When Your Loved One Receives a CAPHS Survey

Helpful Highlights

• The CAPHS survey for health plans is conducted annually, usually in the spring though timing sometimes varies.

• The survey ensures that Medicare beneficiaries have the opportunity to provide feedback on their experiences with their health plans regularly.

• Family caregivers like you may help your loved one complete the survey, though no one else on their medical or insurance care teams may do so.

• It is important to complete the survey (and timely) because it impacts the decision-makers who manage all aspects of the healthcare that touches your loved one.

Please ensure that your loved one completes and submits the CAPHS survey!

The survey itself

The survey consists of a standardized set of questions designed to assess various aspects of patient experience with their health plans and services.

The specific number and types of questions may vary depending on the survey version and any modifications made by the health plan. Examples of the domains addressed by the questions are:

Access to care - getting appointments, wait times for appointments, ease of getting necessary medical care and services

Communication with providers - clarity of information they provide, the ability to ask them questions, the level of respect and courtesy they show

Coordination of care - coordination between care settings such as primary care, specialists, hospitals, other facilities

Customer service - quality of interaction with customer service representatives, including their responsiveness, helpfulness, ability to address concerns or issues

Health plan information and services - the clarity and usefulness of information provided by the health plan, satisfaction with covered benefits, services, programs

Overall rating and satisfaction - rating of overall satisfaction with the health plan and whether they would recommend it to others

Completing the survey

The CAPHS survey may be received by phone, online link, email, or postal mail. It can also be returned in all the same ways. The survey is designed to be anonymous - no names or contact information is required.

Each question has a standardized response scale, though specific response options may vary. Common response scales are:

• Numeric rating scale (0-10 or 1-5)

• Frequency scale (never, rarely, sometimes, often, always)

• Likert scale (strongly agree, agree, neither agree nor disagree, disagree, strongly disagree)

• Yes/No response

• Multiple-choice* (select one or more of the responses provided)

• Open-ended questions* (allow respondents to write whatever and however much they like)

*These response types allow for more than one response.

While there is no universal deadline for the CAPHS survey, timely submission helps with uniform data collection, processing, and reporting, so please make an effort to help your loved one return in without a long delay.

Survey results

Here are the many stakeholders who have an interest in the CAPHS survey results and how those results are used.

Healthcare providers and organizations. Results allow them to identify areas of improvement in care delivery, communication, and satisfaction. Positive results can enhance their reputation and attract more patients, while negative results can publicly highlight areas needing attention and improvement. Results also impact reimbursement.

Policymakers and regulators. Survey data is used to evaluate the quality of care provided by healthcare organizations and inform policy decisions aimed at improving healthcare quality and patient outcomes. Survey results may influence reimbursement policies, accreditation standards, and quality improvement initiatives - in other words, the rules and regulations that healthcare providers, organizations, and plans must follow.

Health insurers and payors. Results are used to assess the performance of healthcare providers and organizations participating in their networks. Positive survey results may indicate high-quality care and patient satisfaction, while negative results may prompt payers to reconsider network participation or contract terms.

Results are also used to determine how benefits should be managed, such as adding new benefits, combining or expanding existing benefits, and contracting or eliminating existing benefits.

Researchers and academia. May use survey data for studies and research projects aimed at understanding patient experiences, evaluating healthcare interventions, and identifying best practices for improving patient-centered care. Research advances practice knowledge and promotes practice innovation.

Your loved one (patients/members) AND you (caregivers). You and your loved one are key stakeholders in the CAHPS survey process. Your feedback drives quality improvement efforts and influences healthcare delivery. CAHPS survey results help your loved one make informed decisions about healthcare providers and empowers them to advocate for better care experiences.