Improving Consumer Assessment of Healthcare Providers and Systems (CAHPS®) scores is challenging for any Medicare or Medicaid plan. Moving the needle on these scores depends on engagement, perception and experience. Thus, the strategies your organization should leverage to improve CAHPS scores must be patient-centric. With this outlook, your plan will align with recent CAHPS changes.
CAHPS scores focus on the patient experience
The Centers for Medicare and Medicaid Services (CMS) made sweeping changes to CAHPS by giving a higher rater to the member’s experience with the health plan more on , as opposed to health care outcomes. . They define “experience” as all the interactions a member has with a plan and the perception of those interactions (i.e., positive or negative).
The specific areas of the patient experience include interactions with member service call centers, resolution of complaints and appeals, care management programs and communications from the plan.
CMS also makes it clear that experience does not equal satisfaction. This distinction will be critical in how you deploy solutions to boost scores. Experience and satisfaction are adjacent but have many nuanced differences. For example, a member could find an experience acceptable but lack satisfaction with the results.
So how can your plan enhance experiences? Let’s look at some innovative options:
5 tactics to improve CAHPS scores
The patient experience is the sum of all events, meaning many factors impact it. So a singular approach won’t be as successful. Instead, your plan should ensure that member experience is the foundation of all interactions.
1. Focus on CAHPS with year-round programs.
You’ll have a more consistent strategy by expanding it beyond the February-April survey period. The scores are a collection of their perceptions throughout the year, at every member touchpoint with your plan and the providers in your plan so it’s necessary to keep value consistent for the member.
2. Improve member service with better technology and more channels.
Member service may be the biggest impact on experience within your control. It encompasses interactions with call center representatives, ease in finding information on your website or patient portal, as well as convenient access to plan benefits, resources and access to providers of service. Training providers about your member experience initiatives is also important as experience with providers is less under your control but very influential in improving perception of the plan.
First, you want to ensure your website is easy to navigate. Layer that with robust member service technology, such as artificial intelligence (AI). An AI bot on your website can help members find common information that doesn’t require human intervention. Doing so can reduce queues, allowing member service representatives to deal with more complex issues.
Second, members want more options to engage with member service representatives through digital channels such as email, chat or text when convenient for them (outside business hours). Meeting members where they are in terms of communication preferences can better support their perception of the health plan.
3. Overcommunicate, but in a personalized manner.
You have lots of data about your members and can use it to personalize communications. The more relevant the information is to them, the more likely they’ll consider it. Personalization could revolve around chronic health conditions, preventative care, medication reminders and more.
You can learn about member preferences based on how they interact with communications. For example, you can send messages to diabetic patients about improving their diet and getting active. If they engage with the content, you know it’s of interest to them and can continue delivering relevant new programs and best practices.
4. Educate members about the program and resources.
You must ensure that communications are understood, as health literacy can be a barrier. A Medicare Advantage literary study revealed that 74.5 percent of members don’t understand their coverage. Additionally, the Center for Health Care Strategies (CHCS) reported that nearly 36 percent of adults have low health literacy.
If members are confused, they aren’t connected, so their perception will likely turn negative. To overcome this barrier, it’s necessary for the plan to develop communications that improve health literacy.
5. Increase engagement by identifying SDOH needs and addressing loneliness.
Member engagement plays a pivotal role in their experiences. Disengaged members often have negative experiences, or simply don’t realize they have the benefits that they do. When a member has no connection to their plan, communication and service must evolve. So how do you connect with those who are disengaged?
It’s vital to determine why the disconnect is happening. It may have little to do with the effectiveness of your plan or outreach. Often, a lack of member engagement can be the result of two outliers:
- First, there’s the impact of social determinants of health (SDOH). Having unmet SDOH needs can prevent engagement. Screening members for this and using the data to classify members can help you build a plan to address SDOH and boost connection.
- Second is the pervasiveness of loneliness and its impact on members. Those who suffer from persistent loneliness have skewed perceptions, impacting physical and mental health. The “lonely brain” works differently than others, and cognition can be impacted.
Interestingly, lonely members tend not to use plan benefits appropriately—leading to avoidable ED visits, negative experiences, and poor outcomes. Reaching this group is critical to help them utilize plan services regularly, receive the appropriate care and avoid costly medical crises.
Treating Loneliness
Evidence-based treatment for loneliness is now emerging, marrying technology and human connection. Providing this to lonely members can deliver significant results, such as decreasing loneliness and depression, boosting engagement and increasing the use of community resources.
When these things improve, CAHPS responses can too. Again, the key threads are engagement and connection. For more insights, download our CAHPS Score Improvement One-Sheet.
