The Many Reasons to Close Your CAHPS Score Gap
Consumer Assessment of Healthcare Providers and Systems® (CAHPS) scores have become a predominant component of Star Ratings. Change Healthcare Consulting helps payers interpret CAHPS data, the annual survey of patients that rates their healthcare experiences on overall access to care, communication skills of providers, customer service, and many other metrics. Plans can take member-experience scores and work to preserve and improve what’s working while mitigating less-positive encounters. That requires plans to identify and prioritize the right investments to improve a member’s healthcare journey — and that’s where help from a healthcare consultant becomes valuable.
By: Mary Branagan, consulting manager, analytics and insights practice, Change Healthcare
Jeffrey Holden, consulting manager, analytics and insights practice, Change Healthcare
CAHPS scores have become an increasingly important component of Star Ratings. That’s why working to increase patient and customer satisfaction not only helps improve scores but also helps plans succeed in today’s increasingly competitive healthcare marketplace.
Leveraging healthcare consulting services can help payers interpret changing, anonymous Consumer Assessment of Healthcare Providers and Systems® (CAHPS) data. CAHPS, the annual survey of patients that rates healthcare experience, covers patient views about such important metrics as overall access to care, communication skills of providers, and customer service, among many other areas.
The link between CAHPS scores and Star Ratings
CAHPS scores, however, shouldn’t be viewed in a vacuum, as they directly impact nearly one-third of the Star Rating system that helps Medicare consumers compare the quality of health and drug plans. Additionally, CAHPS sentiment impacts other plan requirements, such as the Health Outcomes Survey, voluntary disenrollment, and member-adherence behavior. It is estimated that the overall member-experience influence of CAHPS scores on Star Ratings, directly and indirectly, is around 50%.
The minimum Star Rating required for bonus payment is a four (4). If a plan falls below a 4, plans should focus on closing CAHPS score gaps. Understanding the data is key, because analysis of that data provides plans with the insight to close the CAHPS gap. In 2022, there were nearly 100 questions in the CAHPS survey. Improving member sentiment in some of the areas surveyed can help close the CAHPS gap and, by extension, positively affect a plan’s Star Rating.
Using CAHPS scores to improve member sentiment — and financial success
Plans can take member-experience scores and work to preserve and improve what’s working while mitigating less-positive encounters. That requires plans to identify and prioritize the right investments to improve a member’s healthcare journey.
Working to preserve and improve the metrics is not a one-and-done affair. It’s an ongoing process that continuously connects customer and patient satisfaction with CAHPS scores — and Star Ratings.
Plans that receive a 4 or 5 Star Rating are eligible for bonus payments. These payments are in addition to the risk-adjusted base Centers for Medicare and Medicaid Services (CMS) Per Member/Per Month (PMPM) payment. Plans with a 4 rating receive an additional 4% on their CMS PMPM, and plans with a 5 rating receive an additional 5%. That extra revenue can help plans offer richer benefits to new and prospective members, allowing them to better compete in the marketplace.
Plans that receive a 3 Star Rating do not qualify for bonus payments. Furthermore, plans that receive a 3 for two years in a row are in danger of losing the contract.
Moreover, if a plan receives the maximum five-star rating, it can market to and enroll new members throughout the year, not just during the open enrollment period (October 15 to December 7).
How Change Healthcare can help close the CAHPS gap
Change Healthcare’s consulting services can help plans identify and develop strategies to improve Star Ratings. Any plan can analyze their CAHPS data, but that is not as easy as it sounds. The data only tells part of the story. This is where our consultants can play a crucial role in helping your plan understand the meaning of the metrics.
We have experience working with CAHPS data, developing actionable strategies aligned with each plan’s area of need. Our consultants can help develop strategies, including better communications with members, improved customer interfaces (UX), help with mitigating issues related to Social Determinants of Health (SDoH), improved contact-center workflow and processes, member education, and plan and/or provider staff training.
Working with CAHPS data should not be a once-a-year, one-time effort. It requires a long-term perspective and the sharing of knowledge about how to handle, store, and use the data over time to understand trends. Change Healthcare’s consulting team can help plans utilize — and improve — CAHPS data, Star Ratings, and member satisfaction.