Member Experience Surveys (CAHPS® and EES): We All Play a Role
Posted April 27, 2021
Every year, some Blue Cross and Blue Shield of Illinois (BCBSIL) members receive the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey or the Enrollee Experience Survey (EES). Both of these surveys collect information about our members’ health care experiences.
The Agency for Healthcare Research and Quality (AHRQ) developed the methodology of these surveys that are utilized by the Centers for Medicare & Medicaid Services (CMS) and the National Center for Quality Assurance (NCQA) to assess the member experience of care provided by their doctors and other health care providers as well as the member services administration of health plans.
Please encourage your patients to respond to the CAHPS survey or EES if they are selected to participate.
Who gets the CAHPS survey and EES?
The surveys are mailed to a random sample of members who are 18+ years of age and enrolled in one of the following lines of business:
- Retail PPO and HMO (EES)
- Commercial PPO and HMO (CAHPS)
- Medicare Advantage PPO and HMO (CAHPS)
- Medicaid (CAHPS)
When do members receive the survey?
The CAHPS survey and EES are conducted from March through June. Members are asked to rate their last six months of care.
How are the survey results used?
CAHPS and EES results are used for different purposes based on the line of business.
For Retail PPO and HMO: EES results affect Quality Health Program (QHP) Star Ratings. Star Ratings rank health plans on a scale from one to five stars and are posted on the healthcare.gov website. We strive to achieve the highest possible Star Rating for our health plans.
For Commercial PPO and HMO: CAHPS results affect NCQA Star Ratings. Star Ratings rank health plans on a scale from one to five stars and are posted on NCQA's website . We strive to achieve the highest possible Star Rating for our health plans.
For Medicare Advantage (MA): CAHPS results affect CMS’ Star Ratings. Star Ratings rank MA plans on a scale from one to five stars and are posted on CMS’ Medicare website . We strive to achieve the highest possible Star Rating for our MA plans.
For Medicaid: The results of the CAHPS survey are used as a quality improvement initiative to help identify opportunities for improving member satisfaction.
How You Can Help Improve Member Experiences Year-Round
Provide needed care quickly and coordinate care with specialists.
- Leave openings for sick visits and urgent appointments
- Discuss how to access telehealth services and after-hours care
- Follow up with members’ specialists to ensure continuity of care
- Provide reasonable timely access to health care staff, customer service, etc., when BCBSIL transfers a member call for assistance to the provider or medical group
- Ask members about their top health concerns
- Keep conversations clear and simple
- Follow up after urgent or emergency care
Keep members healthy.
- Recommend and/or administer the flu shot during flu season
- Screen members for risk factors, including tobacco use, and recommend appropriate lifestyle changes
- Educate members on preventive services, chronic conditions and ongoing care
- Let members know whether you offer telehealth services that allow them to access care from home
- Discuss the COVID-19 vaccine
- Complete and document any health assessments
- Identify and follow up with members who haven’t visited in the past year
Learn more about the CAHPS survey on the AHRQ website .
This information is for informational purposes only and is not a substitute for the sound medical judgment of a provider. Members are encouraged to talk to their provider if they have any questions or concerns regarding their health.
HMO, HMO-POS and PPO plans provided by Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC). HMO plan provided by Illinois Blue Cross Blue Shield Insurance Company (ILBCBSIC). HCSC and ILBCBSIC are Independent Licensees of the Blue Cross and Blue Shield Association. HCSC and ILBCBSIC are Medicare Advantage organizations with a Medicare contract. Enrollment in HCSC’s and ILBCBSIC’s plans depends on contract renewal.
CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).