# Presentation: 890128

## The CAHPS® Improvement Guide

**Dale Shaller, M.P.A.**
- Principal, Shaller Consulting
- Managing Director, National CAHPS® Benchmarking Database (NCBD)
- Member, Harvard Medical School CAHPS® II Team

## What is the CAHPS® Improvement Guide?

- A resource manual for health plans and medical groups seeking to improve their performance in domains measured by CAHPS®
- Funded by CMS (Medicare)
- Developed by Harvard Medical School CAHPS® Team

## What is CAHPS®?

- Most widely used survey tool for measuring the patient’s perspective on quality
- Funded by AHRQ and developed by the CAHPS® Consortium
- CAHPS® Health Plan Survey assesses care in health plans covering over 125 million Americans
- New CAHPS® surveys now under development for:
- Hospitals
- Medical groups
- Individual clinicians
- New focus on helping plans and providers use CAHPS® for quality improvement

## Performance Domains Measured by the  CAHPS® Health Plan Survey

**CONSUMER REPORTS:**
**Access**
- Getting Needed Care
- Getting Care Quickly
**Interpersonal Care**
- How Well Doctors Communicate
- Courteous and Helpful Office Staff
**Administrative Services**
- Customer Service
- Claims Processing

**CONSUMER RATINGS:**
**Overall Ratings**
- Personal Doctor
- Specialist
- All Health Care
- Health Plan

## A Guide to the CAHPS® QI Guidebook

**Section 4.****Ideas for Improving Experiences with Care**

- Getting needed care

- Getting care quickly

- Doctors communicate well

- Customer service

- Home health & preventive services

- Claims Processing

**Plan Strategy**
- - Create team (if needed)
- - Establish/confirm goals
- - Investigate potential interventions (see Section 4)

**Develop and Test Strategy**
- - Select measures to monitor progress
-  Develop changes using selected intervention
-  Conduct small tests of change
-  Adapt changes to org. context
- - Identify and deal with barriers

**Monitor Strategy**
- - Implement changes and hold the gains
- - Evaluate progress against criteria3

**Reassess & Respond**
- - Use CAHPS® data to assess what worked, what didn’t
- - Spread successful innovations

**Section 2.  Identifying ****Opportunities to Improve**

- For each opportunity:

**Section 1. Setting the Stage:** An Infrastructure that Supports Improved Performance

**Section 3. Implementing the CAHPS **®** Improvement Cycle**

## Using CAHPS®  to Identify Improvement Opportunities

**Getting Needed Care**

- National Adult Commercial Results

- (n=105041)

**8%**

**18%**

**74%**

- Local Sponsor Market Results

- (n=5850)

**8%**

**18%**

**74%**

- Plan A

- (n=1713)

**8%**

**18%**

**75%**

- Plan D

- (n=495)

**9%**

**16%**

**75%**

- HMO/POS Model Type Results

- (n=84728)

**8%**

**19%**

**73%**

- 

- PPO Model Type Results

- (n=20032)

**5%**

**16%**

**79%**

- 

- Plan B

- (n=542)

**5%**

**15%**

**80%**

- 

- Plan C

- (n=405)

**11%**

**19%**

**70%**

- 

- Plan E

- (n=544)

**9%**

**22%**

**68%**

- 

## Using CAHPS®  to Identify Improvement Opportunities

- Low achievement scores on composites highly correlated with rating of overall health care.

**Medium Priority**
- Low achievement scores on composites only slightly associated with rating of overall health care.

**Low Priority**
- Doing very well on composites items not highly correlated with rating of overall health care.

- *	An achievement score is ranked “high” when score is 85 or higher.
- **	An association with Overall Health Care is ranked “high” when correlation is .4 or higher.

- 60        65       70         75        80         85       90        95         100
**   **Low**	****	****	****	****	****       ****	****	****         **High
**                               ****Achievement Score*****  ****	**

**Correlation with Rating of Overall Health Care****

**High**
** **
** **
-    .40
** **
** **
**Low**

**Using CAHPS****®****  to Identify Improvement Opportunities**

**Getting Needed Care****	**

**Customer Service**

**Getting Care Quickly****	**

**Courteous and Helpful Office Staff**

**How Well Doctors Communicate**

**High Priority**
- Already doing very well on composites highly correlated with rating of overall health care.
- Could try to do even better.

## CAHPS® Improvement Process Cycle

**Plan Strategy**
- - Create team (if needed)
- - Establish/confirm goals
- - Investigate potential interventions

**Develop and Test Strategy**
- - Select measures to monitor progress
-  Develop changes using selected intervention
-  Conduct small tests of change
-  Adapt changes to organizational context
- - Identify and deal with  barriers

**Monitor Strategy**
- Implement changes and
- hold the gains
- - Evaluate progress against criteria

**Reassess & Respond**
- - Use CAHPS data to assess what worked, what didn’t
- - Spread successful innovations

**CAHPS**®** Improvement Process Cycle**

## Improvement Strategies

- Over 2 dozen strategies mapped to CAHPS® core questions
- Apply to plan, medical group, or both
- Each strategy includes:
- Problem description
- The intervention and its benefits
- Examples of implementation
- Key resources

## Examples of Strategies for Improving Doctor Communication

- Physician training
- Patient communication tools
- Shared decision-making
- Support groups and self-care
- Delivery of evidence-based information
- Planned visits
- Group visits

## Distribution and Use of the Guide

- CMS sent print and CD-ROM versions to all Medicare managed care plans
- CMS Web site and regional offices
- CAHPS-SUN Web site:
- _[www.](http://www.cahps-sun.org/)__[cahps](http://www.cahps-sun.org/)__[-sun.org/](http://www.cahps-sun.org/)__[WhatsNew](http://www.cahps-sun.org/)__[/](http://www.cahps-sun.org/)__[WhatsNew](http://www.cahps-sun.org/)__[.asp](http://www.cahps-sun.org/)_
- Meetings and conferences
- CAHPS® QI demonstration projects
- Institute for Clinical Systems Improvement
- Seeking feedback for future updates