Implementing CG-CAHPS: Issues and Strategies

1. Implementing CG-CAHPS: Issues and Strategies Dale Shaller, MPA Shaller Consulting Group September 18, 2011

2. Forces Driving Use of CG-CAHPS • Public Reporting • AF4Q and CVE initiatives • State mandates • Possible use in PhysicianCompare • ACOs and Value-Based Purchasing • Patient-Centered Medical Home • HRSA Bureau of Primary Health Care • American Board of Medical Specialties • Rising consumer and patient expectations

3. Profile of CG-CAHPS Users 12-Month Version Visit Version Public reporting initiatives in MN, WI, MI, ME, and other markets Growing numbers of medical practices (including UHC and 6 safety net clinics in CA) Vendors such as Press Ganey, NRC, Avatar ABMS for MOC (Doctor Communication items) • Public reporting initiatives in CA, MA, and other markets • Some health plans and systems (CA, MI, WI, MA) • Medical home evaluations • Department of Defense

4. CG-CAHPS Database Composition(as of December 2010)

5. Key Implementation Issues • Survey version • Patient populations and languages • Unit of sampling and reporting • Source of sample frame • Sample size • Data collection mode • Data aggregation, analysis, and reporting

6. Survey Version • Selection of survey version driven by user objectives, e.g.: • Internal improvement • External reporting • 12-month version • Works well for assessing experiences that transcend individual visits • Commonly used for external reporting • Visit version • Preferred by many clinicians for internal improvement

7. Patient Populations and Languages • Primary/specialty care • Adults/children • Commercial/Medicaid/Medicare/Other • Patients with chronic conditions • English-speaking patients or other

8. Sampling and Reporting Unit • Units of sampling and reporting include: • Individual clinician • Clinic or practice site • Medical group or health system • Community/state/region/other • Sampling and reporting units are often not the same • Users may sample at clinician level for internal use but report results externally at higher levels

9. SampleSize CAHPS guidelines: NCQA recommendations for PCMH survey at site level: • 45 completes per provider • 300 completes per medical group • ~ 220 completes per practice site (based on MN pilot) • New estimates for site-level samples are under development

10. Data Collection Modes: Outbound • Mail • Telephone • Landlines • Cell phones • Interactive Voice Response (IVR) • Touchtone IVR • Speech-enabled IVR • In-office distribution • Paper survey • Kiosk or other electronic modes • Email distribution

11. Field Period • May depend on sampling method • Continuous • Point in time • Same field period needed for comparability of results • Ex: 3rd quarter of the year

12. Regional Implementation Models • Centralized Model • Single vendor • Sample frame drawn from combined files of health plans or medical groups • Examples: MHQP, PBGH, CHECKBOOK • Decentralized Model • Medical practices use their own vendors • Integrate CG-CAHPS into current surveys • Aggregation of multiple data sets through a neutral vehicle (CAHPS Database) • Examples: MN, Detroit, Maine, and WI

13. Minnesota: Leveraged Model • 18 medical groups, 110 clinic sites • 3 different vendors (PG, NRC, PRC) • Common administration protocol • Sampling • Administration (mail mode) • Field period • CAHPS Database merged files and produced clinic-level results for reporting

14. Massachusetts: Centralized Model • Over 500 practice sites • Single vendor financed by health plans • Results reported privately to systems, then publicly (every two years) • Systems collect own data internally more frequently, using same or different survey instruments

15. Implementation Models: Pros and Cons

16. Challenges Ahead • Reconciling multiple survey requirements • Internal improvement • External reporting • Reducing cost of implementation to achieve sustainable business models • Using one survey and administration for multiple requirements • Lowering administration costs through new data collection technologies