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Experience & Outcomes Surveys

Surveys are important tools for collecting data about consumers’ experiences with their health care providers and plans. The data are used by different stakeholders in many ways, including to:

 Equip consumers with information they can use to choose providers and health plans

 Target quality improvement activities and resources

 Evaluate the impact of quality programs

 Monitor performance and reward top-performing providers and health plans

The table below summarizes some of the most frequently-used data sources for measuring patient experience and outcomes.

Tool What does it measure? Who administers it? Why is it important?
CAHPS®1 Health Plan Survey This tool measures consumers’ experiences across the full continuum of care. This includes services received from primary care providers, specialists, and ultimately the consumers’ health plans.   AHRQ2 In the CAHPS, Medicare and commercial members are asked about their interactions with their primary care providers and specialists.

CAHPS results are an integral part of the CMS Star ratings, Health Plan Accreditation, and NCQA Health Insurance Plan Ratings.

H-CAHPS (Hospital CAHPS) This tool measures patients' perceptions of their hospital experience. AHRQ We use data from this survey for our Hospital Performance Incentive Program and as a component of some of our performance programs involving commercial members.
Statewide Patient Experience Survey (PES) This tool asks patients to report on their experiences with providers and staff in primary care and specialty care settings (including telehealth).   MHQP3 We use data from this survey in tiering and performance programs involving commercial members.
Health Outcomes Survey (HOS) This tool collects outcomes information from consumers in Medicare managed care plans. CMS2 CMS uses this data for CMS Star ratings.
Medicare Advantage-specific patient experience and outcomes surveys Blue Cross administers its own periodic surveys of our Medicare Advantage members to understand their experience of care. Blue Cross We use results from these surveys in our performance programs involving Medicare Advantage members.
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Patient experience vs. patient satisfaction

As AHRQ notes, “The terms patient satisfaction and patient experience are often used interchangeably, but they are not the same thing. To assess patient experience, one must find out from patients whether something that should happen in a healthcare setting (such as clear communication with a provider) actually happened or how often it happened. Satisfaction, on the other hand, is about whether a patient’s expectations about a health encounter were met.”

1. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey is a mandated regulatory/accreditation survey sent to a select number of Medicare and commercial members annually. A similar survey, the Qualified Health Plan Enrollee Experience Survey (EES or QHP Enrollee Survey), is used to rate plans in the Health Insurance Marketplace.

2. The Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicare Services (CMS) are both divisions under the U.S. Department of Health & Human Services.

3. Blue Cross Blue Shield of Massachusetts has a long-standing history of participation in statewide quality improvement initiatives administered by the Massachusetts Health Quality Partners (MHQP). MHQP is a broad-based coalition of doctors, hospitals, health plans, purchasers, patient and public representatives, academics, and government agencies working together to promote improvements in health care quality and services in Massachusetts. Blue Cross Blue Shield of Massachusetts currently participates in MHQP's Clinical Quality results and Patient Experience Survey biennial projects.