Improving Consumer Assessment of Healthcare Providers and Systems scores

BrandonTaylorheadshotWith the continued transition to value-based care, the points of differentiation for health plans are narrowing. However, those plans that prove capable of moving the needle on traditionally difficult measures will have the opportunity to become four- and five-Star plans.

One group of those measures — the Consumer Assessment of Healthcare Providers & Systems (CAHPS®) — is becoming increasingly important as patients are being asked to make more informed decisions about their care.cahps-blog-image

Following best practices for member satisfaction is an important step to improving CAHPS scores. The most essential of these include year-round focus, customer service, resolving member issues and leveraging data assets. We review these best practices in more detail here.

Addressing CAHPS in the future

While data sources such as disenrollment surveys, compliant tracking modules (CTMs), customer service data and grievance data help pinpoint member satisfaction, in the future they may not be as sufficient to move the needle on CAHPS measures.

The traditional approach to improving CAHPS is limited by the data, which only exists for a limited fraction of a plan’s membership. Applying solutions for that specific data to an entire population may be ineffective because complaints and customer service data are for an issue that already exists. Applying a blanket approach to a broad segment of your population can be seen as more reactive. The key to improving CAHPS scores in the future is to be more proactive in the future, and engage members in the way they want to be engaged.

Moving from reactive to proactive

There are two key challenges to managing and improving CAHPS performance:

  •  Move from reactive to proactive
  •  Engage members in the way they prefer

Data can help identify members who have issues now, as well as identify those who may be at risk to develop issues in the future. It’s also important to understand the overlap in risk across all measures and communicating with these members by directly addressing their barriers to engagement.

For more insight on key strategies that can impact Stars measures read, “Best practices for a successful Stars management program.”

About the author
Brandon Taylor, JD, MBA
Director of Clinical and Quality Solutions, Optum

Brandon is responsible for product strategy and growth of the Stars line of business. His expertise includes leading HEDIS and Stars strategy, in addition to HIE and EMR data integration strategy, for the first national publicly traded company to receive a 5-Star rating. He also managed IT innovation projects for one of the largest health plans in the industry.

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