What’s the Urgency? Recent Changes in CAHPS Score Weighting Affect Plans' Strategies
Starting this reporting year, CMS is doubling the weight of patient experience measures used to calculate Star Ratings from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.
This change has health plans laser-focused on solutions to improve the member experience. One area of opportunity is the appointment scheduling process for referrals and preventive care visits.
Improving the Appointment Scheduling Experience
Today, 24 million care transitions are missed, often because the patient or member is left on his or her own to find and schedule follow-up care. This experience leads to poor patient outcomes, and was found in a study to have led to $150 billion in unnecessary spend.
Taking the burden of finding and scheduling care off the member — including Annual Wellness Visits and preventive care screenings— breaks down a significant barrier to accessing care.
Consider the typical referral workflow today:
The primary care provider refers the patient to a specialist and (at best) hands the patient a printout of options or just puts the onus on them. Or they point out that the patient is overdue for a preventive care screening and strongly encourage the patient to “take care of it”, leaving the burden on the patient to schedule the appointment.
I like to call this a "referable moment." Similar to the concept of a teachable moment, a referable moment is a point in time that is most conducive to making a patient referral. Yet, most physician practices and provider networks lack the tools to take advantage of this moment and schedule the referral appointment for the patient right then and there when the patient is in the office.
More likely, the practice has a team of referral coordinators that will search and schedule patients for the appointment days after the patient leaves. Even then, these referral appointments can take several weeks to book and once scheduled, referral coordinators send patients appointment confirmations by mail (not the way people want to communicate with their doctors in 2021).
After the appointment, specialists rarely send back consult notes because they lack an easy way to connect. When they do return notes, they are often sent by fax (not the way doctors want to communicate with each other in 2021).
With a solution to drive efficient care transitions, the practice can send all their referrals digitally (increasing the clinical data provided to specialists) and book at the point of care (dramatically improving patients’ follow through rate). After scheduling the appointment, sending automated appointment reminders by email and text helps further improve follow through for members who might otherwise miss simply because they forget to go. Specialists can update the status of each visit and send consult notes back electronically (improving care coordination).
What About Less Engaged Members?
Of course, members have any number of objections or reasons for non-compliance with preventive care — lack of time or transportation, feeling they’re “healthy enough” or fear of in-person appointments during COVID.
This is where a personal touch is key.
Pair your tech-enabled effort with the support of care navigators who can educate members on the importance of preventive care in addition to taking the appointment-making process off their plate. Care navigators can even follow-up with members who missed their appointments, to rebook them.
Tracking Member Compliance and Satisfaction
When you take on this kind of effort, you want to have a baseline and measure the impact. Technology gives you the opportunity to improve reporting on member compliance. It allows you to track all member activity, including completed and missed appointments, how often members choose to go out-of-network and other measures that are important to your organization. Not only does tracking let you measure your improvement, but it also lets you follow up in real-time to take corrective action.
Data shows that adding a solution to schedule care gap and preventive care appointments increases member compliance with recommended care by 60–110%, even among members who are less engaged in their care.
Also try sending a satisfaction survey after the appointment. How members respond to these surveys gives you quicker insight into the positive impact your appointment scheduling initiative is having without waiting for paper surveys to be mailed to members and results to come in.
Improving Provider Engagement
While it won’t raise your CAHPS patient experience scores, it’s important to note that this kind of intervention can also improve your relationships with other providers in your network. Scheduling members directly with providers adds new patients to their practices — patients who will return for care in the future. Plus, you are giving providers a tool to drive efficient care transitions, seamlessly share clinical data and close the loop more easily, all of which makes their administrative workflows simpler and improves patient outcomes.
In short, tech-enabled solutions that improve the appointment scheduling experience offer a huge opportunity to improve access to care, compliance and experience.
As CAHPS moves towards putting a greater emphasis on patient experience, take advantage of simple digital health solutions that can ease the burden of scheduling appointments.
Gene is an expert in building and scaling healthcare businesses, including health plans and provider organizations; payment reform and value-based care initiatives; and post-acute and long-term care. His three decades of experience includes leadership roles at Oxford Health Plans and Cigna, and investor roles in healthcare ventures. As ReferWell’s Executive Chairman, Gene develops strategic relationships with partners to drive short-term revenue and long-term strategic alignment. Gene has been a ReferWell board member since 2015.
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