternative way.
• Care Urgency: Provide education/reassurance if an acute-visit condition can wait until the next day, or explain the appropriate level of care and why it’s recommended.
• Care Team: When your Care Team includes Physician Assistants and Nurse Practitioners to support the Primary Care Provider, explain how they might be the treating provider under certain circumstances when the Primary Care Provider is unavailable.

Thank you for working with us to ensure our members have the best experience possible.