Experts Call For Updated Medicare Advantage Star Ratings Survey

The survey that informs Medicare Advantage Star Ratings requires modernization to accurately gauge member experience and effectively promote value-based care, according to new research conducted by NORC at the University of Chicago.

The Medicare Advantage and Prescription Drug (MA-PD) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey’s response rate has been on the decline in recent years, with an all-time low response rate of 38.4 percent in 2019 compared to 61.7 percent in 2010.

NORC surveyed 800 Medicare Advantage beneficiaries and interviewed 41 experts representing a cross-section of stakeholders to identify shortcomings of the MA-PD CAHPS survey and glean improvements that could be made. Better Medicare Alliance’s Center for Innovation in Medicare Advantage (CIMA) was responsible for unveiling the data.

The MA-PD CAHPS survey does not capture what matters most to consumers when selecting a health plan today, according to MA beneficiaries. For example, current healthcare topics such as telehealth, social determinants of health, and integrated care teams are not included in the survey. To modernize the content of the MA-PD CAHPS, stakeholders suggested that the survey include questions surrounding those topics.

Additionally, healthcare stakeholders called for the survey vendors to consider user testing to account for the way that individuals from different cultural backgrounds perceive their care.

In addition, NORC’s beneficiary survey pointed to the need to modernize the MA-PD CAHPS delivery. Seventy-six percent of beneficiaries said they preferred to receive and complete a survey via web or email, however the MA-PD CAHPS survey is mail-only currently only which could point to the reason why responses have been declining. 

Next, NORC’s interviews with healthcare experts revealed that the MA-PD CAHPS survey lacks actionable data, as data is only aggregated at the contract level, not for specific providers or geographic regions.

Experts suggested that the survey vendors or a third-party vendor provide de-identified CAHPS results that provide more actionable information to health plans about providers, respondent demographics, and geographies.

What’s more, MA-PD CAHPS questions cover topics that health plans cannot directly impact, such as office wait time. Healthcare experts noted that these questions should be eliminated since they are not pertinent.

“As this research from NORC at the University of Chicago shows, there is work to be done to make the MA-PD CAHPS survey more meaningful, actionable, and accurate,” said Allyson Y. Schwartz, president and CEO of the Better Medicare Alliance. 

“Response rates have fallen by more than 37 percent in the last decade as beneficiaries cannot access the survey online and are bogged down by the length and number of extraneous questions that are outside their Medicare Advantage plan’s control. With so much resting on this assessment tool, we owe it to beneficiaries to get it right,” continued Schwartz.

Healthcare experts interviewed by NORC said a pilot program that adds a web-mode MA-PD CAHPS option could help improve response rates. Also, stakeholders suggested that MA plans and survey methods experts should test the validity and reliability of reducing the number of MA-PD CAHPS questions.

In 2023, CMS is set to increase the weighting of member experience measures in the Star Ratings System to promote value-based care. Stakeholders recommended that CMS modernize the survey prior to this change in order to accurately capture member experience.