By the Get Well Team
When Medicare Advantage (MA) members have positive experiences with their plans and providers, and they share this feedback on Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, everyone wins. It not only means members are feeling generally positive, research shows it also means they are doing a better job of managing chronic conditions and maintaining healthy habits.1
Plans come out ahead as well, not only because they are doing the right thing by supporting practices that result in better care and improved health outcomes, their actions are reflected in positive plan performance and governmental financial rewards.
‘They Don’t Understand Me’: Building Member Trust
Sometimes the experiences MA members have had are not perceived as positive and their CAHPS and Star Ratings reflect this. This is particularly true when it comes to earning higher scores from members who have social determinants of health (SDOH) needs. Why might this happen?
“Members want to feel listened to, and want to know they’re understood,” says Bagge. “One key area where plans have struggled in the past is in meeting members with SDOH where they are. They need to build trust and let them know they’re not just a number.”
To better grasp how this might play out, consider this example: 98% of MA plans offer fitness benefits as a key feature.2 However, for members with SDOH needs, prioritizing fitness is complicated by daily struggles, and studies have shown that these populations face unique barriers to engaging in enough physical activity to acquire health benefits.3
71-year-old Elena works evenings as a housekeeper—and from 6:00 a.m.to 4:00 p.m. each day, she babysits her grandson. Elena has diabetes, is overweight and wakes up nearly every night, panicked about the mounting bills she needs to pay. This morning, she reaches for the mail and sees a postcard from her health plan, reminding her she has a gym member benefit. To Elena, getting to a gym feels almost as impossible as flying her family to Disneyland. “Ellos no me entienden (They don’t understand me),” she thinks, as she throws the postcard away.
Understanding CAHPS and Why It Matters
CAHPS surveys are built on guidelines developed by a group of research organizations, presided over by the Agency for Healthcare Research and Quality (AHRQ). Each year, the Centers for Medicare & Medicaid Services (CMS) administer these surveys to a random group of patients to gauge their experience; if they don’t respond, CMS follows up. AHRQ is then responsible for compiling survey responses into measures that are then used to score quality.
CAHPS measures matter to MA plans for several reasons, including the fact that they factor into the calculations in CMS’s Star Ratings, which is a program that asks plan members to score the quality of care using a one to five ranking system. Plans that are able to reach four or more stars receive additional quality bonus payments (QBPs) which can be substantial. Generally, the higher the star ratings score, the more revenue a plan can earn.
Enhancing CAHPS through Personalized Digital Engagement
Leveraging a digital patient experience platform that not only addresses CAHPS categories, but is built to address the complex issues most SDOH members face, is an excellent path forward for MA plans wanting to optimize their resources.
Here are some features to consider when assessing digital experience platforms that can help make a meaningful and lasting impact on CAHPS scores:
- Chronic Condition Management: Look for a platform that provides personalized engagement that not only ticks the necessary boxes, but actually demonstrates you understand the unique challenges people with chronic conditions face—and that you care about their health. Their ongoing need for care can also bring an opportunity to build trust over time.
- Member Health Support: Does the platform offer interactive resources that engage members in their health journeys, and provide follow-ups beyond what’s absolutely required, so members genuinely feel supported? This level of tailored interaction fosters a stronger connection between members and their health plans, ultimately enhancing their experience and makes it more likely they’re experiences will be reflected positively on CAHPS surveys.
- Service Satisfaction: Traditional service models can leave members frustrated. Look for a provider that has the capability to transform this experience into a positive one. One way is by routing members to live navigators when needed. The platform should also make it easy for members to reach out when they need it.
“Proactive digital engagement is not just a nice-to-have; it’s essential and a cost-effective way for MA plans aiming to improve member experience and CAHPS performance. Our platform breaks down barriers to care and helps members feel valued and heard.”
About Get Well
With Get Well, you can deliver a personalized, digital member experience in order to drive higher satisfaction scores (CAHPS), and support your plan’s Health Equity initiatives. Our Health Plan and Payer solutions let you customize campaigns to attract and engage members. As a result, you can simultaneously achieve your business goals, like revenue growth, as well as meet the unique needs of your member populations. Learn More here.
- Agency for Healthcare Research and Quality (AHRQ): https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/improvement-guide.html ↩︎
- Extra Benefits Offered by Medicare Advantage Firms Vary. Jeannie Fuglesten Biniek, Nolan Sroczynski, Meredith Freed and Tricia Neuman. Kaiser Family Foundation. November 16, 2022. https://www.kff.org/medicare/issue-brief/extra-benefits-offered-by-medicare-advantage-firms-varies/ ↩︎
- Overcoming barriers to physical activity in underserved populations: Amy Bantham, Sharon E. Taverno Ross, Emerson Sebastião, Grenita Hall, Progress in Cardiovascular Diseases, Volume 64, 2021, Pages 64-71. https://pubmed.ncbi.nlm.nih.gov/33159937/ ↩︎
