Ninety-one percent of consumers read online reviews for restaurants, home repairs, and numerous service providers in order to make an informed decision. While not quite the same, Medicare Advantage also offers seniors and individuals with disabilities who are eligible for Medicare a window into consumer experiences with a particular health plan before making an enrollment decision.
In Medicare Advantage, the federal government holds health plans accountable for quality and consumer experiences through the Star Rating System. The Centers for Medicare and Medicaid Services (CMS) score Medicare Advantage plans on a one-to-five scale, with five stars being the highest rating. There is not an equivalent tool in Traditional Fee-For-Service (FFS) Medicare, but CMS does use a similar five-star rating system for nursing homes and commercial health plans offered on health exchanges for individuals under 65 through Healthcare.gov.
The Star Rating System measures both clinical care and consumer experience. This system has been successful in driving quality in Medicare Advantage. Health plans and providers work to meet the goals set by CMS and today 77 percent of enrollees in Medicare Advantage are in high quality plans, up from 24 percent a decade ago when the program started. This quality accountability also works to drive innovations and improvements in Medicare Advantage as health plans seek better scores and better standing as compared to their competitors.
Higher Star Rating scores also yield opportunity for quality bonus payments that health plans use to enhance care and benefits. Health plans, providers, and advocates all agree that accountability metrics are important and that efforts are needed to continually update the measurements and advance quality.
CMS tracks consumer experiences in Medicare Advantage through the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. The survey – 68 questions long for most recipients – is sent by mail annually to a random sample of Medicare Advantage beneficiaries in most health plans. Exceptions are made for small plans with enrollment numbers below a certain threshold.
CMS plans to double the weight of consumer experience measures in its Star Ratings calculations next year – a move that demands increased focus on what matters for consumer experience in Medicare advantage and how it is measured in the CAHPS survey. A new study from the Center on Innovation on Medicare Advantage and NORC at the University of Chicago shows shortcomings in the consumer measurements that deserve policymakers’ attention.
Namely, beneficiaries are sent a lengthy paper survey—rather than being able to log onto a computer and answer a few questions after a specific episode of care. 76 percent of Medicare Advantage beneficiaries now say they would prefer to complete the survey online.
Like other consumer health surveys, response rates have fallen dramatically in recent years—the CAHPS survey fell to an all-time low of 37 percent with unknown impact on the representativeness of the respondents.
In addition, the CAHPS survey includes questions that are in some cases beyond Medicare Advantage plans’ control. For example, consumers are asked about physician office wait times, even as 88 percent of beneficiaries agree this is the primary responsibility of their doctor.
First established in the 1990s, many of the core CAHPS survey questions need updating to reflect how care is delivered in the 21st Century. For instance, there are no questions about telehealth and virtual visits that can address the way many beneficiaries receive care today, especially during the COVID-19 pandemic.
The survey also asks beneficiaries to recount health care experiences they may have had months earlier. There is a lack of clarity as to which visit in the last six months a respondent may be thinking about when providing survey responses. Given the number of clinicians a senior with multiple chronic conditions may see in half a year, this does not help either the consumer or the health plan identify where a problem may be.
Since both consumers and health plans rely on the Star Ratings Systems to be accurate, meaningful, and actionable, this assessment tool must be updated to meet the realities of today’s Medicare beneficiaries.
Thankfully, in addition to identifying current problems, the Center for Innovation in Medicare Advantage and NORC have also proposed a way forward. The report offers sensible solutions like adding an online survey component, condensing survey questions to get to the heart of consumer experiences that are most meaningful to consumers and within Medicare Advantage plans’ control, and providing geographic-specific survey data to enable health plans and providers to make improvements.
Sensible changes as these can do right by seniors and deliver a more impactful, modernized consumer survey that holds Medicare Advantage accountable for continuing to deliver the high-quality, high-satisfaction care that beneficiaries have come to know and trust.
Allyson Y. Schwartz is President and CEO of Better Medicare Alliance and serves on the board of its sister research organization, the Center for Innovation in Medicare advantage. Schwartz is a former Member of the U.S. House of Representatives from Pennsylvania, serving from 2005-2015.
Caroline F. Pearson is a Senior Vice President at NORC at the University of Chicago.
