CAHPS and HOS

 Consumer Assessment of Healthcare Providers and System (CAHPS) (Medi-Cal and Medicare)

  • CAHPS is a series of patient surveys rating health care experience (Medicare & Medi-Cal Product lines).
  • Random members are selected by the contracted vendor to ask members to complete a number of survey questions regarding the member’s perception from the last 6 months for urgent and routine care they received from their Primary Care Provider, Specialist, Health Plan, etc.)
  • Four global rating questions reflect overall satisfaction:
    1. Rating of All Health Care.
    2. Rating of Personal Doctor.
    3. Rating of Specialist Seen Most Often.
    4. Rating of Health Plan.
  • Five composite scores summarize responses in key areas:
    1. Customer Service.
    2. Getting Care Quickly.
    3. Getting Needed Care.
    4. How Well Doctors Communicate.
    5. Shared Decision Making.

How Can Providers Improve CAHPS Performance?

  • Provide good customer service to members and conduct annual customer services training to all your staff.
  • Show members you care and encourage members to complete their annual preventive screenings.
  • Acknowledge member if they are waiting longer than 30 minutes in the office and offer member a cup of water.
  • Remind members about the Flu shot they received in the prior year and explain to members the importance of taking the Flu shot.
  • Encourage all your members who received the survey to complete it. This will offset the members completing the survey who may not be happy with their experience.
  • Consider offering evening and/or weekend appointments.
  • Provide clear instructions on how to access care after office hours. For example, in the event of an emergency, make it clear that they need to dial 911 or go to the nearest Emergency Department.
  • To potentially shorten wait-time, consider assigning staff to perform preliminary work-up activities (e.g., blood pressure, temperature, calculate and document BMI value, complete Well-Child or Senior Annual Wellness Exam, etc.)
  • If possible, ensure a few appointments are available each day to accommodate urgent visits and provide future appointment date and time reminder card (especially Seniors/Medicare members).
  • Provide courtesy call with members to remind them on upcoming appointment date and time 1-3 days before the office visit.
  • Ask/remind members to bring all the medications they are taking and document in Medical Record/Chart.
  • If needed, assist members with transportation services.
  • Offer appointments with a nurse practitioner or physician’s assistant to patients who cannot be seen by their doctor.
  • Understand Health Plans’ access standards for appointment wait times for urgent and routine care.
  • Remind members that there is a Nurse Advise Line available 24 hours a day, 7 days a week for health questions.
  • Post on wall/door and inform members on the closest urgent care facilities and contact information.
  • Timely submit specialist referral to IPA and attach needed record/material.
  • Ask member if all their questions and concerns were addressed before ending the office visit and allow member an opportunity to ask questions.
  • Listen carefully to your members’ needs and explain things in a way that your member can understand.

Health Outcomes Survey (HOS) (Medicare Only)

Medicare HOS is a patient-reported outcomes measure. The goal is to use the survey information to improve quality activities and resources; monitor Health Plan performance and rewarding Plans.  Medicare members are randomly selected by a contracted vender to field the survey.

  • Survey asked patient how they perceived their current mental and physical health status.
  • Same members are surveyed to ask patient how they perceived their mental and physical health status.

Five HOS measures (two functional health measures and three HEDIS Effectiveness of Care measures) are included in the annual Medicare Part C Star Ratings:

  • Improving or Maintaining Physical Health
  • Improving or Maintaining Mental Health
  • Monitoring Physical Activity
  • Improving Bladder Control
  • Reducing the Risk of Falling

How Can Providers Improve Health Outcomes Survey (HOS) Performance?

  • Improving or Maintaining Physical Health, Monitoring Physical Activity or Fall and Risk Management
  • Educate office staff to complete physical health screening and place reminder in EMR to complete physical health and fall risk screening at least once a year or more.
  • Address with member any mobility issues that patient may have or health conditions that might limit physical activity and ensure that they are able to maintain their daily living activities.
  • Activities of Daily Living (ADL) assessment annually or more.
  • Medication Review (ask member to bring all medications they are taking)
  • Pain Assessment (ask members pain level from 0-10)
  • If member is at risk for falling, consider different options such as a cane, walker, monitor or assistive devices (e.g., grab bars, toilet and/or bed safety rail guards, etc.).  
  • Provide members tip sheet for stretches, exercise they can do to improve or maintain their physical health.
  • Schedule member with a future appointment (4-6 months or as needed) to discuss physical health.
  • Assess BMI at each visit and share with member the healthy weight range and discuss options for diet and weight loss plans.
  • Improving or Maintaining Mental Health
  • Screen members 65 years and older for possible/early sign of dementia and conduct cognitive impairment evaluation.
  • Educate office staff to complete mental health screening and place reminder in EMR to complete depression screening, anxiety, thoughts of self-harm or substance use disorder (example: PHQ-9, SBIRT, etc.).
  • Members may struggle with grief and loss; the death of family members, close friends and even pets which may impact their quality of life. Provide community resource information for members to seek help/support and provide education in the event of crisis.
  • The stigma of receiving mental health treatment often prevents members from seeking the care they need. Provide reassurance that depression is common and can be treated.
  • Encourage mental and physical stimulations (example: board games, bingo, dancing, walking/biking, etc.)
  • Proper nutrition, living environment and social supports are important components for member’s emotional wellbeing.
  • Assess for signs of abuse or neglect and report to appropriate agencies.
  • Improving Bladder Control
  • When office staff are taking member’s vital signs, routinely ask members 65 years and older if they experience problems or have any concerns with urinary incontinence and document discussion in intake form.
  • Ask members the medication(s) he/she is taking as some medications may contribute to the bladder control problems and switching medication(s) may avoid urinary side effects.
  • The pelvic region may be strengthened using Kegel exercises and biofeedback.
  • Review exercises with patients to help manage bladder control issues (e.g., finding a pattern, sticking to a schedule, relaxation practice and increasing the intervals between trips to the bathroom; alarm clocks are helpful reminders).
  • Ask member to have a commode close by or in their room if their restroom is far from their bedroom.
  • Sharing treatment plan with the member, family and/or caretaker(s) is a good reminder practice.
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