Case Studies / Best Practices

Case Study - Using CG CAHPS to Increase Medicare Star Ratings 19.4.2

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SPH Population Engage ™ Summary: A large health plan standardized its patient experience surveys using the CG CAHPS survey instrument recommended by SPH Analytics. SPH Analytics' reporting and the health plan's targeted follow-up provided physicians with timely feedback that yielded a measurable improvement in various aspect of patient care as reported by the plan's members. The marked uptick in scores contributed to the company's high CMS Star Rating for their Medicare Advantage contract. Background: The health plan is system-owned, integrated, and NCQA-accredited. Nearly 25% of its members are Medicare enrollees. As many people throughout the region were already beginning to select their Medicare Advantage plans for the coming year, the health plan hoped that they would be positioned in the marketplace as one of the best. A great CMS Star Rating would do precisely that. The company's previous year's CMS rating of 4.5 was definitely strong, but the quality team did not feel confident that they would be able to repeat that rating in the coming year. The health plan decided to take a targeted approach to assessing their members' experience across the continuum of care to try to improve their Star Rating. Challenge: To zero in on the areas where a measurable improvement would have the highest impact on ratings, the health plan consulted with their CAHPS survey administrator, SPH Analytics. Patient satisfaction throughout the health system's medical practices was identified as an area in need of focus, because research indicates that members' experience with their providers is highly correlated with the ratings of their health plan. The plan's results from patient satisfaction surveys in years past were largely inconclusive – the company's various provider offices were all independently using different survey formats, thus making it difficult to acquire helpful, comparable, and consistent data from across its provider network. Using Clinician & Group CAHPS ® (CG CAHPS) to Increase Medicare Star Ratings Case Study TM 25 % Medicare 24,000 Total Members

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