Let’s set the scene. In the United States, all baby boomers will be age 65 or older by 2030, the age at which they are eligible for Medicare. The “gray tsunami,” as it is often referred to, will have far-reaching impacts across society. Perhaps most notable is in the health care system. Because of the aging baby boomer population, the spotlight is on Medicare.


Patients who are at this age of eligibility can choose whether to enroll in Medicare, or Medicare Advantage (MA), the private insurance alternative to Medicare. MA is growing steadily in popularity. In 2022, more than 28 million people were enrolled in a Medicare Advantage plan, which is nearly half (48% to be exact) of the eligible Medicare population.


To reach MA patients, carriers must pay careful attention to quality of care. This is where the critical importance of surveying comes in.


Medicare Advantage and Prescription Drug Plans CAHPS Surveys


CAHPS surveys are conducted annually for patients enrolled in MA, the Medicare Advantage Prescription Drug Plan (MA-PD), and Prescription Drug Plans (PDP) plans. Patients must be enrolled for six months or longer to be eligible, and roughly 1000 patients per health plan are asked to participate. The survey is approximately 80 questions and is sent via mail twice. Non-respondents will receive a follow-up phone call. The content of these surveys is made up of questions about various aspects of a patient’s health care over the past six months, including:


“Questions ask about ease of getting needed care and seeing specialists, getting appointments and care quickly, doctors who communicate well, coordination of members’ health care services, health and/or drug plan provides information or help when members need it, ease of getting prescriptions filled, rating of health and/or drug plan, rating of health care quality, annual flu vaccine, and pneumonia vaccine.”


Once all completed surveys are accounted for, calculations are made by CMS. Reports from the CAHPS survey results are made public by CMS for three important reasons: so patients can choose a high-ranking plan, provider networks are made aware of areas to improve upon, and CMS can best manage the program moving forward by increasing transparency and accountability. Moreover, since CAHPS scores MA, MA-PD, and PDP CAHPS surveys affect Star Ratings, higher reimbursement and enrollment follow suit.


Despite the fact that MA plans are becoming more popular and have lower out-of-pocket costs, it bears repeating that patients still have choices of carriers. There are over 40 plans to choose from, so it’s important for carriers to monitor quality of care and put concerted efforts towards achieving high Star Ratings.


Composite Scores – What are They?


Health care is undoubtedly a broad concept to measure. Since CAHPS surveys cover several areas of quality of care, composite scores are also calculated. Composite measures are two or more measures that are aggregated, resulting in a single score. The benefit of these measures is that they help reflect aspects of health care that contain several factors. Essentially, it is an aggregate score of a larger aspect of a patient’s health care. The questions are combined into the following six composite measures:


  1. Getting Needed Care
  2. Getting Appointments and Care Quickly
  3. Doctors Who Communicate Well (this is not reported to consumers)
  4. Customer Service
  5. Getting Needed Prescription Drugs (MA-PD and PDP)
  6. Care Coordination


Regarding the measure of “doctors who communicate well,” it is worth noting that this piece of data is only reported to carriers. Since it is not consumer-facing, carriers should utilize this as a way to both monitor and improve relationships with network providers. One option is for carriers to collaborate with the providers who are communicating well and encourage them to be mentors to providers needing assistance.

Working Together: Carrier and Provider Networks


The results of MA, MA-PD, and PDP CAHPS primarily affect the carrier. However, a critical component of quality of care that occurs out of their control — the provider/patient relationship. It’s imperative for carriers to have strong relationships and open communication with network providers in order to understand what challenges they face and how best to overcome them.


Regarding PDP surveys, transparency is key to quality of care. Carriers need to ensure enrollees know what is covered in their plan, and how much their co-pays are in order to set expectations. These efforts will help to curb any surprises that could negatively impact CAHPS survey responses.


How Continuous Surveying Can Help Medicare Advantage Carriers


MA, MA-PD, and PDP CAHPS surveys convey an annual snapshot of how a carrier is performing. If patients are only asked for their feedback once a year, they are less likely to feel that their voice is being heard. Carriers must engage their patients on a continuous basis in order to score well on these CAHPS surveys and to ensure quality of care.


More concretely, it is highly recommended to identify weaknesses and monitor improvement initiatives at the provider level. Carriers and providers should be strategic partners in this effort as there are direct impacts on both parties. Improvements to quality of care adds revenue by driving higher brand preference, lowering the cost of acquisition, and reducing churn.


Brenmor surveys are electronic and multi-modal, which helps maximize response rates. CAHPS surveys, while technically multi-modal, are conducted primarily through the mail, which could challenge the response rate. In fact, digital communication (email and SMS) is rapidly accelerating amongst individuals in the 65-74 age range. Since Brenmor surveys identify the preferred communication channel, it increases the response rate by up to 50 percent.


By conducting surveys continuously, improvement initiatives can be enacted in real time by providing the carrier with data immediately. As mentioned before, having access to data is a powerful thing.


For the patient, quality of care provides them with the best health care experience possible in order to improve their quality of life and reduce frustration. For the carrier, it results in better CAHPS scores, higher reimbursement, and continued plan enrollment. Continuous surveying is certainly a win-win for both parties.


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