What is the purpose of the CAHPS Improvement Guide?

The extensive and growing use of CAHPS surveys to assess the quality of health plans, medical groups, and other organizations has created a demand for practical strategies that organizations can use to improve patients’ experiences with care. This guide is designed to help meet this need. It is aimed at executives, managers, physicians, and other staff who are responsible for measuring performance and improving the quality of services provided by health plans, medical groups, and individual physicians. Over time, this guide will be updated to include new improvement interventions and offer additional resources.

What surveys are addressed by this guide?

The guide is structured around the aspects of health care assessed by two CAHPS surveys: the CAHPS Health Plan Survey and the CAHPS Clinician & Group Surveys. If you are new to these surveys, you may want to explore the CAHPS Web site, which contains a great deal of information about the development, content, and use of these instruments.

The guide does not currently address the needs of organizations that use the CAHPS Hospital Survey (H-CAHPS) or other CAHPS surveys. However, much of the guidance about the prerequisites for effective quality improvement, the process of analyzing performance issues, and the cyclical approach to implementing interventions is pertinent to all organizations seeking to improve patients’ experiences with care.

What are the performance issues listed in the guide?

The guide allows users to search for quality improvement strategies that can address performance issues assessed by CAHPS surveys. Those issues are reported to consumers and patients in the form of composite measures, which combine the results for two or more questions into one score.

The first table below organizes the core composites from the Health Plan Survey and the Clinician & Group Surveys into the major domains covered by CAHPS surveys. The term core refers to the fact that these measures are based on items that must be included in the questionnaire in order for it to qualify as a CAHPS instrument.

Core Composite Measures in the CAHPS Health Plan Survey
and the CAHPS Clinician & Group Surveys

CAHPS Survey

Domains

Access

Interpersonal Care

Administrative Services

Health Plan SurveyGetting Needed CareHow Well Doctors CommunicateHealth Plan Information and Customer Service
Getting Care Quickly Claims Processing*
Clinician & Group SurveysGetting Timely Appointments, Care, and InformationHow Well Providers (or Doctors) Communicate With PatientsHelpful, Courteous and Respectful Office Staff

* " Claims processing” is not technically a composite, but this category represents a set of measures collected by nearly all health plans for HEDIS reporting (i.e., supplemental measures required for those plans reporting CAHPS 4.0H).

The guide also offers information on interventions that address topics that survey sponsors may choose to add to their questionnaires. For both the Health Plan Survey and the Clinician & Group Survey, these topics are drawn from supplemental items, which are optional questions included in CAHPS surveys. These items enable sponsors to assess performance in areas not covered by the core items. Other topics come from the HEDIS and Medicare versions of the Health Plan Survey. The following table shows the additional topics covered by the two surveys.

Full List of Topics Addressed in the Guide, Organized by Survey

 

Health Plan Survey

Clinician & Group Surveys

Core Topics
Access

X

X

Claims processing (from HEDIS item set)

X

 

Communication with doctors

X

X

Customer service

X

X

Additional Topics
Communication about costs of care

 

X

Coordination/Integration of care

X

X

Health promotion/Education

X

X

Preventive services

X

 

Shared decisionmaking

X

X

What is in this guide?

The CAHPS Improvement Guide has several parts:

  • Why Improve Patient Experience?– A compelling case for health care organizations to focus on improving their patients' experience with care.
  • Are You Ready to Improve? – An overview of five behaviors common to health care organizations that have been effective in improving their CAHPS-related performance.
  • Analysis of CAHPS Results – A discussion of various approaches to analyzing data from CAHPS surveys in order to identify opportunities to improve and priorities.
  • Quality Improvement Steps – A walk through the basic steps of a CAHPS-related quality improvement process.
  • Browse Interventions – Descriptions of interventions that health care organizations can implement in order to help improve consumers’ and patients’ experiences with care.
  • Resources – Quick access to lists of published studies, Web sites, books, and other resources that address the various issues discussed in the guide.

What information can I find about improvement interventions?

The guide presents approximately 20 ideas for improving the patient’s and consumer’s experience of care as measured by the CAHPS surveys. They are organized on the site by performance problem (e.g., access, communication, customer service) and by the composite measures for each survey (e.g., “Getting Care Quickly” from the Health Plan Survey).

The descriptions of the interventions are intended to give you enough information to determine whether the strategy is pertinent and worth further investigation. Specifically, the summaries of each intervention cover the following questions:

  • What is the problem that is shaping the patient’s or member’s experience with the health care organization?
  • What is the practice that can help address this problem? What is its purpose? What benefits does it offer to patients, providers, and plans? How has it been implemented?
  • What are the published results of an evaluation (if any)?
  • What are some key resources for more information on the intervention?

How do I select an intervention?

The interventions outlined in this guide represent a range of possible solutions. When you review your options, keep these considerations in mind:

  • Appropriateness for your organization: Some interventions are more appropriate for health plans, while others are better suited to medical groups. In some cases, the strategies are directed at both stakeholders, but one will have to take the lead.
  • Resources and time available: Some interventions are easy and inexpensive to implement, while other are much more logistically complex and require a significant investment of money, resources, and time. If you find a strategy that seems appropriate but overwhelming, it’s fine to “start small” — perhaps by tackling one component of the strategy, or even by stepping back to assess your organization’s readiness for the change. You may also want to explore ways to stage the implementation of one or more strategies to make them more feasible.
  • How quickly you need to see results: As you review your options, consider the immediate and long-term goals of your organization, as well as its constraints. Some strategies are likely to address the performance issue directly, while others may have an indirect impact. Some may allow you to see results right away, whereas others may take months or even years to make a measurable difference.

Who is responsible for this guide?

The CAHPS Improvement Guide was produced by a team of researchers based at Harvard with the support of the Centers for Medicare and Medicaid Services (CMS). CMS is a major sponsor of the CAHPS Health Plan Survey, which it uses to assess the performance of the Medicare program and its health plans. Since 1998, it has collected CAHPS data from members of all Medicare HMOs in order to assess their experiences; it has collected data from beneficiaries in the traditional Medicare program since 2001. These results are shared with the health plans as well as with beneficiaries, who are encouraged to use the information to help choose the plan that best meets their needs. (Publicly reported results are available at https://www.medicare.gov/find-a-plan/questions/home.aspx)

Since CMS released the guide in 2003, it has been disseminated in print to Medicare health plans and more broadly in PDF format. In 2008, CMS funded a research team associated with Massachusetts General Hospital and Harvard to transform the printed guide into a Web-based resources that could join the many CAHPS-related resources made available by the Agency for Healthcare Research and Quality.

While initially designed for Medicare health plans, the guidance and quality improvement interventions are intended to help all health plans and medical groups, regardless of their patients’ source of coverage.