“One area of opportunity that a lot of health plans overlook, is taking a step back and looking at data that’s right in front of them with a new perspective..”
The weight of the CAHPS survey has steadily increased over the years from 8% in 2014 to 32% of the overall Star Rating in 2021. Scoring is complex and there’s no one size fits all strategy. Two health plans the same size can do the same thing and get different results. The reason for this is attributed to the unique nature of every member experience in different member populations.
There are a number of variables that contribute to positive CAHPS performance. Although CAHPS performance can’t be pinned to one effort, the health plans that are most successful have a wholistic strategy that involves multiple departments and synergies between their member communications and outreach. Every single thing that’s printed on paper, published on websites, sent via email, or communicated verbally—matters. Carefully crafting and optimizing a targeted member journey is essential to successful CAHPS. It’s often forgotten that health plans are surveyed not just on their own interactions with members, but also their agents and provider networks. Education and onboarding partners to deliver a member experience is just as important as training customer service representatives. All member touch points are a reflection of the health plan.
In order to improve the member journey, plans must evaluate their available data from multiple perspectives. For example, it’s no longer sufficient to evaluate appeals and grievances through the narrow lens of whether it was an appropriate denial or not. Today, plans need to also analyze complaint data from a quality vantage point and determine it its more expensive to have an abrasive member experience.
About Our Guest
Amy Weiser is an accomplished healthcare executive with 20+ years of experience in health plans and facility and practice management. Weiser has experience with Medicare Advantage, Dual Special Needs Plans, MMP, and Medicaid lines of business. She has had responsibilities that have included Star and Hedis oversight, operations, member and provider materials and engagement, medical management leadership over care management and utilization departments, as well as experience starting a new quality and patient experience department for a large physician network.