CAHPS Overview

Hello and welcome to Medicare CAHPS resources and support.

Here is the agenda: What is CAHPS? What is Medicare stars? Why do we focus on CAHPS?

Health plan CAHPS in the Horizon proxy survey.

Horizon Blue Cross Blue shield of New Jersey resources and support.

CAHPS is the consumer assessment of healthcare providers and systems.

CAHPS are mandated surveys administered by CMS that are sent out to a random sample of the health plan members between March through June every year.

The surveys contained 68 questions and measure the members perception of care they received during the prior measurement year.

CAHPS accounts for 9 measures within the overall star ratings the CAHPS results contribute to over one third of the star weights. Measure weights range from 1 to 4, which equate to star points.

On the top, right corner you will find 2022 Medicare CAHPS timeline and on the bottom right corner are the different domains of CAHPS survey.

These are some of the actual survey questions that members are asked to answer as they think back over their experience.

The first category is overall rating of personal doctor, this is where the member rates, their personal doctor from 0 to 10.

Next category is Access to Care.

An example of this is, how often was it easy to get the care tests or treatment you needed.

Next is Care Coordination. An example of this is how often did you and your personal doctor talk about all the prescription medications you were taking?

Next is Provider Communication. How often did your personal doctor listen carefully to you, spend enough time with you?

And then you have overall ratings, and this is where the member rates their overall ratings from 0 to 10.

Improvement in the stars measure, translates to added benefits for our members.

CMS evaluates progress towards star ratings to include improving the patient experience of care, such as quality, access, and reliability, improving the health of populations, and the highest rating is 5 stars.

Member benefits, ability to compare health plans, increased level of customer service, greater focus on preventative services for early detection of disease, health plan focus on the access to care and the quality of care, improved relationships with their doctors, strong benefits to support chronic condition management.

As you can see here, 1 or 2 stars indicates a lower performance.

3 is average, and it is in the 4 and 5 star range that the members enjoy better benefits.

So, why do we focus on CAHPS?

There are many benefits that come with the improvement of patient experience, such as better adherence to medical advice and treatment plans, proven to contribute to better health outcomes, reveal problems and gaps and communication that can have broad impact on the clinical quality safety and efficiency, lower medical malpractice risks, and there is more, better physician and employee satisfaction, reduce employee turnover rate, attract new patients and retain existing ones, and competitive edge for providers, the results are reported on physician compare and Medicare plan finder sites, such as the one below.

Health Plan CAHPS, select domains and best practices.

The following slides will highlight the 2021 CAHPS domains where the greatest opportunities for improvement were identified.

Small changes that can yield big results within your practice. Member health outcomes and experience. Let's take a look at access to care.

Patient centric hours of operation, same day appointment slots, block for urgent care.

Implement pre-registration process for expedited check in, provide patient updates every 15 minutes during wait times for delayed communication, utilize available rooms to triage patients prior to seeing the provider.

In the area of care coordination, implement standardized process for sharing test results with patients, provide specific timeframe for test result follow up.

Implement pre-visit planning to ensure all test results are received prior to the patient's appointment, develop a pre-checklist to ensure all test results are available prior to the appointment.

Remind patients to bring all medications to their visit

Utilize horizon prescription drug formulary, mail order or 90 day supply options when possible.

Established care agreements with high referral specialists to ensure patients can be seen quickly and a compliant system for sharing patient records.

Ask patients to schedule, follow up appointments before leaving the office and ask patients is sign up for appointment reminders.

In the area of Provider Communication, provide patients and or family with visit summary, highlighting important details. Use the 1 minute rule, allow the patient or family to speak for 1 minute before interrupting.

Confirm what name the patient would like to be called and how they would prefer to be addressed, avoid asking questions with 1 hand on the door, as if you're ready to leave.

Encourage patients to sign up for the patient portal.

Horizon Blue Cross Blue Shield of New Jersey resources and support.

In an effort to assist and support our providers in their patient improvement efforts Horizon provides a wealth of free resources and support as follows: Coaching program, CAHPS coaching program.

The CAHPS coaches work in partnership with the providers to facilitate action plans to enhance the member patient experience and improve practice operations using the CAHPS proxy survey.

Scorecards. The coach will target areas of opportunity within the CAHPS composite.

In areas, such as care coordination, getting needed care and getting care quickly.

The coaches create a custom design, tactical approach to meet the varying interests, needs, and availability of the practice partners also primary care providers with Medicare membership are eligible.

To participate in the free CAHPS coaching program. A custom coaching plan is created to meet providers’ needs, wants and availability.

Your CAHPS coach is an expert in designing tactical, evidence-based initiatives that will support your organization.

These benefits include improve overall CAHPS performance, drive results towards achieving your patient's experience goals, build stronger relationships with your patients and co-workers, and increase engagement of patients providers and employees.

Additionally, we offer the PlayBook. It is an online guide developed by Horizon to help practices improve their patients’ health and experience.

It offers key tips and best practices in these areas, such as patient experience to include patient interaction, access to care, care coordination, HP operations and rating of health plan.

Next is health outcomes to include medication adherence, tests and screenings, hospital readmissions, and physical and mental health. Then we have a series of 6 best practice videos, which covers, introduction to CAHPS, improving patient experience, care coordination, parts 1 and 2, and access to care parts 1 and 2.

Use the link below to access a microsite for a simple registration process that will prompt for username and password.

https://www.horizonblue.com/patient-engagement

The playbook for patient engagement contains resources for providers. The site provides tips on how to help improve the patient's health and experience.

To learn more and join the CAHPS coaching program contact us today. The number is 1-888-652-2477. You can also engage with your Clinical Quality Improvement Liaison to develop strategies to increase patient compliance and outcomes.

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