The Better Medicare Alliance’s Center for Innovation in Medicare Advantage today released new research that examines the current limitations of measuring patient experience in the Medicare Advantage and Prescription Drug (MA-PD) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Based on those findings, the advocacy group proposes changes to modernize the measurement tool.

The Better Medicare Alliance (BMA) contracted with NORC at the University of Chicago to conduct research related to the MA-PD CAHPS to assess the accuracy and usefulness of the assessment tool.

BMA notes that in recent years the Centers for Medicare & Medicaid Services (CMS) has pushed the importance of measuring patient experience and access to care in MA-PD plans and has tied plan payment to those metrics. The agency relies on the CAHPS survey to assess patient experience and includes the data in MA Star ratings. These measures will become more heavily weighted in 2023 to determine health plan quality ratings and payments.

NORC surveyed 800 MA beneficiaries and interviewed 41 experts across 20 organizations representing a cross-section of health care stakeholders to better understand beneficiaries’ perspectives and experiences with MA-PD CAHPS, including asking questions taken directly from the MA-PD CAHPS instrument and probing follow-up questions. The report essentially finds that measuring patient experience in MA needs to be more accurate, meaningful, and actionable.

Indeed, BMA President and CEO Allyson Y. Schwartz said in an announcement that the response rates to the 68-question CAHPS survey have fallen by more than 37 percent in the last decade because Medicare beneficiaries can’t access the survey online and are bogged down by the length and number of questions outside their MA plan’s control.

“The research from NORC not only identifies the problems but also offers sensible recommendations to modernize this measurement tool,” Schwartz said. “By bringing the MA-PD CAHPS survey into the 21st century with a web component, condensing survey questions to get to the heart of consumer experiences that are within MA plans’ control, and providing more geographic-specific survey data to plans in order to spur continued improvement, we can do right by Medicare Advantage beneficiaries, providers, and plans alike.”

The research found that the MA-PD CAHPS survey:

  • Doesn’t capture the diversity of MA beneficiaries and doesn’t address what matters most to beneficiaries in selecting a health plan or how beneficiaries experience care today. For example, survey questions don’t address changes in benefit design and care delivery, such as telemedicine and social determinants of health.
  • Doesn’t provide granular survey data that health plans can use to improve the consumer experience. For example, current survey results are aggregated at the contract level. The results are not provider or geographic specific.
  • Bases measures largely controlled by the provider rather than the health plan, such as office wait times and follow-up on test results.
  • Continues to see a drop in survey response. In 2019, the MA-PD CAPHS survey had an all-time low response rate of 38 percent compared to 62 percent in 2010. One reason for the decline in survey response that it IS only a paper-mode survey. NORC research indicated that 76 percent of beneficiaries preferred to receive and complete the survey via web or email.

To improve the survey, BMA and NORC recommends the following policy changes:

  • Modernize patient experience measurement: Include questions about care coordination, care management, and navigation roles that payers increasingly play for their MA members. Ask questions about patient experience with virtual appointments and visits, which may include ease of scheduling the virtual visit, timely follow-up from the provider and/or plan on the virtual visit, visits with non-physician health professionals, and overall satisfaction with the virtual visit. Modify questions to capture health IT advancements that payers and providers use to communicate test results and coordinate follow-up care. Consider additional user testing to address and account for the ways that individuals from different cultural backgrounds perceive care and how they respond to standardized survey questions. Include questions that matter most to beneficiaries when they choose a plan, such as affordability and the provider network.
  • Provide more granular survey results to health plans while protecting beneficiary confidentiality to empower better health plan quality improvement. Empower survey vendors or another third-party to provide de-identified CAHPS results that offer more actionable information to the plans. This should include more information about providers, respondent demographics, and geographies, but not beneficiary identifiable information.
  • Remove MA-PD CAHPS questions that health plans cannot directly impact. Many questions on the MA-PD CAHPS survey ask about experiences that are outside the control of health plans. Similarly, beneficiary survey responses show a similar pattern of attributing responsibility for questions asked about in the survey to entities other than the MA plan.
  • Reduce the burden on beneficiary survey respondents to improve response rates. Conduct a pilot program that adds a web-mode MA-PD CAHPS option to assess the impact on completion rates. Have MA plans and survey methods experts take part in a transparent exercise to test the validity and reliability of reducing the number of MA-PD CAHPS questions.
  • Delay the increase of weighting of patient experience measures in the Star ratings systems until after the patient experience measurement survey is updated.