cahps, hos and the patient experience: taking the next...
TRANSCRIPT
CAHPS, HOS and the Patient Experience: Taking the Next Step
2480ALL0516
Matt Fillipps [email protected] Humana Stars Quality Member Experience
CMS Official Surveys CAHPS and HOS overview
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CAHPS survey
Consumer Assessment of Healthcare Providers and Systems (CAHPS)
• Survey assesses consumers’ experiences with the quality of their health care and other plan services.
• Medicare Advantage and Prescription Drug Plan version of survey asks 95 questions.
• Annually, between 800 and 2,000 members are randomly selected from each plan to participate.
• Five attempts are made to survey the member: two paper, three telephonic.
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CAHPS survey question domains
Weight Measure Components
1.5 Getting care quickly • Scheduling an appointment • 15-minute wait time
1.5 Coordination of care • Review medications • Informed about specialist care
1.5 Getting needed care • Getting specialist appointment • Care, tests, treatments through the plan
1.5 Customer service • Customer service courteous and informative • Health plan forms
1.5 Getting needed prescription drugs • Ease of getting prescribed medications • Obtaining medications at retail or via mail
1 Annual flu vaccine • Obtaining flu vaccination during prior season
1.5 Rating health care quality • 0-10 rating of health care
1.5 Rating the health plan • 0-10 rating of health plan
1.5 Rating the drug plan • 0-10 rating of drug plan
Composite Single item Overall
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HOS survey
Health Outcomes Survey (HOS)
• This tool assesses the ability of a Medicare Advantage organization to maintain or improve its members’ physical and mental health.
• Survey asks 68 questions.
• Annually, between 800 and 2,000 members are randomly selected from each plan to participate.
• Members are selected to receive a baseline survey and a follow-up survey two years apart.
• Five attempts are made to survey the member: two paper, three telephonic.
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HOS survey measure domains
Weight Measure Components
3 Physical health • Self-assessment (past four weeks) • Accomplishing daily activities
3 Mental health • Self-assessment (past four weeks) • Daily mood, emotional state
* Bladder control • Issue (past six months) • Physician discussion • Treatment
1 Fall risk • Issue (past 12 months) • Physician discussion (past 12 months) • Treatment
1 Physical activity • Physician discussion (past 12 months) • Recommendation – start, increase, maintain
activity level (past 12 months)
Improvement Discussion
*Bladder control is a display measure only this year. It will be tracked, but not counted for “score.”
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Timeline: CAHPS & HOS official surveys
January
2016 February March April May June July
CAHPS survey 3/4 Prenotification letter
3/10 First paper questionnaire mails
4/4 Second paper questionnaire mails
4/21 Telephonic outreach begins
6/5 Follow-up calls end
6/5 Cutoff date for phone and mail surveys
6/18 Final data files due to CMS
HOS survey HOS baseline cohort survey
begins
HOS baseline cohort survey ends
5/6 Interim data files due to CMS
HOS follow-up cohort survey
begins
HOS follow-up cohort survey
ends
• Blackout period: Late February–June. The health plan is prohibited from asking members any CAHPS-related questions that could influence official survey responses. Physicians, however, may discuss CAHPS and HOS quality topics with patients during this period.
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Why are CAHPS & HOS important?
• At 28 percent, CAHPS and HOS make up a larger combined slice of the overall CMS Stars rating than any other focus area.
• At a 4-Star level or above, each plan is eligible for a bonus based on membership.
11%
17%
25% 8%
14%
12%
13%
Stars category weight
HOS
CAHPS
HEDIS
IRE
CMS
Patient safety
Improvement measures
HEDIS: Healthcare Effectiveness Data and Information Set; IRE: Independent Review Entity
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What are my clinical and business incentives?
Clinical case • Positive patient experiences correlate with:
o Adherence to medical advice1 (especially among patients with chronic conditions)
o Better health outcomes2
Business case • Providing a quality experience:
o Leads to patient retention3
o Keeps employees engaged and less likely to leave4
o May lower risk of malpractice suits5
Footnotes 1
DiMatteo MR, Sherbourne CD, Hays RD, et al. Physicians’ characteristics influence patients’ adherence to medical treatment: Results from the Medical Outcomes Study. Health Psychology. 1993; 12:93-102. 2
Rave N, Geyer M, Reeder B, Ernst J, Goldberg L, Barnard C. Radical systems change: Innovative strategies to improve patient satisfaction. Journal of Ambulatory Care Management. 2003; 26(2):159-174. 3 Safran DG, Montgomery JE, Chang H, Murphy J, Rogers WH. Switching doctors: Predictors of voluntary disenrollment from a primary physician’s practice. Journal of Family Practice. 2001; 50(2):130-136. 4
Rave N, Geyer M, Reeder B, Ernst J, Goldberg L, Barnard C. Radical systems change: Innovative strategies to improve patient satisfaction. Journal of Ambulatory Care Management. 2003; 26(2):159-174. 5
Fullam F, Garman AN, Johnson TJ, Hedberg EC. The use of patient satisfaction surveys and alternate coding procedures to predict malpractice risk. Medical Care. May 2009; 47(5):1-7.
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Financial impacts
Humana’s Star quality rating may impact rewards programs.
• For Risk and partial-risk providers − CMS Star ratings of Humana Medicare Advantage plans can impact
premium funding from CMS, which can in turn affect provider compensation depending on the contractual arrangement
• In 2016, patient experience rating is part of Humana’s Medicare Advantage rewards program for primary care physicians.
• For providers participating in Humana’s Medicare Advantage Model Practice or Medical Home Rewards Programs:
− The provider’s patient experience rating, as measured by results from a Humana-designed Patient Experience Survey, must be 80 percent or greater to earn a reward or care coordination fee, as applicable.
Measuring the Patient Experience Humana’s internal survey
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Patient experience overview
• Patient experience at physician’s office is key to CAHPS and HOS success.
• Humana measures patient experience using its own Patient Experience Survey (distinct from the official CMS surveys). • Voice-automated telephone survey • Survey season July to early February (return rate approximately 40 percent)
• Survey of patients who visited their PCP in the previous 60 days • Thirteen questions aligned with the following eight CAHPS & HOS measures:
- Getting needed care without delay (CAHPS) - Getting appointments and care quickly (CAHPS) - Getting needed prescription drugs (CAHPS) - Coordination of care (CAHPS) - Reducing the risk of falls (HOS) - Bladder control (HOS) - Physical activity (HOS) - Mental health (HOS)
• Goal: Look for best practices and areas of opportunity
Patient experience: Score calculation breakdown
• 11 questions on the Patient Experience Survey count toward the member experience score.
• Only questions 4 and 5 are excluded from the overall score because they are plan- and physician-driven measures.
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Q1
Q2
Q3
Q6
Q7
Q8
Q9
Q10
Q11
Q12
Q13
Member Experience Rating
(average of 3 categories)
Target = 80%
Coordination of Care Description
Access to Care Average of: Q1, Q2, Q3 scores
Coordination of Care Average of: Q6, Q7 scores
Patient Discussion
Average of:
Fall Risk Score (Q8, Q9 average),
Bladder Control Score (Q10, Q11 average),
Physical activity (Q12),
Mental health (Q13)
Patient experience: Cut points for the questions
Thresholds for Patient Experience Survey questions are based on industry cut points for the related CAHPS and HOS measures.
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1. Low threshold cut points are greater than or equal to the number shown. 2. High threshold cut points are less than, but not equal to, the number shown.
Question Low High Low High Low High Low High Low High
1 Difficulty Scheduling Appointment 0 70.99 71 72.99 73 76.99 77 78.99 79 100
2 Doctor Wait Time 0 70.99 71 72.99 73 76.99 77 78.99 79 100
3 Referral for Specialist 0 78.99 79 80.99 81 83.99 84 85.99 86 100
4 Insurance Covering Medications 0 86.99 87 88.99 89 90.99 91 91.99 92 100
5 Approval – Tests and Procedures 0 78.99 79 80.99 81 83.99 84 85.99 86 100
6 Doctor Review Medications 0 83.99 84 85.99 86 87.99 88 90.99 91 100
7 Doctor Informed – Specialist Care 0 83.99 84 85.99 86 87.99 88 90.99 91 100
8 Fall Risk – Discussion 0 52.99 53 59.99 60 66.99 67 72.99 73 100
9 Fall Risk – Treatment 0 52.99 53 59.99 60 66.99 67 72.99 73 100
10 Bladder Control – Discussion 0 30.99 31 35.99 36 59.99 60 70.99 71 100
11 Bladder Control – Treatment 0 30.99 31 35.99 36 59.99 60 70.99 71 100
12 Physical Activity 0 43.99 44 48.99 49 54.99 55 61.99 62 100
13 Mental Health 0 74.99 75 76.99 77 79.99 80 81.99 82 100
1-Star 2-Star 3-Star 4-Star 5-Star
Incorporating the Quality Experience
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Goals for “Incorporating the quality experience”
• Discuss each Patient Experience Survey topic
• Consider new tips to improve the process • Explore best practices and supporting
materials • Assess how each topic is incorporated into
your practice - Internal and external obstacles to
success?
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Topic: Difficulty scheduling appointment
Patient experience No. 1: Did you experience any difficulty setting up your appointment?
Remind patients to schedule their next visit well in advance if your practice is booking up quickly.
PCP Staff Advance scheduling
Dedicate staff members to patient scheduling, and book patients automatically for follow-up visits before they leave your office.
Pre-book follow-up
Use business card appointment reminders or tear off sheets so that the patient can have a date and time for their next visit to take with them.
Appointment reminder card
Call the patient a few days before a scheduled appointment and remind them (two to three attempts if patient does not answer).
Appointment reminder calls
Ensure that address, phone and email information is up-to-date before or following patient visit.
Records check
Reach out via phone and email to patients who have not been in for a visit in for six to 12 months and get them scheduled.
Annual wellness scheduling
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Topic: Difficulty scheduling appointment
Patient experience No. 1: Did you experience any difficulty setting up your appointment?
Utilize an online system as another source for appointment confirmation
PCP Staff
Patient Portal
Utilize an online system as another source for appointment confirmation
Patient Portal
Use business card appointment reminders or tear off sheets so that the patient can have a date and time for their next visit to take with them
Appointment Reminder Card
Call the patient a few days before their scheduled appointment and remind them (2-3 attempts if patient does not answer)
Appointment Reminder Calls
Ensure that address, phone, and email information is up-to-date before or following patient visit
Records Check
Reach out to patients via phone and email who have not been in for a visit in for 6-12 months and get them scheduled
Annual Wellness Scheduling
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Topic: 15-minute wait time
Patient experience No. 2: How long after your scheduled appointment time did you wait to see the person you came to see?
Remind patients that they need to arrive 15-30 minutes prior to their scheduled appointment time to complete necessary paperwork.
PCP Staff
Early arrival
Triage patients within 15 minutes of scheduled appointment time and take them back to exam room early.
Triaging and staging
Encourage patients to schedule appointments on days when your practice is less busy.
Off-peak scheduling
Schedule fewer patients whenever possible or factor in catch-up time. Fewer patients scheduled
Book similar tests and appointments on the same day whenever possible to keep appointment volume down.
Incorporate greeters or experience guides to welcome patients and help them through the appointment process.
Greeters
Similar appointments
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Topic: 15-minute wait time
Patient experience No. 2: How long after your scheduled appointment time did you wait to see the person you came to see?
Make fliers, pamphlets, posters and other health education items available to patients.
PCP Staff Educational materials
Hand out short surveys or assessments that could stimulate patient thinking on important health topics.
Surveys and assessments
Provide a clean, comfortable and visually appealing environment for patients to wait in.
Comfortable environment
Keep board games, decks of cards, dice, checkers, chess, magazines, a television and any other possible entertainment in the waiting room.
Provide entertainment
Place vending machines in the office or make healthy snacks, coffee and water available.
Give your staff tip sheets about how to manage patient wait-time expectations and how to improve patient perceptions.
Office tips sheet
Food and drink
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Topic: 15-minute wait time
Patient experience No. 2: How long after your scheduled appointment time did you wait to see the person you came to see?
Utilize an online system that allows patients to check in, communicates delays and gives patients other relevant information.
PCP Staff
Patient portal
Consider using a form or tear-off pad that enables patients to give feedback about their waiting room experience.
Patient feedback
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Topic: Specialist referral
Patient experience No. 3: Did you have any trouble getting a referral from your personal doctor to see a specialist ?
Schedule any necessary specialist follow-up on behalf of the patient before the patient leaves the office.
PCP Staff Pre-schedule specialist
Check to see if the specialist participates in the Humana network before scheduling, and make the patient aware.
Specialist network
Check to see if the recommended specialist appointment is covered by the patient’s plan and inform the patient of the copay.
Specialist coverage
Ensure patients understand that some specialty appointments are not urgent or emergent and that waiting a few weeks to be seen is OK.
Set expectations
Call to remind the patient of his/her specialist follow-up visit or to ensure the visit gets scheduled if the patient has not yet done so.
Consider using Humana’s specialist appointment reminder pads. Specialist pads
Appointment reminder call
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Topic: Specialist referral
Patient experience No. 3: Did you have any trouble getting a referral to see a specialist from your personal doctor?
Complete and send to the treatment center any physician referral forms and justifications, and ensure patient has referral before leaving.
PCP Staff Referral paperwork
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Topic: Difficulty obtaining prescribed medications
Patient experience No. 4: Did you have trouble with your prescription drug plan covering any medication your doctor prescribed?
Recommend mail order whenever possible to improve adherence, convenience and possibly reduce medication cost.
PCP Staff
Mail order
Ask if the patient has a convenient pharmacy that he or she already goes to. If the patient doesn’t, try to recommend one.
Pharmacy recommendation
Understand what is covered by the patient’s Humana Part D plan. Review formulary
If a prior authorization is required, call the pharmacy and do the leg work on the patient’s behalf.
Prior authorization
Check to see if there is a covered equivalent medication that could be prescribed if the proposed medication is not covered or is high tier.
Call on behalf of the patient to see how much he or she will be responsible for of the new prescription.
Copay
Generic or equivalent Rx
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Topic: Difficulty getting tests or treatments
Patient experience No. 5: Did you have any problem getting approval through your health plan for any test or procedure your doctor said you needed?
Check to see if recommended treatments, tests or procedures are covered under the patient’s plan.
PCP Staff
Coverage
Check on the patient cost share for any recommended test or treatment.
Copay
Help the patient identify where to receive any necessary follow-up treatment or tests.
Treatment location
Book follow-up appointment for tests or treatment for patients before they leave the office.
Schedule treatment
Complete and send any physician referral forms and justifications to the treatment center, and ensure patient has referral before leaving.
Ensure patients understand that some specialty appointments are not urgent or emergent and that waiting a few weeks to be seen is OK.
Set expectations
Referral paperwork
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Topic: Review medications
Patient experience No. 6: Did your personal doctor talk about all of the prescription medicines you were taking?
Encourage patients to write down and bring with them all of their prescriptions and directions about quantity and consumption frequency.
PCP Staff
Medication list
Consider having patients bring pill bottles of all prescriptions to their appointment, for a more thorough review with the physician.
Prescription bag
Look for duplicate medications and negative drug interactions; try to eliminate unnecessary prescriptions and switch to cheaper alternatives if medically appropriate.
Prescription analysis
Provide educational material to stress the importance of physician-patient conversations about reviewing prescription medications.
Educational postcard
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Topic: Physician informed about specialist care
Patient experience No. 7: Did your personal doctor seem informed and up to date about the care you got from specialists?
Follow up with the specialist’s office to ensure that any patient care results are sent to your practice.
PCP Staff Request records
Discuss with patients the results of specialist appointments, treatment or procedures, and recommend next steps.
Close discussion loop
Encourage patients to keep tear-offs to remind them of appointments leading up to the follow-up visit with the primary care physician (PCP).
Specialist pads as reminder
Provide educational material to stress the importance of PCP-patient conversations about specialist care results.
Educational postcard
Keep detailed records in patient charts about recommended specialist care and expected results, for review with patients.
Clearly convey to patients that you want them in for a follow-up (to discuss specialist care) within one month following the specialist visit.
Follow-up visit expectations
Patient chart notes
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Topic: Falls discussion
Patient experience No. 8: Did your doctor or other health care provider talk to you about falling or problems with balance or walking?
Assess severity of the issue through dialogue with the patient.
PCP Staff Problem assessment
Hand out questionnaires and materials to assist patients in evaluating the issue and its severity prior to seeing the physician.
Educational material
Advise patient to move or secure rugs, wires and other tripping hazards.
Tripping hazards
Advise patient to use a night light to avoid falls in the middle of the night.
Night light
Consider using visual media in the waiting room and computer screen savers in the exam room to help educate patients.
Provide reinforcement once the physician has addressed this as a topic of concern.
Reinforce discussion
Educational media
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Topic: Falls treatment
Patient experience No. 9: Did your doctor or other health care provider suggest any treatment, such as using a cane or walker, having your blood pressure checked or having regular vision
or hearing tests?
Check patient’s blood pressure in sitting and standing positions.
PCP Staff
Blood pressure
Evaluate patient’s vision or refer to a specialist who can assist further if necessary.
Vision test
Recommend physical therapy to rehabilitate weak muscles or bones that could make the patient prone to falling.
Physical therapy
Encourage patients in good health to strengthen bones and muscles through exercise.
Exercise
Help patients schedule any follow-up treatment required for this issue before they leave your office.
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Referral assistance
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Topic: Bladder control discussion
Patient experience No. 10: Have you ever talked with a doctor, nurse or other health care provider about leaking of urine?
Assess the severity of the issue through dialogue with the patient.
PCP Staff Problem level assessment
Hand out questionnaires and materials to help patients evaluate the issue and its severity prior to seeing the physician.
Educational material
Advise patients to hang a night light to avoid falls if they need to hurry to the bathroom in the middle of the night.
Night light
Consider using visual media displays in the waiting room and computer screen savers in the exam room to help educate patients.
Educational media
Provide reinforcement once the physician has addressed this as a topic of concern.
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Reinforce discussion
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Topic: Bladder control treatment
Patient experience No. 11: Did your doctor, nurse or other health care provider talk to you about ways to control or manage the leakage of urine?
Discuss bladder strengthening exercises with the patient if he or she has a minor issue.
PCP Staff Bladder exercises
Decide if medication is appropriate to treat the issue. Bladder medication
In more severe cases, bladder surgery may be recommended and referral assistance can be provided.
Bladder surgery
Help patients schedule any follow-up treatment required for this issue before they leave your office.
Referral assistance
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Topic: Physical activity
Patient experience No. 12: Did your doctor or other health care provider advise you to start, increase or maintain your level of exercise or physical activity?
Advise patient to take on an appropriate level of exercise.
PCP Staff Prescribe exercise
Write your recommendation on a tear-off pad and encourage patients to take the note with them.
Physical activity pads
Encourage patient to review any plan benefits that may allow him/her to join a gym, health club or other active group for a discount.
Gym or club membership
Post a calendar and include any fitness-related events offered at or near your office location.
Activities calendar
Send a newsletter to patients that mentions upcoming fitness or health events sponsored by your practice or the local community.
Provide reinforcement once the physician has addressed this as a topic of concern.
Reinforce discussion
Patient newsletter
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Topic: Mental health discussion
Patient experience No. 13: Did your doctor or other health care provider ask you about your mental or emotional health?
Remind yourself that many patients need help understanding that emotional health is a part of their primary care.
PCP Staff Educate the patient
Make use of physician educational material provided through Humana and any other organization with subject matter expertise.
Provider information
Encourage patients to take mental health preassessments while they wait, to assist the physician during discussion.
Mental health screens
Provide patients material that educates them on signs of depression or encourages them to be upbeat.
Educational material
Provide reinforcement once the physician has addressed this as a topic of concern.
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Reinforce discussion
Provider information Depression is a difficult thing to recognize in patients and talk about with them. Humana offers materials like this one-page flier and detailed presentation to support treatment
of patients who may be depressed.
Mental health screens
PHQ-2 and PHQ-9 mental health
screens can help assess the emotional health state of your
patients.
Educational material Humana provides this mental health
poster to encourage positive feelings and
emotional health among patients.
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Best practices and materials: Mental health discussion
Patient experience No. 13: Did your doctor or other health care provider ask you about your mental or emotional health?