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Driving member experience success: Insights for health plans from the 2024 CAHPS survey season

Published Date
Author David Larsen

August and September are pivotal months for health plans, as they receive final 2024 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey reports and begin preparing for next year’s survey process. It’s the perfect time to review member feedback, address emerging trends, and strategize for future improvements.

A key topic often raised in these discussions is the survey response rate—an area of concern for many, as response rates continue to decline across most survey product lines, aside from the Qualified Health Plan (QHP) survey.

Internet survey protocols, particularly QR codes, have been instrumental in mitigating some of these declines. However, health plans have limited ability to take further steps due to the Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA) survey technical specifications. With these restrictions in place, one of the most effective strategies health plans can adopt is improving the accuracy of member contact information—especially valid email addresses—to ensure surveys reach the right audience. The accuracy of contact information varies greatly across health plans—as does the percentage of members in the CAHPS sample with valid email addresses. For example, the availability of email addresses in the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) survey ranged from 0% to 80% across plans.

One way plans can improve member contact data is by leveraging data exchange programs already in place with their provider networks. Since patient contact information is updated several times a year during office visits, this partnership can yield a more accurate, up-to-date member database.

Interestingly, an analysis of the MCAHPS survey results revealed that members who responded via internet protocols report higher satisfaction than those who used traditional methods. While the internet option has enhanced member satisfaction, it hasn’t significantly increased response rates. From this, we infer that respondents would have likely responded via mail if an online option hadn’t been available.

CMS and NCQA now require more survey responses for measures to be considered valid in accreditation and quality ratings. This means some plans can’t report certain measures. To avoid this, health plans can leverage a few proactive strategies—like oversampling—to meet the new thresholds. We encourage health plans to explore these options to ensure their CAHPS results are valid and actionable. This also lets plans direct resources effectively, improving the areas of member experience that need it most.

5 pillars of an exceptional member experience

While health plans often seek quick fixes to improve CAHPS scores, the reality is that lasting improvements in member experience require a long-term approach.

Plans should focus on building strong foundations in a few key areas. 

  1. Enhancing member services: Investing in staffing and training for member service lines can have a significant impact. Members value timely responses from knowledgeable staff who can resolve their issues efficiently.
  2. Listening to members: Actively listen to members—not just through annual surveys, but by continuously monitoring complaints, appeals, and call data. This ongoing feedback helps identify and resolve issues before they appear in CAHPS results. Leveraging targeted, digital listening strategies throughout the year can provide real-time insights into members' experiences at various touchpoints, such as enrollment, access to care, and prescription fulfillment.
  3. Proactively managing changes: Members often react negatively to changes in benefits or policies, particularly those that increase out-of-pocket expenses or disrupt their relationships with providers. When changes are necessary, health plans should communicate with affected members well in advance, offering support and solutions to minimize the impact.
  4. Partnering with providers: Provider partnerships play a critical role in member experience, as approximately 70% of CAHPS measures are directly influenced by members' interactions with their providers. Plans that engage providers through post-visit surveys and pay-for-performance programs can make significant strides in improving CAHPS scores.
  5. Utilizing predictive analytics: Predictive analytics help health plans focus their outreach efforts where they will matter most. By identifying dissatisfied members who are likely to respond to surveys, plans can target interventions to improve both member satisfaction and survey participation.

When health plans focus on these strategies, they not only can improve their CAHPS scores, but also build stronger relationships with their members—leading to long-term success. While the journey to better member experience may take time, with a commitment to proactive engagement, listening, and partnership, plans can see meaningful improvements in both satisfaction and survey outcomes.

To learn more about Press Ganey’s solutions for health plans, reach out to a member experience expert. 

About the author

David L. Larsen currently works as Senior Advisor Member Experience at Press Ganey and prior to that he worked as an independent healthcare consultant working with predictive analytics, member engagement, and pharma vendors to improve their offerings and sales approach to managed care plans and working with managed care plans to improve their Medicare Advantage Star Ratings focusing on improvements related to CAHPS, HOS, HEDIS, medication adherence, and member experience measures. David served as the Director of Quality Improvement for SelectHealth in Salt La­ke City, Utah for 32 years and worked for Intermountain Healthcare for 38 years. SelectHealth is a mixed model HMO with more than 950,000 members in Utah, Idaho, and Nevada across all insurance product lines including, Medicare Advantage, manage Medicaid, large, small, and individual commercial plans, and ACA plans. Intermountain Healthcare is an integrated health care delivery system with 23 hospitals and over 1,500 employed physicians. As the Director of Quality Improvement, David had responsibilities for oversight of the Medicare Advantage Stars program for which SelectHealth received a 5 Star rating in 2022, maintaining NCQA accreditation; HEDIS performance measurement and improvement; CAHPS and HOS measurement and improvement, public reporting (transparency), and population health. David has also been responsible for the oversight and development of chronic disease registries, performance measurement and web based reporting systems, quality improvement pay for performance incentives for providers, provider transparency programs, and direct patient improvement interventions related to chronic illnesses including patient adherence monitoring, reminders, and incentive programs.

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