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Medicare's Customer Satisfaction

Topics: CAHPS , Health Care Reform , Medicare , NCQA

So what has higher customer satisfaction. private health insurance plans or the Medicare program? The answer, revealed in my NationalJournal.com column for the week, may surprise you.

Some additional details that were a bit too wonky for the column: I cite results from surveys conducted using a standard questionnaire developed by a the Consumer Assessment of Healthcare Providers and Systems program, known better by its acronym, CAHPS (pronounced "caps"). The program is an initiative of the U.S. Agency for Healthcare Research and Quality (AHRQ) of the Department of Health and Human Services to create a standardized survey for patient satisfaction that could be used by health insurance plans and hospitals (and, full disclosure, my wife used to work at AHRQ, though she was not directly involved with the CAHPS program).

Why would the government care about creating a standardized "customer satisfaction" questionnaire for health care? In the late 1990s, Congress allowed states to enroll Medicaid recipients into managed care plans run by private insurance companies, but the states had to offer multiple plans. One of the reasons for the CAHPS initiative was to create a standard for providing uniform quality information to Medicaid recipients.

The non-profit National Committee for Quality Assurance (NCQA) also played a significant role in the CAHPS' creation. NCQA uses CAHPS data to evaluate and accredit private health plans, so those companies that wish to receive NCQA's seal of approval or rank high in the U.S. News & World Report annual feature on "America's Best Health Insurance Plans" have an incentive to participate. As a result, roughly 90 percent of private insurers conduct CAHPS surveys and provide the data to NCQA.

Survey reachers of all stripes can learn from the extensive research and development that went into the creation of CAHPS program. One of its goals was to create a survey questionnaire based on the "best science...the state-of-the-art in survey and report design," and there are few precedents for what they achieved. In its first phase, the CAHPS program spent over $5 million on cognitive pre-testing and other pilot studies of a questionnaire developed jointly by RTI, RAND, Harvard Medical School & Westat. The lessons they learned should be of interest to anyone conducting a customer satisfaction survey.

Most of the CAHPS data I cited in the column come from a Health Plan Survey Chartbook published by AHRQ that includes compilations of data culled from over hundreds of individual surveys and literally hundreds of thousands of interviews conducted with patients in private insurance plans and managed care plans that enroll Medicare and Medicaid beneficiaries. The comparison data for those in traditional, fee-for-service Medicare comes from a spokesperson for the Centers for Medicare & Medicaid Services (CMS). Note that although the AHRQ chart book includes more recent data, I cited data from 2007 that would be comparable to the survey data on fee-for-service Medicare recipients that I received from CMS.

 

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