At Home-Star Member Talking Points What are the CMS Medicare Star Ratings? The Center for Medicare & Medicaid Services (CMS) is a federal agency that oversees Medicare & Medicaid, and is part of the Department of Health & Human Services. CMS developed the Medicare Star Ratings to help consumers compare health plans and providers based on quality and performance, and to reward top-performing health plans. The Medicare Plan Finder (MPF) tool (www.medicare.gov/find-a-plan/questions/home.aspx) allows consumers to search for health plans in their geographic area and compare cost-estimates and coverage information. CMS rates the relative quality of service and care provided by MAOs based upon a five-star rating scale that utilizes the contract level data. There are 44 unique quality measures are included in the Medicare Part C and D Star Ratings, including success in providing preventive services, managing chronic illness, access to care, Healthcare Effectiveness Data and Information Set (HEDIS ) measures, the Consumer Assessment of Healthcare Providers and Systems (CAHPS ) survey, and responsiveness. The Medicare Star Ratings helps Medicare members compare Medicare Advantage (MA) plans, helps educate consumers on quality, and makes quality data more transparent and comparable between plans. CAHPS Survey Details What are the surveys? Consumer Assessment of Healthcare Providers and Systems (CAHPS ) surveys ask consumers and patients to report on and evaluate their experiences with health care. These surveys cover topics that are important to consumers and focus on aspects of quality that consumers are best qualified to assess, such as the communication skills of providers and ease of access to health care services. The survey is sponsored by CMS, and National Committee for Quality Assurance (NCQA) is responsible for recruiting, training, certifying, and providing quality oversight to survey vendors who collect data for this survey. CAHPS measurements include Getting Appointments & Care Quickly, Getting Needed Care without Delay, Customer Service, Coordination of Care, Getting Needed Rx Drugs, Flu Vaccine, & Overall Rating of Health Care Quality, Health Plan, Drug Plan, etc. Why it is important for members to take the survey? The purpose of this survey is to learn more from a member s perspective about the care they have received and use these data to provide information about the quality of healthcare services to Medicare members. Important aspects of the member s experience with healthcare and prescription drug plan services are collected through this survey. The data from the survey compares consumer experiences of health care and prescription drug plan services. By participating in this survey, the member helps Medicare to improve its health-care services. Who is eligible to receive the survey? Members who have been continuously enrolled in their Medicare Advantage Organization (MAO example, is a MAO) for a six-month period are eligible. When will selected members receive survey and how they may receive it? Consumer Assessment of Health Plans Survey (CAHPS ) surveys is conducted during the early spring of each year. Members are selected at random. For 2015, pre-notification letters were mailed to selected members on March 4. The surveys & cover letters were mailed to selected members March 11 through March 15. Surveys must be received at the return address or completed via phone no later than June 5. What is the deadline for completing the survey? The deadline for returning the surveys by mail and completing the survey by phone is Friday, June 5, 2015. However, it is best if members can complete and return the surveys within two weeks of receiving. What can I say or not say about survey? is allowed to notify members that they may be asked to participate in CAHPS Survey. However, certain types of communication (either oral, written, or in the survey materials, e.g., cover letters and telephone scripts) are not permitted, because they may introduce bias in the survey results. It is very important that survey vendors conducting the MA & PDP CAHPS Survey and plans participating in the survey initiative (), must NOT attempt to influence or encourage members to
At Home-Star Member Talking Points answer survey questions in a particular way. For instance, survey vendors, contracts, or their agents are not allowed to: Attempt to influence or encourage members to answer survey questions in a particular way Imply that the plan, its personnel, or agents will be rewarded or gain benefits for positive feedback from members by asking the member to choose certain responses or indicate that the plan is hoping for a given response Offer incentives of any kind for participation in the survey Show or provide the MA & PDP CAHPS Survey or cover letters to members prior to the administration of the survey Indicate that the health or drug plan s goal is for all members to rate them a 10, Definitely yes, or Always Click on the links from CMS for examples of surveys and the letters being sent to members. Please note that these documents are for your viewing only, and should NOT be shown to members due to the regulations set forth by CMS. - CAHPS: http://www.ma-pdpcahps.org/content/surveyinstruments.aspx - HOS: http://www.hosonline.org/content/surveyinstruments.aspx HOS Survey Details What are the surveys? The Health Outcomes Survey (HOS) is the first patient-reported outcomes measure used in Medicare managed care. The goal of the HOS program is to determine how well each health plan is able to maintain or improve the health and wellbeing of its members over time. The Medicare HOS program gathers valid and reliable clinically meaningful data that have many uses, such as targeting quality improvement activities and resources; monitoring health plan performance and rewarding top-performing health plans; helping beneficiaries make informed health care choices; and advancing the science of functional health outcomes measurement. Managed care plans with Medicare Advantage (MA) contracts must participate. Each spring, a random sample of Medicare members is surveyed from each Medicare Advantage Organization (MAO) that has a minimum of 500 enrollees. Members are asked questions about improving and maintaining mental and physical health. Surveys are administered to a different baseline cohort each year. Two years later, the baseline respondents are surveyed again for the follow-up measurements. HOS is administered by DSS Research on behalf of. Members can complete the survey by completing the paper survey that is mailed or by phone interview. Why it is important for members to take the survey? HOS results are a very important part of CMS quality improvement activities. The survey ensures that medical care paid for under the Medicare program meets professionally recognized standards of health care and assesses the quality of health plans. By participating, the member helps Medicare improve its health care services, as well as the quality of health plans. Who is eligible to receive the survey? For surveys taken between 1998-2008, members were required to be continuously enrolled in their MAO for a six-month period for inclusion in the baseline sample; however, that requirement is waived for surveys with data collection in 2009 or after. Prior to 2009, members with End Stage Renal Disease (ESRD) were excluded as well. When will selected members receive survey and how they may receive it? There is standard protocol for each annual round of HOS data collection, data management, and reporting results. Medicare HOS baseline is completed between April and June each year. The follow up is completed in May-July of each year.
At Home-Star Member Talking Points What can I say or not say about survey? See following attachments from CMS for examples of surveys and the letters being sent to members. Please note that these documents are for your viewing only, and should NOT be shown to members due to the regulations set forth by CMS. Refer to previous section under CAHPS for more detailed CMS guidelines. Additional Member General Questions and Answers When members have more detailed questions put them in contact with the survey vendor, DSS. They are experts on this topic. Phone numbers to DSS are listed at end of this document. Possible Member General Question Concerns about privacy. Who will see my answers? What happens to my answers? Will I get junk mail if I answer? Answer The information you provide is protected by the Privacy Act and will not be shared with anyone other than by authorized persons at the Center for Medicare & Medicaid Services (CMS) and DSS Research. Your answers are kept confidential and will only be seen by authorized persons at the Center for Medicare & Medicaid Services (CMS) and DSS Research. No, you will not get any junk mail. Your name and address will be kept absolutely confidential. Who is DSS Research? Will my answers affect my benefits? Where do I put my name and address on the survey? I just completed a survey a few months ago. Why am I getting this again? I have misplaced my survey; can you please send me another one? I received a postcard reminding me to take a survey, but I did not receive the survey. Can you please send me another one? Can I take the survey online instead of the one I received in the mail? DSS Research is a CMS certified vendor that is conducting the CAHPS & HOS Surveys on behalf of. DSS can assist you with completing the survey and/or answering any questions you may have. No. Your answers will not affect your benefits in any way. You should not write your name and address on the survey. Each survey has been assigned an identification number that allows us to keep track of which respondents have returned a completed survey. However, the last page of the survey may contain a few optional questions to assist us with contacting you two years from now. You may have received a Medicare Satisfaction Survey. This is a different Medicare survey that asks about health outcomes. DSS Research can send you another survey or you can complete the survey by phone with DSS. (See below for phone numbers.)
At Home-Star Member Talking Points I need a copy of the survey in a different language. What languages are available, and how do I get a copy in my language? What if I need a language other than English, Spanish, or Chinese? I do not have a health plan. Member is unable to complete the survey (in a nursing home, dementia, very frail, etc.) I am concerned that if I answer questions on behalf of that I am violating HIPAA. I have been advised not to give out my personal information over the phone. I am on the DO Not Call List. Is DSS Research supposed to be calling me? What if I do not want to answer some of the questions? The Medicare Health Outcomes Survey is also available in English, Spanish, & Chinese. A copy of the Medicare Health Outcomes Survey can be requested by contacting DSS Research at the phone numbers listed below in this document. If a member is requesting the survey in a language other than English, Spanish, or Chinese: At this time, the Medicare Health Outcomes Survey is not currently translated into [insert language]. If you have difficulty reading English, you can either complete the survey by phone or have someone who knows about your health, such as a family member, relative, friend, or professional caregiver complete the survey for you as a proxy. [If the member states he/she has Medicare, then ask him/her to complete the questions based on his/her Medicare enrollment. Members may have someone who knows about your health, such as a family member, relative, friend, or professional caregiver complete the survey for you as a proxy. HIPAA permits covered entities to disclose protected health information or PHI for the purpose treatment, payment, or health care operations. Because CMS will use information collected by the HOS for health-care operations to monitor health plan performance, the disclosure of this information to CMS is permitted. I understand your concern but hope you will consider participating. This is a very important survey that is sponsored by CMS. Your participation will help CMS monitor and improve the quality of care provided under the Medicare program. To verify the legitimacy and/or to find out more about this survey you can call Medicare at 1-800-MEDICARE (1-800-633-4227). The Do Not Call List prohibits sales and telemarketing calls. DSS Research is calling on behalf of your health plan. DSS will not try to sell you anything or ask for any money. I can understand your concern, but this is a very important survey. You can skip any question you do not want to answer and move on to the next question.
At Home-Star Member Talking Points I have not been to the doctor. I have not used my plan yet. My is deceased. What should I do with the questionnaire? Even if you have not been to the doctor and/or used the plan, it is still important to answer the questions. You may skip the questions that do not apply to you. I m very sorry to hear that. Please discard the questionnaire. If you let DSS Research know, they can make sure that we don t contact you again. (See below for phone number) Additional Member CAHPS Questions and Answers Possible Member CAHPS Question I do not have a lot of time, how long will it take me to complete the survey? I am very busy. I do not have time. Answer We know your time is limited and very important. The average time needed to complete the survey is about 11-20 minutes depending on the type of plan you have (MA, PDP, etc.) You can complete the survey at a time that is convenient for you. If you wish to complete the survey by phone, you can even do so in the evening or on a weekend if you prefer. Additional Member HOS Questions and Answers Because the HOS survey follows a group of members for two years there are other questions members in year two of survey may have. In addition, the survey time-frames are different compared to CAHPS. Possible Member HOS Question I do not remember participating before. I already completed the survey two years ago. Why do I have to do it again? My health has not changed. Why do I have to take the survey again? Will I have to take this survey every two years? I do not have a lot of time, how long will it take me to complete the survey? I am very busy. I do not have time. Answer We asked you some general questions about our health and well-being. Because the survey was fairly short, and it was two years ago, many people do not remember participating. When you start answering questions, you may find that you remember some of the questions as the questions are the same. The survey is designed to measure the health and wellbeing of Medicare beneficiaries over time. By comparing the answers you give now with the answers you gave two years ago, we can determine whether your health plan is keeping its members as healthy as possible. No, because this survey is done only twice with each respondent; however, it is possible that you will be selected for a new survey in the future. The paper survey takes about 15 minutes to complete, and the phone interview takes about 20 minutes to complete.
At Home-Star Member Talking Points Members with questions should contact DSS Research, if they have additional concerns and would like to contact CMS or NCQA, a representative from DSS can provide them with appropriate phone number. CAHPS & HOS Phone Numbers DSS Research Contact Line DSS Research Phone Number: English DSS Research Phone Number: Spanish Medicare CAHPS (English) 1-877-866-2480 1-877-866-2481 Medicare HOS 1-800-872-0696 ext. 4183 1-800-872-0696 ext. 4193 Commercial and Medicaid 1-888-797-3605, ext. 4190 (English) 1-888-797-3605, ext. 4191 CAHPS QHP (877) 215-4079, ext. 8023 (877) 215-4079, ext. 8024