Summer Surveys Coming to a Member’s Mailbox Near You!

Starting in late July, some HealthTeam Advantage (HTA) members may receive the Medicare Health Outcomes Survey (HOS) and/or the Mock CAHPS® survey in mail. If selected, members will receive communications from CMS and SPH, our Medicare-approved survey vendor, requesting their responses. Please encourage them to respond! For beneficiaries who are unable to complete the survey via mail or phone, a family member or other proxy may complete the survey for them.

We know that you do your best to provide exceptional care to your patients. These surveys are used by Medicare and the National Committee for Quality Assurance (NCQA) to compare plans and healthcare throughout the country, which includes their time with you, their providers.

What is the HOS survey?

Annually, from mid-July through October, Medicare Advantage plans with 500 members or more are required to participate in the Medicare HOS survey. This is a longitudinal survey that measures the health plan’s ability to maintain or improve the health and health-related quality of life of its members using self-reported evaluations of their physical and mental health. Responses are compared over a two-year period with risk factors. Then the member’s physical and mental health status is categorized as “better,” “the same,” or “worse than expected.”

This year, HTA meets this requirement for our PPO and our Diabetes & Heart Care (HMO CSNP) plans. The baseline sample size is 1,200 for each plan, but oversampling is optional. For each member who completes a Baseline survey, they will be sent a Follow-Up survey two years later. Therefore, some HTA PPO members may receive the Follow-Up survey this year.

The HOS survey is currently used to calculate the following Star measures:

1. Monitoring Physical Activity: Percent of senior plan members who discussed exercise with their doctor and were advised to start, increase, or maintain their physical activity during the year.
2. Reducing the Risk of Falling: Percent of plan members with a problem falling, walking, or balancing who discussed it with their doctor and received a recommendation for how to prevent falls during the year.
3. Improving Bladder Control: Percent of plan members with a urine leakage problem in the past 6 months who discussed treatment options with a provider.
   
   

Additional measures are currently on display with the possibility to be used again to calculate Star measures in future years:

1. Improving or Maintaining Physical Health: Percent of plan members whose physical health was the same or better than expected after two years.
2. Improving or Maintaining Mental Health: Percent of plan members whose mental health was the same or better than expected after two years.
   
   

Physical Functioning Activities of Daily Living is a newer measure that combines Physical Functioning (PF) questions with Activities of Daily Living (ADL) questions to calculate scale scores. Please click here for a more detailed methodology used to score the PFADL change measure.

You can find more information on the Medicare HOS surveys here.

What is the CAHPS survey?

Each year from February through June, the Medicare CAPHS survey is used to evaluate the quality of health services provided through Medicare Advantage (MA) and Part D (PDP) programs. This health plan survey has been conducted annually since 1998, and the drug plan surveys were added in 2007.

CMS requires all MA and PDP contracts with at least 600 enrollees to participate. Unlike the HOS survey, members must be with the contract for six months or longer and live in the United States. HTA was only required to participate with the PPO plan for the 2022 season, but both plans will be required in 2023.

HTA will have a mock CAHPS survey for our CNSP members from late July through September of this year. The survey will be a duplication of the required 2022 CAHPS with four additional custom plan questions. The responses on the required survey are anonymous, but they are not anonymous for the mock survey. The individual responses will be used to help better understand the member experience with the Diabetes & Heart Care (HMO CSNP) plan and their providers. There will be no retaliation for negative responses.

The questionnaire includes the following domains: Your Healthcare in the Last 6 Months, Your Personal Doctor, Getting Healthcare from Specialists, Your Health Plan, Your Prescription Drug Plan, and About You. For scoring and reporting purposes, some questions within those domains are combined into the following six composite measures:

1. Getting Needed Care
2. Getting Appointments and Care Quickly
3. Customer Service
4. Getting Needed Prescription Drugs (MA-PD and PDP)
5. Care Coordination
6. Doctors Who Communicate Well (reported to contracts – not reported to consumers)
   
   

In addition to the publicly reported composite measures listed above, the survey questionnaires include several publicly reported “member overall” ratings based on a 0-10 scale, where 0 is the lowest rating and 10 is the highest:

1. Rating of Health Plan
2. Rating of Health Care Quality
3. Rating of Drug Plan (MA-PD and PDP)
   
   

All above measures were a 2x weight for the 2022 Star Ratings. However, they will increase to 4x weight for the 2023 ratings, starting with the 2022 surveys from earlier this year. The MA and PDP CAHPS Survey also includes the following single item measures, which are publicly reported:

1. Annual Flu Vaccine (1x weight)
2. Pneumonia Vaccine (reported to contracts – not reported to consumers)
   
   

You can find more information on the CAHPS survey here. More information will be provided during the 2023 season, but if you have any questions, please call our Provider Concierge team at (855) 218-3334 or email providerconcierge@htanc.com.