The Centers for Medicare & Medicaid Services (CMS) developed the Medicare Advantage (MA) and Prescription Drug Plan (PDP) Consumer Assessment of Healthcare Providers and Systems (CAHPS)—also known as Medicare CAHPS—surveys to collect health plan member experience data. As opposed to fee-for-service (FFS)—i.e., Original—Medicare plans, MA and PDP plans are run by private entities. CMS specifically developed these surveys to measure critical aspects of the patient journey undetectable by other channels.
If you’re involved with a Medicare Advantage Organization (MAO), it’s important to know what the MA-PDP CAHPS surveys measure and how member experience influences calculating Star Ratings and Plan quality improvement.
What is MA-PDP CAHPS?
MA-PDP CAHPS surveys collect feedback on Medicare beneficiaries’ healthcare experiences with Medicare Advantage (MA-only) plans, Medicare Advantage Prescription Drug (MA-PD) plans, and Medicare Prescription Drug Plans (PDP). All results from these member experience surveys factor into Star Ratings for health plans published on the Medicare Compare website.
Is participation in Medicare CAHPS mandatory?
CMS requires all MA and PDP plans, 1876 cost contracts, and Part D sponsors with 600 or more enrollees as of July of the previous year to survey a defined sample of their eligible members. Organizations must contract a CMS-approved MA-PDP CAHPS vendor like Press Ganey to administer the survey annually.
What types of questions do MA-PDP CAHPS Surveys ask?
The survey asks questions about MA and PDP plan member experience with numerous aspects of their health plans, including:
- Getting Needed Care
- Getting Care Quickly
- Coordination of Care
- Health Plan Customer Service
- Getting Needed Prescription Drugs
- Provider and Plan Ratings
- Doctors Who Communicate Well
- Other Single-Item Measures
- Whether They Received Annual Vaccines
Survey questions vary between questionnaires designed for beneficiaries enrolled in MA-only, PDP-only, and combined MA-PDP plans. The survey also asks standard demographic questions.
Who is surveyed with Medicare CAHPS?
All U.S. MA and PDP plan members over the age of 18 enrolled for six months or more are eligible for the MA-PDP CAHPS survey. CMS selects a random sample of eligible members from each plan every January. People who are institutionalized at the time of CMS’s sample draw are ineligible.
How do I administer the Medicare CAHPS Survey?
MA-PDP CAHPS surveys are administered by certified survey vendors from March to June each year. Members sampled for the survey will receive a prenotification and two mailed surveys with phone call follow-up with nonrespondents.
Why is the Survey important for Medicare Advantage and Prescription Drug Plans?
MA-PDP CAHPS survey feedback helps organizations understand and act on the needs of health plan members. Member experience results captured in MA-PDP CAHPS surveys identify strengths and weaknesses of health plans—and help CMS determine Medicare Advantage (Parts C and D) Star Ratings, contributing to the CMS Quality Bonus program.
How does Medicare CAHPS surveying benefit plan members?
These surveys give MA and PDP members the opportunity to provide experience input on their Medicare plan provider. The resulting insights are publicly reported on the Medicare Compare website, helping people aging into Medicare eligibility make informed decisions about their health plan. Publishing results for consumer comparison also compels MA and PDP entities to self-assess and understand how to improve CAHPS scores, benefiting the Medicare system as a whole.
How can my organization get started with Medicare CAHPS measures?
The best way to get started is to consult a CMS–approved survey vendor, such as Press Ganey, to administer your MA-PDP CAHPS survey and help your organization stay up to date on all associated requirements. Press Ganey also offers continuous member experience insights through flexible outreach options, consulting solutions, industry-leading expertise, and compliance management to help participating sites adhere to survey requirements.
The MA-PDP CAHPS surveys are standard CMS-required measurement tools for MA and PDP plan sponsors. To ensure your organization complies with survey requirements, it’s crucial to understand the survey program, how to implement the survey, and what vendor to partner with to administer the MA-PDP CAHPS survey.
Read more about CAHPS surveys and regulatory offerings or speak with an expert to learn how your organization can best measure patient experience and comply with CMS requirements.