A highly competitive market

In the highly competitive health insurance market, those who invest in improving consumer engagement and patient satisfaction will thrive.

In fact, the Centers for Medicare and Medicaid Services (CMS) give patient experience more weightage in calculating the star ratings for Medicare Advantage and Part D plans for 2023. This has cascading consequences since patients also depend on star ratings to choose their health plans. Higher ratings impact a provider’s profitability through bonus payments for the .

Patient experience surveys have a huge role to play in gauging people’s sentiments. Healthcare organizations can use this survey data to understand and improve their patients’ care experiences. This white paper explores the importance of surveys in driving the next steps towards value-based care.

Measuring patient satisfaction with surveys

Patient experience encompasses all the interactions influencing patient perceptions across the care continuum.

An individual’s healthcare experience is often difficult to measure and reduced to a simple metric. When it comes to scoring, most patients only consider their overall satisfaction level. When patients carefully evaluate the care they receive, it provides an accurate representation of the quality of service and unlocks opportunities to improve care delivery, reduce cost, meet patients’ expectations, and track the performance of health plans.

Patient experience surveys ask patients their experiences with, and ratings of, their healthcare providers and plans. These include hospitals, doctors, and health and drug plans. These surveys attempt to translate results into meaningful, quantifiable, and . The data not only measures quality but is also designed to reimburse services based on quality outcomes. Surveys support the belief that high-quality outcomes and high levels of patient satisfaction lead to quality developments, better reimbursements, and are closely linked to member churn. The CMS gives additional motivation for high-scoring plans, in which enrolment is granted all through the year.

CMS and star ratings

The star ratings for Medicare Advantage and Part D, published by the CMS every year, measure the quality of services received by beneficiaries enrolled in their health plans.

Consumers can select a plan and evaluate how well those Medicare-contracted plans perform. The star ratings reflect a plan’s performance on over 40 quality measures with varying weights. Of these, 14 are associated with customer experience metrics such as a consumer assessment of healthcare providers and systems (CAHPS) and a health outcomes survey (HOS). Together, they constitute 27% of the health plan score, indicating the success or failure of a plan.

In May 2020, CMS changed the method for calculating star rating quality scores. It elevated access to care and patient experience to be in line with outcome measures. CMS has increased the relative weight of patient experience from 1.5 to four (see Figure 1). This means that patient experience-related metrics compose 57% of the star ratings, (see Figure 2). Moving forward, patient experience will become increasingly important.

Increasing the weight of patient experience from two to four for the CAHPS star ratings is significant for both payers and providers. They stand to gain about $15 billion in incentives. Additionally, they can use bonuses and rebates—provided for plans that win four or more stars—toward member benefits.

The new rules for CAHPS scores will impact star ratings in 2023 but are based on care delivered in 2021. Plans could see an impact on the revenue with the change in weight of patient experience measures if their performance along those metrics don’t change. For example, a plan with five stars overall for 2020 could have gotten away with a patient experience score below five stars. But, in 2023, these identical scores and the increased weight of customer experience measures will equal a lower overall star rating of four or less, resulting in lower profits.

Efforts to enhance patient experience through CAHPS scores need to be year-round. Payers and providers must establish real-time and reliable communication through traditional or digital channels. Further, by using advanced analytics, the data obtained from complaint trackers, disenrollment surveys, and grievances can become the right tools to gain insight into member perceptions. This allows health plans to offer targeted, issue-specific programs, and stage interventions when needed for more improved patient experiences.