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QHP Survey 101: What This Member Survey Means for Quality Health Plans

The Quality Health Plan (QHP) Enrollee Survey was developed by the Centers for Medicare & Medicaid Services (CMS) to measure the experience of consumers purchasing health plans through the Health Insurance Marketplace established under the Patient Protection and Affordable Care Act (PPACA). CMS rolls the results of these surveys into the Quality Rating System (QRS) scores that are publicly reported on HealthCare.gov so that consumers may better research and compare health plans.  

If you’re involved in operating a QHP, it’s essential to understand how this survey works and how to get started. 

What Is the Quality Health Plan Enrollee Survey?

The QHP Enrollee Survey collects feedback on member experiences with QHPs available through the Health Insurance Marketplace.  

Survey results serve to help consumers choose health plans available through the Health Insurance Marketplace, provide QHPs with information to assess strengths and weaknesses, inform initiatives to improve member experience, and give oversight agencies insights for regulation, accreditation, and quality improvement.  

Is Participation in the QHP Enrollee Survey Mandatory?

Every QHP issuer is required to conduct the QHP Enrollee Survey using a CMS–approved vendor like Press Ganey if it meets the following requirements. 

  1. Offered through the Health Insurance Marketplace in the year prior to the ratings year (with more than 500 enrollees as of July 1 of the prior year) 
  2. Offered through the Health Insurance Marketplace during the ratings year (with more than 500 enrollees as of January 1 of the ratings year)  

What Types of Questions Does This Member Experience Survey Ask?

The QHP Enrollee Survey is based on the Medicaid Adult CAHPS survey and asks members questions about receiving services through their health plans, covering topics such as: 

  • Access to care 
  • Access to information 
  • Care coordination 
  • Ratings of specialist, personal doctor, healthcare, and health plan 
  • Plan administration 
  • Flu vaccination for adults (age 18–64) 
  • Medical assistance with smoking and tobacco use cessation 

In addition to the above measures, which are pertinent to the QRS, the survey gauges experience with cultural competence, how well doctors communicate, customer service, and enrollee experience with cost. The survey also asks standard demographic questions.  

Who Is Surveyed with the Quality Health Plan Enrollee Survey?

All adults enrolled for at least six months, with no more than one 45-day break in QHP enrollment, are eligible to take the QHP Enrollee survey. A CMS–approved vendor selects a random sample of eligible members from each QHP to survey.  

How Do I Administer the QHP Enrollee Survey?

QHP Enrollee Surveys are administered by CMS–approved survey vendors like Press Ganey from January to May every year. Health plan members are surveyed through mail, phone, and web-based modes. The survey takes approximately 12 minutes to complete. 

Why Is the Survey Important for the Patient Protection and Affordable Care Act (PPACA)?

Survey feedback helps Health Insurance Marketplace plans understand and act on members’ needs. A positive member experience indicates high-quality care coverage has been provided—and gives CMS necessary data and insights to maintain the accreditation process, helping ensure the Health Insurance Marketplace provides valuable options for consumers.  

How Does QHP Enrollee Surveying Benefit Patients?

QHP Enrollee surveys give members the opportunity to provide feedback on the experience with their health plan. In turn, these insights help organizations better address enrollee needs and improve the quality of care. Since QHPs expand access to care, leveraging survey data can help these entities better implement aspects of the PPACA. 

How Do QHP Enrollee Surveys Improve Healthcare Delivery?

Collecting member experience feedback on several facets of health plan service provides QHPs with important insights. Key stakeholders can leverage this information to assess service gaps and develop specific improvement strategies. Everyone benefits from QHPs providing better care plans—from members experiencing better care to healthcare systems reducing costs. Press Ganey offers benchmarks, consulting services, and additional tools to ensure success. 

How Can My Organization Get Started with Quality Health Plan Enrollee Surveys?  

QHPs required to administer QHP Enrollee surveys should consult a CMS–approved survey vendor, such as Press Ganey, to implement the survey and help leaders 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 assist participating plans in adhering to survey requirements.  

The QHP Enrollee Survey is a valuable measurement tool for CMS to gauge the effectiveness of QHPs on the healthcare marketplace. To ensure your organization meets the survey requirement, it’s critical to understand the basics of the model and survey program, how to implement the survey, and what vendor to partner with to administer the QHP Enrollee Survey. 

Read more about our regulatory offerings or speak with an expert to learn how your health plan can best measure member experience and comply with CMS requirements.