member engagement


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  • Written by Dan Ready

Given the recent changes to Star by CMS to account for the dramatic impact that COVID-19 has had on health plans and their interactions with members, I spoke with Lisette Roman, Director of Analytics here at Decision Point, to assess the state of CAHPS.

On March 30th, CMS announced several changes to data collection for the Star ratings program as part of an effort to provide temporary relief as providers and plans respond to COVID-19. See the ‘Patients Over Paperwork’ section of the official notice here. Although the flexibilities announced introduce a host of questions and uncertainty for Medicare Advantage plans, there are several definitive conclusions that plans can draw and act on now.

What do plans need to know about the impact of these changes on CAHPS?

Let’s start with what the changes include for 2020. The idea is to provide temporary relief from paperwork and reporting, so CMS has removed the requirements to submit HEDIS 2020 data and 2020 CAHPS survey data. Both of those cover the 2019 measurement year. Also, the Health Outcomes Survey (HOS), is being postponed until late summer.

The first thing to know is that investments in CAHPS made in 2020 in preparation for the anticipated 2021 increase to 2x-weights were not useless. In fact, the opposite is true. This is a pivotal time to elevate members’ perception of the plan. The COVID-19 outbreak is an opportunity to show members that you are truly there for them, which will pay dividends in years to come.

What should or shouldn’t plans do in 2020 to build towards a 4+ Star rating on CAHPS?

First, determine which measures to focus on. Definitely set access and provider related CAHPS measures aside for now. Stay-at-home orders mean that we’re already in a major dip in members’ engagement in primary and preventive care. Instead, focus on plan related CAHPS measures. Target Rating of the Plan, Rating of the Drug Plan, and Customer Service. And include a Net Promoter Score if you haven’t already – CMS is exploring adding a question related to NPS or customer loyalty to the survey, so we’re likely to see an NPS-type measure in the future.

Second, make 2020 a CAHPS learning year. Test messaging in preparation for next year by identifying high risk members (members likely to rate the plan negatively on any of the above measures) and testing out new scripting. And by test I mean have an evaluation plan. Conduct an outreach now and evaluate its impact in an off-cycle (“mock” or “simulation”) survey later in the year, making sure to include members that were part of the outreach. Communicate in a way that’s more relevant than ever to change their opinion.

What should Stars teams do if the organization must de-prioritize CAHPS in 2020 due to COVID-19?

This is a real challenge that we’ve already heard from plans. Remember that there is substantial overlap between members likely to rate negatively on CAHPS and members likely to choose to leave the plan, as well as overlap between likely negative CAHPS raters and other important measures like medication adherence. Piggyback on planned retention calls and med adherence outreaches. Knowing who is high risk in your plan for CAHPS and why they are high risk; what their concerns, barriers, and perceived issues are provides talking points that help tailor the message to these members that are already part of a non-CAHPS outreach.

We hope this helped to shed some light on the changes that CMS has made to account for the impact of COVID-19 on CAHPS and ways in which health plans can strategize to stay on top of performance improvement. You’re invited to join us as we take a deeper dive on Wednesday, April 29th at noon EST, on our CAHPS & COVID-19 webinar. You can register here.

As always, please feel free to reach out if you have any questions, comments, or feedback. We’d love to hear from you.