‘Quality of care’ means different things to different people based on their perspective. As a result, defining and delivering quality can be elusive. The Institute of Medicine (IOM) defines quality as ‘the degree to which healthcare services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.’ A simpler definition might be doing the right thing — at the correct time and in a proper manner — for the right person, and getting the best possible health outcomes.
Managed care organizations are charged with delivering on this promise of quality care and measuring the results through various standards including NCQA, HEDIS, CMS Star Ratings, and QRS measures. For the most part, these measures are objective and quantifiable.
But let’s take a look at quality measures that are less objective, and, more specifically, at quality from the consumer’s lens. Consumer perceptions of care quality can be wildly different from a healthcare executive’s as it is based on the member’s individual healthcare experience. Oftentimes, it can be simply whether they were able to see a doctor in a timely manner, or whether that network doctor helped them feel better quickly by addressing their immediate needs.
For managed care organizations, member perceptions on quality and experience are also measured by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, and the Health Outcomes Survey (HOS) for Medicare Advantage plans. These assessments can provide valuable insight into the consumer perceptions of care, but the results are limiting. Based on sampling methodology, the survey results are aggregated so specific individual member data is not available. Health plans are essentially blind to the populations performing well or poorly beyond overall market trends or significant shifts in results.
Despite these limitations, health plans utilize HOS and CAHPS results as a starting point to improve the consumer’s experience and perspective on the quality of care delivered through their plan. Here are some steps to think about when formulating your quality care and experience improvement action plans that incorporate the consumer perceptions of care quality and member experience:
- Begin with the aggregated trends gleaned from the CAHPS and HOS survey results. Dig deeper by performing off-cycle surveys of the full member population to gather detailed data about experience and perception. Interactive voice-response or web-based surveys are faster, generally less expensive, and have higher response rates than mail surveys.
- Supplement these off-cycle surveys with additional information gathering, such as collecting data around members’ social and economic barriers, health literacy or other social determinants of health.
- Develop targeted interventions for at-risk members such as those at-risk of diabetes or hypertension. Intervene at the individual member level whenever possible. Once you’ve identified those members, provide immediate support through your care management or services teams. Mitigate issues quickly and demonstrate your commitment to your members.
- Follow member communication preferences when possible; if a customer prefers email or text, email or text her. Also, encourage members to take action and enlist in the treatments and/or actions required to improve their health. A recent review of 37 randomized controlled trials found that providing patients with targeted education materials led to greater overall satisfaction with care.
- Develop a continuous improvement cycle that assesses, analyzes, acts, measures and repeats year-over-year. Focus your finite resources on a limited number of interventions to drive positive member care experiences at first, and then expand to additional interventions over time. It’s difficult to immediately improve member perceptions of quality and experience, so it requires a long-term commitment.
The CMS continues to push on measuring and reporting information from the consumer perceptions of care for Medicare Advantage and Part D contracts. Others will follow, and we can expect more emphasis on member-reported outcomes and experience measures across all lines of business.
So the time to focus on health plan members and more specifically, improving consumer perceptions of care quality and experience, is now.
To learn more about improving your Star Ratings, read this eBook that highlights the impact of actionable member data on key HOS and CAHPS measures.