Last month I provided an overview and some general best practices related to the CMS Star Rating program that evaluates the quality of modern day health plans. This month I’ll discuss, in more detail, the benefits of monitoring member experience and engaging the health plan’s provider network to improve the patient’s experience in the care setting and subsequent Star Ratings.
Health plans, generally speaking, are J.D. Power’s second worst ranking industry sector for customer satisfaction, slightly ahead of public utilities.1 This is especially troubling for health plans offering Medicare Advantage plans given that Quality Bonus Payments (QBP) are tied directly to their STAR Ratings. In 2016, CMS reported a three-year Medicare Advantage Quality Bonus Payment payout of nearly 11 billion,2 underlining how vitally important member satisfaction and quality of care are to MA health plans.
In an effort to improve member satisfaction, health plans are beginning to engage their provider networks to focus on the overall experience and quality of care their members receive during healthcare encounters. The member’s care delivery experience and relationship with their provider directly impacts the perceived value and overall satisfaction with the health plan and subsequently STAR Ratings and Quality Bonus Payments. It is a critical component of attracting and retaining members.
The Challenge – CMS Annual Measurement
The annual Centers for Medicare and Medicaid Services (CMS) Medicare Advantage and Prescription Drug Plan (MA-PD) CAHPS Survey measurement is a significant component of the STAR Rating calculation and subsequent payment received through the QBP program that are critical to a health plan’s success. Health plans that rely solely on their annual MA-PD CAHPS survey results to identify opportunity and implement improvement efforts will face many challenges. Foremost is that the annual CMS measurement was not designed as an improvement tool. The single annual measurement employs a target sample size of 800 cases that generate a very small number of surveys from which to identify and commit to organizational level changes. Additionally, the data collection period lasts from December through June, with survey results released in the early Fall. This leaves no time to react and improve before the next Annual Enrollment Period.
The MA-PD CAHPS survey is also 60+ questions, and can take up to 30 minutes to complete, which is burdensome to most members. Some health plans have attempted to implement a continuous MA-PD CAHPS survey instrument for their members but have quickly faced escalating levels of survey fatigue and plummeting response rates. Most members may be willing to submit the survey initially but are extremely reluctant to invest the time to rate their experience on future encounters.
Health plans that are intentional in their efforts towards organization-wide STAR Rating improvement realize the inadequacy of this approach and are beginning to implement continuous data research efforts to measure the experience and quality of care received by their members.
The Solution – Provider Network Engagement
The shift from volume to value has created an environment of conflicting priorities and has compelled health plans to collaborate with providers within their network to improve the member/patient experience. This collaboration, to reach and maintain aligned goals, allows payers and providers to engage members/patients more effectively than either could alone. Health plans and providers are working more closely than ever to deliver a more personalized patient/provider relationship to their members.
Pay for Performance and other value-based payment models are successful in stimulating improvement when health plans and providers have a mutual agreement on the size and structure of the incentives, implement a statistically defendable survey methodology and measure performance on a manageable number of key performance indicators (KPI).
Continuous Survey Approach
Utilizing continuous patient experience surveys allow health plans to gather real-time, actionable data across their provider network that can be leveraged immediately versus months in the future. There are several benefits to the health plan, member and provider in engaging members consistently throughout the year.
- Instills a level of confidence and allegiance with the member by demonstrating the commitment of both the health plan and the provider to collaborate to improve the experience and quality of care for the member.
- Improve the timeliness and accuracy of the survey by requesting member feedback within hours or days of the encounter. Members will provide much more accurate and relevant data by submitting their feedback while their visit is still fresh in their mind.
- The consistent longitudinal flow of data engages individual providers with valuable insight into how they are perceived by their patients in an almost real-time basis.
- Equips health plans with the data required to identify trends and areas of opportunity that may negatively affect their members quality of care and patient experience.
Minimize the Member Burden
Utilizing a concise survey instrument that will take members three to five minutes to complete will limit burden and survey fatigue and promote long term response rates. Ten questions that align with MA-PD CAHPS composite measures and key performance indicators (KPI) that are scored on a 5-point Likert scale combined with an open-ended free text question can be very effective in a continuous survey environment. The ability to customize two or three additional questions that focus on short term initiatives will round out a powerful data collection tool that will promote informed decisions across your organization and provider network(s).
Multiple Engagement Channels
Effective outreach to members is paramount to maximizing response rates. Mail surveys have been the preferred way to communicate with members for survey collection. However, mail surveys can be complicated and costly to field continuously, and the process creates long delays before the survey data is compiled and available for analysis. Historically, seniors and Medicare Advantage members did not respond well to digital outreach, but this trend is changing rapidly. The digital age is well upon us.
Email – As the Baby Boomer generation continues to age in, collecting survey data by email outreach has become a viable approach. Baby Boomers are now more likely to respond to a healthcare related email survey than Millennials or Generation X.3
Telephone – Telephonic surveys have proven, over time, to be a convenient way for members to provide feedback about their experience with their health care providers. A telephone call from a live agent is a highly personalized outreach to the member and consistently deliver an 85-90% conversion rate (percent of right party contacts that agree to complete a survey).4 The telephonic mode can be used strategically to augment underrepresented demographic segments that are sometimes identified in digital survey response.
SMS – Generation X and especially Millennials cannot imagine a world without their smartphone and depend on it for their news, entertainment, shopping and communication. It’s no surprise that it is their preferred method to respond to their health care provider. Like email, it is quickly becoming an accepted communication channel for seniors as well. In the past three years smartphone ownership in the 65+ population has increased by over 50%.5
Email, telephonic and SMS survey modes all support real-time results and provide a user-friendly experience for the participant. Depending on the demographics of the audience a single mode may be the most preferable. However, in most cases a combination of these communication channels will prove to be the most cost-effective approach to maximizing survey response.
Real-time Actionable Data
Transparent, real-time report analytics that are easily accessed with automated dissemination tools are a vital component to successful ongoing care-delivery improvement. Survey analytics must be provided in an easy to understand, digestible format that includes immediate access to important KPIs, meaningful stratification (i.e. Region, Department, Provider) and data base query capabilities that allow detailed analysis to identify root cause down to the provider level. If providers and administrators have to work for their data, they will not use it.
Reports should contain more detailed data than what is available from public reports that are associated with the MA-PD CAHPS annual measurement, including comparisons of individual providers vs. their peers to help health plans and providers pinpoint areas in need of improvement. Provider level data creates a sense of competition among providers to improve and promotes dialogue between health plans and doctors about ways to improve the member experience and other quality measures.
Creating a reliable, continuous, survey-based feedback loop between members, providers and the health plan will create the foundation for a collaborative approach to improving the quality of care. When health plans and providers can identify opportunities to improve care delivery together and affect change through aligned strategies and goals, members are rewarded with a consistent, high-quality experience resulting in stronger member loyalty,6 improved adherence to medical advice/treatment plans7-10 and often better health outcomes.11-12
Brenmor offers customized patient experience surveys via a combination of email, SMS (text) and/or telephonic modality that are supported by robust real-time, permission-based data analytics.
3 2017 Brenmor email survey response rates by age
4 2017 Brenmor telephonic overall conversion rate
6 Safran DG, Montgomery JE, Chang H, et al. Switching doctors: Predictors of voluntary disenrollment from a primary physician’s practice. J Fam Pract 2001;50(2):130-6.
7 DiMatteo, MR. Enhancing patient adherence to medical recommendations. JAMA 1994;271(1):79-83.
8 DiMatteo MR, Sherbourne CD, Hays RD, et al. Physicians’ characteristics influence patients’ adherence to medical treatment: Results from the Medical Outcomes Study. Health Psychol 1993;12(2):93-102.
9 Safran DG, Taira DA, Rogers WH, et al. Linking primary care performance to outcomes of care. J Fam Pract1998;47(3):213-20.
10 Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: A meta-analysis. Med Care 2009;47(8):826-834.
11 Greenfield S, Kaplan S, Ware JE Jr. Expanding patient involvement in care: effects on patient outcomes. Ann Intern Med 1985;102(4):520-8.
12 Stewart MA. Effective physician-patient communication and health outcomes: A review. CMAJ1995;152(9):1423-33.