Why Medicare Advantage CAHPS Survey Scores Matter

Nearly 28 million people are enrolled in Medicare Advantage (MA), and the eligible population, aging Baby Boomers, is growing steadily every year. In fact, MA provides care to nearly half of those 65 and over. MA CAHPS surveys are conducted annually to determine the quality of care that carriers and providers offer members, resulting in a Stars rating. Carriers and providers must pay particular attention to member experience as it now represents 57 percent of overall Stars ratings in 2023.

MA CAHPS surveys matter because they dictate Star ratings, reimbursement rates, plan enrollment and determine quality of care. Therefore, achieving a 4 or 5 Star rating is critical to remaining competitive in the landscape and, ultimately, the plan’s future.

These surveys are conducted annually for patients enrolled in a MA plan for six months or longer. It consists of 80 questions ranging from how quickly they can get appointments to how well they are listened to by their doctors. These scores affect patient enrollment and reimbursement for carriers and providers. With over 40 plans to choose from, carriers and providers must stay competitive by removing barriers to care.

Pay Attention to Composite Measures

Carriers and providers should pay particular attention to composite measures. These are calculated to ascertain how to represent six broader concepts of a member’s health care journey: Getting Needed Care, Getting Appointments and Care Quickly, Doctors Who Communicate Well, Customer Service, Getting Needed Prescription Drugs, and Care Coordination. These composite measures result in an aggregate score calculated from several data points.

The first three composite measures listed above significantly impact quality of care and CAHPS scores. Getting Needed Care is an important measure that will help ease any burdens to achieving quality of care. The second measure, Getting Appointments and Care Quickly, covers the speed at which patients get appointments and are seen once they are there. While the score received on the measure Doctors Who Communicate Well is not reported back to members, this internal measure of successful communication is an essential component of a successful relationship between carriers and providers.



Collaboration Between Carriers and Providers

To improve quality of care, carriers and providers should have open communication and be actively engaged in a collaborative effort to continually improve member experience.

Ideally, carriers and providers should be strategic partners. Alignment of care and consistent communication between carriers and providers will enhance the member experience. Carriers can identify weaknesses at the provider level and assist in monitoring improvement. The bottom line is that higher quality of care affects the bottom line.

Every step in a member’s health care journey matters. Therefore, carriers and providers should view their members from a holistic health care angle so they feel listened to and cared for. As mentioned earlier, it bears repeating: member experience is a crucial component of CAHPS survey measurement. At four times the weight in 2023, this is the key to achieving a 4 or 5 Stars rating.

Continuous Surveying Will Improve Quality of Care

Unfortunately, MA CAHPS surveys are limited by nature since they are only conducted annually. It is worth noting that MA CAHPS surveys are also conducted primarily through the mail, which is not the recommended mode to elicit a high response rate. Soliciting feedback on such an infrequent basis poses two significant issues: patients don’t feel heard, and carriers and providers don’t have the opportunity to address issues in a timely manner. Continuous surveying through Brenmor will ensure better Star ratings and quality of care.

Brenmor surveys are electronic and multi-modal, which helps maximize response rates, even amongst the Baby Boomer population. In fact, digital communication is rapidly accelerating amongst these individuals, specifically in the 65-74 age range. Brenmor surveys are designed to identify the preferred communication channel of its respondents, thereby increasing response rates by up to 50 percent. By conducting surveys continuously, carriers are provided with timely data that can empower them to make changes in real time.

Want to learn more about how Brenmor surveys can help? Speak with an expert today.