Responses to the CAHPS survey are grouped together to make up nearly a fifth of a health plan?s total CMS Star Rating. CMS also puts greater weight on CAHPS-related Star measures when compared to a number of other Star measures.
How can you impact a member?s experience?
There are a number of ways that a member?s experience can be affected, both by Independence and in your provider office. We fully acknowledge that you are already working hard to provide exceptional care to our members. In order to continue improving performance, Independence wants to collaborate with you to maximize the member?s experience in the provider office.
As part of this effort, Independence wants to share the specific areas in which CMS is measuring performance. The areas below are the categories found in the CAHPS survey that you directly impact. In addition to highlighting these areas, we have included brief reminders on best practices for you to consider.
- Getting appointments with specialists as soon as patients need them. Some patients believe that they must see a specialist urgently when, in reality, the referral is not always urgent. Please establish a reasonable time frame for when patients should expect to see a specialist.
- Getting appointments for checkups as soon as patients need them. Please let your patients know that if their condition is urgent, you will ensure they are seen as quickly as possible.
- Patients see their provider within 15 minutes of the appointment time. When your patients check into the office for their appointment, please notify them if the office is running behind. By letting members know ahead of time if they should expect a wait, you can hopefully alleviate any concerns patients may have with an extended wait time.
- Provider offices follow up with patients to give test results after ordering a blood test, X-ray, or other test. Set expectations with your patients about when they should expect to hear from your office regarding their test results.
- Providers discuss prescription medications patients are taking. Discussing prescription medications with your patients will help them to better understand their options for filling prescriptions (e.g., mail order), correct dosage, side effects, and how different medications can interact.
- Personal physicians help their patients manage their care and stay informed. Staying up-to-date on visits to specialists and coordinating care are important aspects to keeping your patients as healthy as possible. Staying informed can also reduce patients? out-of-pocket costs by removing any unnecessary duplication in tests or services.
How does a health plan?s Star Rating impact providers and members?
The biggest motivator to improve the Star Rating for our health plans is our members. In addition to our members being more satisfied with the care they receive from Independence network providers, health plans that earn at least a Four-Star Rating qualify for federal bonus payments, which by law, must be returned to the beneficiary in the form of additional or enhanced benefits, such as reduced premiums or cost-sharing (e.g., copayments) or expanded coverage.
Network providers may also benefit from an improved Star Rating, including the following:
- potential for increased patient base (Five-Star Rating plans are granted a special enrollment period, allowing Medicare beneficiaries to enroll throughout the year);
- better performance in Independence quality incentive programs, such as the Quality Incentive Payment System program, Preventive and Quality Improvement Program, and Primary Care Advancement Model;
- improved relations with your patients and Independence.
For more information
Independence Medical Directors are focused on improving the health of our members and the quality of care provided. If you have questions about this information or would like to know more about the CAHPS survey or Star Rating Program, please email Heidi Syropoulos, M.D. You can also read more about the CAHPS survey on the CMS website.