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Changes are coming to CAHPS survey methodology. Here’s what you need to know.

Medicare Advantage (MA) plans should start beefing up their databases of email addresses. The payoff? An increase in your health plan survey responses.

Pending changes from the Centers for Medicare & Medicaid Services (CMS) include one that CMS has long hinted at: the addition of email or web-based responses to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey methodology, specifically for MA and Medicare Part D prescription drug plan (PDP) CAHPS surveys. This change in survey methodology, in response to overwhelming support from health plans and other patient/member advocates to the 2023 Advance Notice, will go into effect with the CAHPS survey scheduled for February 2024. That means health plans have less than a year to prepare.

CMS field-tested this change with two random samples of MA enrollees. One used the old survey methodology: two mailings and as many as five or six phone calls. The new test methodology was a “three-phase sequential multimode approach, web followed by mail followed by telephone,” giving enrollees a choice in how they responded to Medicare CAHPS survey requests.

In its field test, CMS found that, for enrollees with email addresses, the web-mail-phone protocol boosted response rates by 4 percentage points. CMS also determined that adding an email protocol to the survey methodology would not bias plan scores, because the field-tested survey that included the email protocol did not drive results statically different from the longstanding mail-phone survey protocol.

Most respondents (79%) with the web option still chose to respond by mail or phone, with 21% replying via email. Looking at age, sex, low-income subsidy (LIS) or dual eligibility (DE) status, race/ethnicity, education, and health status, the overall pattern of differences between the two protocols was consistent with chance.

When the revised survey methodology launches in February 2024, it will employ a prenotification letter (sent through the mail), a reminder email or letter survey invitation with a personalized link to complete the survey online, up to two mailings of the questionnaire for nonrespondents, and telephone follow-up with those who still don’t respond.

Declining response rates have been a big issue for insurance plans, especially MA plans. Now is the time to position your plan to take advantage of this change in Medicare CAHPS survey methodology.

It’s all about your health plan member database

CMS cites two main reasons for using email and web-based Medicare CAHPS surveys:

  1. They increase response rates.
  2. They cost less.

Phone surveys are expensive—not to mention, few members respond by phone in the first place. Being able to reply by email or online makes the survey process easier for everyone involved. For this to work, however, health plans need to make sure their email databases are up to date. Only then can plans efficiently and cost-effectively reach members for feedback.

I should note that, in the aforementioned field test, CMS didn’t see a significant statistical change between the two survey groups in terms of member satisfaction. Email responses changed only the response rate, not the overall level of satisfaction. That said, I hesitate to rule out the possibility that some health plans might see increased satisfaction: In an “off cycle” CAHPS simulation, Press Ganey sent surveys to 10,000 plan members via email, and received email responses from 1,600 of them. Email respondents to the surveys reported higher satisfaction than mail and phone respondents. But even if that weren’t the case, an increased response rate translates into better data for driving improvement through more robust segmentation—a win-win overall.

3 strategies for keeping member information accurate and up to date

To make sure you have your members’ current email addresses, engage with them outside of the survey process. Plans should have a routine process for requesting contact information. For example:

  1. Ask for email addresses at the time of enrollment. Health plans contact members soon after enrollment to educate them about the process around using plan benefits, and to conduct a health risk assessment. This is a good time to capture and verify contact information, including email addresses.
  2. Build a digital front door. More and more plans are implementing a “digital front door” or member portal, which uses automation to help members navigate healthcare. Encourage members to access information about their plan through a digital front door that requires them to register with an email address.
  3. Partner with the provider network. Each time someone visits the doctor’s office, they’re asked if their contact information is correct. But health plans tend to get that information periodically at best, and may not receive timely notifications about changes. Actively partnering with the provider network can keep plans equipped with members’ up-to-date emails, phone numbers, and mailing addresses.

Plans with low response rates tend to have poor contact information overall—including phone numbers and mailing addresses. The more accurate the information in your database, the higher your response rate.

Remember: Medicare CAHPS survey responses should include telehealth visits

Meanwhile, CMS has reiterated its guidance to capture feedback about telehealth visits (via phone or video). CMS had previously modified survey questions to include wording around telehealth appointments, but wanted to make sure that members keep such visits in mind when completing a survey.

Given the more recent rise and mainstreaming of telehealth, CMS is removing the third component of the “getting care quickly” composite measure, which asks, “In the last six months, how often did you see the person you came to see within 15 minutes of your appointment time?”

The two questions that remain in this measure are:

  • In the last six months, when you needed care right away, how often did you get care as soon as you needed?
  • In the last six months, how often did you get an appointment for a checkup or routine care as soon as you needed?

How to improve Medicare Star Ratings and the member experience

Among the proposed changes to the Medicare Advantage program’s Star Ratings system, which I wrote about earlier this year, was one to reduce the weight of the member experience measures from a factor of 4 to a factor of 2. That change will take effect with the Medicare CAHPS survey conducted in 2025.

Despite that pending adjustment, our message remains largely unchanged: Happy, engaged members are those who go to the doctor regularly, seek preventive care, self-manage chronic illnesses, take their medications as prescribed, and remain enrolled in their plan. Because of this, a member’s experience impacts almost every other Star measure.

CAHPS remains the backbone of the MA Star Ratings program, and the ROI of prioritizing members’ satisfaction, engagement, and happiness is high for health plans. And part of that ROI is an improvement in the other Star measures along the way.

The ‘unfair treatment’ CAHPS question is still up in the air

The issue of whether to add a question about perceived unfair or insensitive treatment to MA and PDP CAHPS surveys remains undecided. According to CMS: “We will consider this item as a display measure for 2025 Star Ratings.”

A test question asked enrollees if, in the last six months, anyone from a clinic, emergency room, or doctor’s office had treated them in an unfair or insensitive way due to disability, age, culture or religion, language or accent, race or ethnicity, sex, sexual orientation, gender or gender identity, or income. Few enrollees reported unfair treatment. Among the 9.4% of MA respondents in the field test who did perceive unfair or insensitive treatment, their health condition was the most common reason cited, followed by disability and age.

Regardless of whether that question ultimately becomes a part of future surveys, health plans must be attuned to healthcare inequities, and how those issues relate to the patient and member experience.

Stay a step ahead of CAHPS regulatory changes

Getting a head start on updating your database of email addresses will help us help you when the new CAHPS survey methodology takes effect next year.

Press Ganey’s health plan consulting team can help you improve your Medicare CAHPS survey rates, CMS Star Ratings, and scores. Together, we can find root causes of dissatisfaction among members of your plan and target specific membership populations with outreach efforts. Reach out to our team of health plan experts to learn how.

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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