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Changes to MCAHPS 2024: What’s new, and what’s staying the same

MCAHPS 2024 is quickly approaching, and several substantial changes are planned for this year’s survey. As announced previously by the Center for Medicare and Medicaid Services (CMS), modifications are being made to the survey administration process that will allow for web-based survey responses. Additionally, there are changes to the questions included in the survey.

Outlined below are the major MCAHPS changes and some reminders of survey protocols. Before we get into all the changes, it’s important to note that plans still have time to update their members’ email addresses, which is a vital part of the survey administration. If you want help collecting email addresses, consider working with your health plan provider partners, and ask them to share those email addresses with you if you have a data sharing agreement. CMS indicated in the advance notice that the field testing of the added web-based survey protocol increased the overall response rate by 4 percentage points. Responses to the MCAHPS survey are more robust than other product lines,  but they’ve declined for some plans and slowed for others.

MCAHPS overview

Medicare Advantage (MA) and Prescription Drug Plan (PDP) contracts with 600 or more enrollees as of July 2023 are required to administer MA and PDP CAHPS in 2024.

The MA and PDP CAHPS survey is conducted with a sample of Medicare enrollees who are:

  • At least 18 years of age
  • Enrolled in the MA or PDP contract continuously for six months or more at time of CMS sample draw in January 2024 
    • Continuous enrollment is determined using CMS monthly enrollment data
  • Living in the United States
  • Enrollees known to be institutionalized at the time of the sample draw are excluded 

CMS sample procedures prevent the selection of more than one enrollee per household.

CMS will draw the sample and provide approved survey vendors with sample files for each Medicare contract.

Updates for MCAHPS 2024: Web-based survey administration

CMS is replacing the current mail-phone survey administration protocol with a web-mail-phone survey administration protocol for the 2024 MA and PDP CAHPS survey.

The web-mail-phone protocol includes:

  • Mailed prenotification letter to all sampled enrollees (day 1)
  • Mail a web invitation letter to sampled enrollees without an email address with a web-based survey URL and PIN code (a QR code will not be utilized) (day 3)
  • Two email invitations (if email address is available) with a web-based survey URL (days 6 and 9)
  • Two survey mailings to nonrespondents of the web-based survey (days 14 and 34)
  • Up to five telephone follow-ups with enrollees who do not respond to the web or mail surveys (day 57–67)

Questions added:

  • What language do you mainly speak at home? (Q43 MA-only, Q50 MA-PD, Q12 PDP
  • Treated in an unfair or insensitive way: In the last 6 months, did anyone from a clinic, emergency room, or doctor’s office where you got care treat you in an unfair or insensitive way because of any of the following things about you? (Q48 MA-only, Q53 MA-PD) 
    • Health condition
    • Disability
    • Age
    • Culture or religion
    • Language or accent
    • Race or ethnicity
    • Sex
    • Sexual orientation
    • Gender or gender identity
    • Income

Question deleted:

In the last six months, did you receive any mail-order medicines that you did not request? (2023 question numbers: Q47 MA-only, Q52 MAPD, Q14 PDP)

Change to Star measure:

  • The 15-minute in-office wait time question is not being eliminated from the survey; however, it will not be included in the Getting Care Quickly composite measure for the 2025 Star Rating

Some questions have been revised to more directly reference receiving care in different ways (in person, phone, video):

  • MA-only: Q3; Q5; Q7; Q11; Q12; Q18; Q20; Q27; Q28; Q29; Q30; Q31
  • MA-PD: Q3; Q5; Q7; Q11; Q12; Q18; Q20; Q27; Q28; Q29; Q30; Q31; Q44; Q46
  • PDP: Q6; Q7; Q8 

Sample selection for MA–PD plans

Samples for the 2024 MA and PDP CAHPS Survey will be selected for MA and PDP contracts’ current enrollees, including 1876 cost contracts and Medicare/Medicaid plans, in January.

Sample size varies by type of contract:

  • For MA contracts with 800 or more eligible enrollees, CMS will sample 800 cases; contracts may request a larger sample via a web-based request, but prior approval from CMS is required, and the deadline to submit an over sample approval request is November 30, 2023
  • For MA contracts with between 600 and 799 eligible enrollees, CMS will sample all eligible cases
  • MA contracts with between 450 and 599 eligible enrollees have the option to participate in the survey, but participation is not required; however, contracts that choose to participate will have their scores reported and used in Medicare Star Ratings

MA contracts with fewer than 450 eligible enrollees may not participate in the survey.

The survey version for MA contract enrollees is determined by the plan benefit package at the time of the January sample draw

Medicare Advantage Stars 2025

The 2024 MCAHPS survey results will remain weighted at a factor of 4 for Medicare Advantage Stars 2025 before the weighting drops to a weighting of 2 for Medicare Advantage Stars. Regardless of the weighting, CAHPS survey measurement and member satisfaction/engagement are the backbone of the Stars program. Happy and engaged members are those who see their healthcare provider on a regular basis, seek preventive care, self-manage their chronic illnesses, take their medications as prescribed, avoid the emergency room, and remain enrolled on the plan. The characteristics of happy and engaged members cover most of the Star measures.

For more information, reach out to one of our health plan strategic consultants—they’re ready to answer all of your questions.

About the author

David L. Larsen currently works as Senior Advisor Member Experience at Press Ganey and prior to that he worked as an independent healthcare consultant working with predictive analytics, member engagement, and pharma vendors to improve their offerings and sales approach to managed care plans and working with managed care plans to improve their Medicare Advantage Star Ratings focusing on improvements related to CAHPS, HOS, HEDIS, medication adherence, and member experience measures. David served as the Director of Quality Improvement for SelectHealth in Salt La­ke City, Utah for 32 years and worked for Intermountain Healthcare for 38 years. SelectHealth is a mixed model HMO with more than 950,000 members in Utah, Idaho, and Nevada across all insurance product lines including, Medicare Advantage, manage Medicaid, large, small, and individual commercial plans, and ACA plans. Intermountain Healthcare is an integrated health care delivery system with 23 hospitals and over 1,500 employed physicians. As the Director of Quality Improvement, David had responsibilities for oversight of the Medicare Advantage Stars program for which SelectHealth received a 5 Star rating in 2022, maintaining NCQA accreditation; HEDIS performance measurement and improvement; CAHPS and HOS measurement and improvement, public reporting (transparency), and population health. David has also been responsible for the oversight and development of chronic disease registries, performance measurement and web based reporting systems, quality improvement pay for performance incentives for providers, provider transparency programs, and direct patient improvement interventions related to chronic illnesses including patient adherence monitoring, reminders, and incentive programs.

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