Patient experience and outcomes measures make up a significant portion of the overall Medicare Star Rating score. Since patients are the best and/or only source of information for these outcomes and experience measures, this data is collected through the use of surveys, such as the Health Outcomes Survey (HOS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. These surveys gather clinically meaningful patient-reported outcomes and health status data, which in turn can help payers and providers improve on any uncovered shortcomings.
Medicare Advantage plans often admit that the set of measures associated with the HOS and CAHPS surveys remain among the most challenging to improve. These measures are challenging because they are based on individual member perception. But, let’s face it, perception is a very individualized thing. Therefore, assessing personal experience requires a personalized approach.
Unlike the official surveys that extrapolate results to give a population-level score, Eliza’s Consumer Experience and Health Outcomes Survey Solution seeks to understand individual issues and perceptions for each member. More importantly, once Eliza identifies an issue, we can mitigate it through targeted support, such as encouraging members to speak to their PCP, or offering transfers to a resource while the member is engaged. It’s Eliza’s unique ability to identify and support members that drive the best outcomes.
Here are five reasons to improve HOS and CAHPS scores:
1. Medicare Star Ratings affect payments to Medicare providers and managed care organizations, and HOS and CAHPS survey measures contribute to these overall Star Ratings.
2. Several of the HOS and CAHPS measures are weighted more heavily than process measures in computing the overall Medicare Star Rating. Among the measures that comprise CMS’ Medicare Star Rating System, patient outcomes are weighted the highest, with a relative value three times that of process measures, and patient experience and access measures are weighted at 1.5 times that of process measures.
3. Patients are making more informed healthcare decisions and rely on these publicly available survey results when deciding where to receive care.
4. The survey results can be incorporated into provider incentive programs to drive improvements in patient care.
5. Most importantly, improved patient experiences and outcomes lead to healthier, happier patients.
In a recent Eliza HOS/CAHPS outreach, to a large Medicare Advantage Plan’s target population, Eliza developed proxy scores for their CAHPS measure, offering insight into which areas the plan could focus on to drive improvements.
To learn more about improving your Star Ratings, read the HOS and CAHPS eBook which includes case studies that highlight the impact of actionable member data on key measures.