The Financial Impact of Dissatisfied Medicare Beneficiaries 

Healthcare organizations across the country use the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to assess patient experiences. CAHPS insights help organizations understand their strengths and identify weaknesses with the goal of improving the quality and safety of healthcare throughout the United States.  

CAHPS is also an important factor in the Centers for Medicare & Medicaid Services (CMS) Star rating system. The agency deploys the Medicare Advantage and Prescription Drug Plan CAHPS Survey to evaluate, incentivize, and rank health plans, which can have a serious financial impact for underperforming organizations.  

The CAHPS survey has influenced Medicare’s Star ratings, which consumers have used to evaluate and select Medicare Advantage health plans for many years, but the stakes continue to get higher. The results of the CAHPS survey will now account for 32 percent of a health plan’s Star rating, and plans that receive at least a four-out-of-five Star rating also receive a Quality Bonus Payment 

With CAHPS having such an impact on ratings and payments, organizations can benefit from acting early on assessment measures. Because member-reported experiences can serve as an early warning system before the CAHPS survey is deployed, periodic surveys can help ensure organizations know what’s going well and where they may need intervention. 


Getting Ahead of the Medicare Advantage CAHPS Survey 

According to CMS, the primary focus of the CAHPS survey is “on matters that patients themselves say are important to them and for which patients are the best and/or only source of information.” The agency is trying to determine if members can get the care they need, quickly secure appointments, reach their doctors, receive coordinated care, and more.  

As a health plan, it may be difficult to track those categories and have a good understanding of the patient experience, especially over time. However, if an organization isn’t aware of deficiencies its members are experiencing in these critical categories, it’s putting its members as well as its Star rating and payments at risk. 

Automating Member Engagement to Understand Their Experience 

Despite the value of engagement, it’s not realistic to contact every plan member and collect feedback about multiple aspects of their healthcare experience. Instead, leveraging patient engagement technology allows organizations to automate outreach to prompt member feedback periodically. If members are having a negative experience accessing high-quality care, this proactive outreach helps organizations identify trends and intervene early, before the results become available to the public and have a negative impact on the Star rating.  

Enrich the Member Experience with Added Support and Resources 

Deploying a member satisfaction survey on a regular basis not only allows health systems to become aware of issues and act early, but also gives organizations an opportunity to simultaneously enrich the member experience. Configurable patient engagement technology gives organizations the flexibility to make questions easy to understand, allows patients to provide qualitative feedback, and enables health systems to respond based on member responses.  

For example, if a member reports difficulty accessing care, the organization can prompt the patient to provide their zip code, then connect them with a care coordinator. This timely feedback immediately changes the member’s perception of their health plan. Addressing concerns also encourages members to participate in future surveys because they are confident the organization will process and act on the information.  

Once a member engages with an organization, the health plan also has an excellent opportunity to learn more about their needs, connect them with resources, such as support groups or transportation services, and deliver coaching and encouragement for healthy living.   

For care coordination teams, the convenience and cost-effectiveness of automated member-direct digital communications can replace traditional methods of phone calls and direct mail, which are resource intensive and time consuming.  

Don’t Wait Until It’s Too Late to Improve Your Members’ Experience 

Healthcare leaders who wait to learn about their members’ care experience from the CAHPS survey may be too late to positively impact the organization’s CMS Star rating. Furthermore, a delayed response to CAHPS feedback is a lost opportunity to ensure members have access to the best healthcare possible.  

Maintaining ongoing communication makes organizations aware of member concerns while also improving the member experiences on an ongoing basis. The most effective approach to high-quality engagement is a technology platform that can evolve with organizational needs, healthcare regulations, and member expectations. 

Learn how Twistle by Health Catalyst can help power your member engagement strategy. Download our free Member Engagement Guide.