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CAHPS Overview

The CAHPS presentation will provide an overview of Medicare CAHPS and STARS. Learn more about the CAHPS survey and the importance of the patient experience. Review tools and resources available to help ensure that your patients always receive exceptional care from you and your staff.

CAHPS Overview


Thank you for attending the Results and Recognition Quality Programs 2023 Medicare CAHPS Resources and Support WebEx. This WebEx will review the resources and support offered by Horizon Blue Cross Blue Shield of New Jersey.

Agenda: The Centers for Medicare and Medicaid Services, CMS Star Ratings.

Consumer Assessment of Healthcare Providers and Systems.

The many benefits of improving the patient experience.

Building or enhancing a patient experience program.

CAHPS discussion checklist. CAHPS Tools, Resources, and Support.

CMS Star Ratings. Medicare uses information from the health plan and member satisfaction surveys, CAHPS Surveys, to give an overall performance Star Rating to Medicare health and prescription drug plans.

The system supports CMS’s effort to empower people to make the best unbiased healthcare decisions.

It evaluates the patient experience of care, and strives to improve the health of populations.

The Star Ratings are important to both Medicare Advantage plans and to beneficiaries who are looking for Medicare coverage.

One star represents poor performance and five stars represents excellent performance.

Plans that achieve 4 or 5 stars receive quality bonus payments, and these are used towards enhancing member benefits.

Star Ratings are publicly reported and people with Medicare can compare quality, along with other information, such as cost and coverage, on the online Medicare Plan Finder tool available online.

Star Ratings are released annually and reflect the experience and health outcomes of people enrolled in Medicare Advantage Part D prescription drug plans.

CAHPS. Consumer Assessment of Healthcare Providers and Systems.

CAHPS surveys are an integral part of the Centers for Medicare and Medicaid Services or CMS’ efforts to improve healthcare in the U.S.

CAHPS are mandated surveys administered by CMS that are sent to a random sample of the health plan members and fielded annually March to June.

The surveys contain 68 questions and measure the member's perception of the care they receive during the prior measurement year. CAHPS accounts for 9 measures within the overall Stars Rating.

21 questions impact Star performance. Measure weights range from 1 to 4.

The CAHPS results contribute to over one third of the 2024 Star weights.

The CAHPS survey aims to focus on how patients experience critical aspects of care in the following areas:

Care coordination, getting appointments and care quickly, getting needed care, rating of health care quality, getting needed prescriptions, rating of drug plan, customer service, rating of health plan, and annual Flu.

These are examples of Star Measure questions asked within the CAHPS Survey asking about care coordination and getting care quickly.

These are examples of Star Measure questions asked within the CAHPS Survey, asking about receiving needed care, rating of health care, getting needed prescription medications, rating of health of the drug plan.

These are examples of Star Measure questions within the CAHPS Survey pertaining to customer service, rating of health plan, and annual flu vaccine.

Many benefits of improving the patient experience.

What is the patient experience? The patient experience includes the range of interactions that patients have with the healthcare system.

This includes care from doctors, nurses, non-clinical care teams, their health care plan, and other health care facilities.

An important component of the healthcare quality patient experience includes several aspects of healthcare delivery that patients value highly when they seek and receive care, such as getting timely appointments, easy access to information, and good communication with healthcare providers.

Although a variety of things influence a patient's experience, research shows that the factor with the greatest impact is how the provider and care team make the patient feel.

Communication between the patient, physician, providers and staff are among the key determinants of patient experience.

The many benefits of improving patient experience. Evidence suggests that good patient experience go hand in hand with better clinical outcomes and a host of business benefits.

Better patient experience is correlated with better clinical outcomes.

Better patient experiences with health care translates into better adherence to medical advice and treatment plans.

This is especially important and true among the patients with chronic conditions where a strong commitment to work with providers is essential towards achieving positive results.

Better patient experience is correlated with a host of business benefits.

Reveals problems with gaps in communication that can have a broad impact on clinical quality, safety and efficiency.

Improves the processes and systems that enables clinicians and staff to provide more effective care.

This in turn reduces staff turnover and increases employee and physician satisfaction.

Improving patient experience for attracting and retaining patients.

Patients keep or change providers based on experiences and the quality of this relationship is a major predictor of loyalty.

A recent national poll conducted in 2020 by the University Of Michigan Center for Healthy Aging, shows choosing a doctor by using online ratings is not just something younger people do, but it's also common among older adults.

Polling results show the following, 65% of older adults who search online for a physician read online physician ratings.

34% read reviews to find a doctor, while 31% read reviews for a doctor they had already seen. 71% of the patient respondents said they would select a doctor with positive ratings, even if he or she had some negative reviews, but about 69% said they would avoid seeing a doctor with mostly negative ratings.

This poll concludes that it's expected that online research and rating of providers and healthcare systems will increase in the near future and years to come.

Building a Patient Experience Program in your practice.

Monitor and assess performance with a survey tool.

Analyze your Horizon annual Proxy Survey Scorecard, if applicable.

Analyze your annual CAHPS vendor scores, if applicable.

Also, compare all survey tools to see what areas that need improvement may align.

Survey tool resources. Users of CAHPS surveys typically seek out and contract with survey vendors, like Press Ganey, NCR Health, etc.

For guidance and resources on hiring one, please find additional information resources on the useful links below.

Survey Monkey offers sample online CAHP survey templates to survey your patients and benchmark your practice.

American Academy of Family Practice has developed a model questionnaire that physicians may use in their own practice.

Building a patient experience using a variety of ways.

Use a variety of ways to evaluate the process of care delivery.

Combine survey analysis with other forms of patient feedback.

Some examples are a verbal question or two at checkout, office suggestion box in waiting area, post survey sent via EHR or Survey Monkey.

Consider including a patient and family advisory council, which is a partnership between patients, families, caregivers, and members of the care team that encourages honest feedback and constructive criticism to make the practice better.

Read your patient reviews on some of the most popular websites.

Engaging key stakeholders is imperative to a successful patient experience program. Share patient experience survey scores with your staff, and discuss other findings and information. Conduct brainstorming sessions.

Elicit their feedback and listen with empathy. Research consistently shows when employees feel heard, they are better engaged in their work and this leads to a happier more productive staff and a better patient experience.

Strategies can be simple or complex, but the recommendation is to start small. Break it down into smaller components as it is best to tackle one thing at a time.

Some strategies may yield positive results more quickly than others, so decide where to focus your time and resources.

CAHPS Discussion: Checklist, Tools, Resources, and Support.

Talk with your patients about their health and healthcare experience at every visit.

Here are some questions to ask to start the conversation:

Have you had your annual flu shot?

Are you having issues receiving services for any test or treatments?

Recommendations: Educate patient on vaccine benefits.

Review medical history, including visits with specialists and records from specialists.

Ask patient about any specialists they are seeing. Summarize and review any test orders.

Call patient with test results promptly. Give patients copies of their records or post to portal.

Here are additional questions to ask patients:

Did you experience any delays while waiting for today's appointment?

Do you need assistance with scheduling follow-up appointments?

Are you experiencing any delays in receiving treatments or services?

Do you have any questions regarding your existing treatments or tests you're receiving?

Do you have any questions about your medications or any issues surrounding receiving your medications?

Recommendations: Encourage patients to schedule visits in advance.

Schedule follow up visits when applicable.

Ensure that there is time to set aside for urgent visits.

Communicate with patients if there are delays with appointments.

Inform patients how to access care after hours.

Assist with scheduling specialist visits that are time sensitive.

Refer patients to in-network specialists and ensure they are accepting new patients.

Ensure that patients are informed about decisions regarding referrals and tests.

Review medication lists and monitor medication adherence.

Ensure patients understand medication schedules.

The Horizon BCBSNJ Playbook for Patient Engagement, 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: Patient Experience, Health Outcomes, and a series of 6 Best Practice videos.

Thank you for listening to this recorded webinar.

Below there is a link to our Survey Monkey. Please complete this brief survey, we value your feedback.

If you have any questions, please email them to your designated CQIL or to the mailbox.

Thank you.

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