The Gravity of CAHPS

The earth, as complex and magnificent as it is, spends every second of every day revolving around the sun. The gravitational pull of the massive star is so strong that the earth cannot fight it. It simply has no choice in what it orbits.

But our organizations do.

In mid-March, a random sample of members from every Medicare Advantage plan will be mailed a 2019 Medicare Experience Survey, otherwise known as the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®). This survey will ask those members 68 questions that will tell the Centers for Medicare & Medicaid Services (CMS) how well each plan is serving its members.

The survey responses will reveal what your organization chooses to revolve around.

It’s likely one of the following.

Health Plans Attracted to Providers

In Star Ratings, it’s my experience that providers are the most important piece of the puzzle. You simply cannot perform highly in Stars without strong engagement with providers. Not to mention the fact that more than ½ of the CAHPS measures are directly influenced by what happens – or doesn’t happen – in the provider’s office between the member and provider.

However, the gravitational pull – for every entity, including the provider - must be toward the member. Plans sometimes seem to shift their entire focus to providers. Especially provider-owned plans. Sometimes the providers demand it and the plans abide. Sometimes the plans are admirably trying to be more tightly coordinated with providers so that the members benefit, and perhaps they allow the pendulum to swing a little too far and they take their eyes off the member.

The health plan absolutely must engage the provider, and be easy to work with, and incentivize them for providing the highest quality care to the members.

But the member should always be the primary focus.

Incent the provider to care for the member. Engage the provider so the member feels the coordination between their plan and provider. Share timely and actionable data so providers have better visibility into what the member needs.

The provider should be a partner. An ally in providing the very best care - and the very best experience - for the member.

Health Plans Attracted to Nothing

In health plans with silo’s, everyone does their own thing. There is no gravity. And where there is no gravity, objects are not attracted to another mass. They just float. Aimlessly. Each silo, each functional area, and each line of business operates independently, focused on its own goals. It is in no way attracted to other silo’s, let alone anything outside the organization. Including the member.

Health Plans Attracted to a Problem Vendor

Sticking with the laws of physics, this scenario is the equivalent of a black hole, where nothing – not even light – can escape. A vendor upon which your health plan is dependent is failing to perform, and your members are paying the price. But you are so deeply entangled with this vendor that you cannot separate from it. Like the earth unable to break away from the sun, you find yourself in a situation where the gravitational pull of the problem vendor feels impossible to break free from. All energy is consumed in trying to fix the overwhelming problems, and the entire organization’s focus seems pointed directly at this object, which by definition means that the organization’s focus cannot be on the member.

In his book The Order of Time, theoretical physicist Carlo Rovelli says “the mass of a black hole slows time to such a degree that…time stands still… So, in order to exit from a black hole, you would need to move…toward the present rather than toward the future!” Similarly, when you find yourself overly entangled with a problem vendor, you cannot dwell on how long it will take - or how hard it will be - or how much it will cost - to become unentangled. You simply must become unentangled.

All of the scenarios above, I would argue, have a strong and misaligned gravitational pull. And they very likely manifest themselves as follows:

• Failing to create a more positive experience for its members, a health plan finds itself in poor financial condition and having to make tough choices about how much of the financial burden to pass onto its members, who ironically, if the health plan would have focused on more initially, it wouldn’t be in this situation now. The additional financial burden yields even poorer experiences for the health plan’s members. And the cycle never ends.

Health Plans Attracted to Members

A relentless focus on the member prevents the organization from suffering an agonizing death by a thousand priorities.

The more massive an object is, the stronger its gravitational pull is. The scenarios above involve massive objects which fight for attention, and I didn’t even mention health plans attracted to profits, or investors, or egoic CEOs (not all CEOs – just those whose ego rivals the mass of our sun). There are countless objects constantly vying for the plan’s attention. But the object that is most deserving of that attention sometimes doesn’t put up a fight at all.

Members do not typically exhibit the strongest gravitational pull. They desire to be heard, and they definitely deserve to be heard. Especially Medicare Advantage members, which are made up entirely of the elderly and disabled.  But they won’t always fight to be. So, your organization must consciously shift its attention to them. You must intentionally make them the center of your solar system. Every department, every vendor, every provider – everyone must make the member the priority.

The Natural Disorder of Things, As It Relates to Member Experience

The member experience is not a single event or a single moment in time. It’s continuous. It’s a spider web of events. And it’s different and unique for every member.

A problematic past produces anxiety about the future. Every encounter the member has influences this. Though the future is not here yet, the past already shapes their expectations of it. Their muscle memory tells them whether or not they can trust their health plan. Whether or not Customer Service will actually be able to help them. Whether or not their plan has their back.

Time heals all wounds, but we don’t have time. With the weight of every CAHPS measure not named Annual Flu Vaccine increasing from 1.5 to 2.0 beginning with the 2021 Star Ratings, as laid out in the final rule, there’s little time to change. The 2020 CAHPS survey, expected to be fielded March through May of 2020, will be the first survey with the increased weights. The CAHPS measures already made up nearly 20% of the entire weight of Stars. Now, even more.

There is a natural disorder to things. Members will experience disruption, sometimes beyond our control. When members are disrupted, they need to know the plan has their back. They need the plan to repair the damage. They need the plan to help the member navigate through the disruption.

Too often, health plans accept that their members will have poor experiences. They accept that vendors will under-perform. That they themselves will under-perform. They tell themselves they did enough. When a member is surprised at a change that happened, the plans tell themselves that the member should have read the Annual Notice of Change that the plan sent them, when they should’ve done more to ensure the member was aware of the change coming.

Member experience is relative. And dynamic. And relational. We can’t predict with a scientific formula what the member will experience when they try to schedule an appointment with a specialist. Or pick a new prescription at the pharmacy. Or call Customer Service. Their experience will be based on their interaction with those other people that we can't control, but we can influence.

Whether the specialist leaves slots for near-future appointments or it takes six months to get in. The plan can’t control this, but it can influence this.

Whether the new prescription was covered on the member’s formulary or the provider prescribed a non-covered drug. The plan can’t control this, but it can influence this.

Whether the Customer Service Representative is seasoned and empathetic or brand-new and insensitive. The plan can’t control this, but it can influence this.

The member sees it all as one continuous experience. And the plan can influence this.

Your organization makes decisions every day regarding who it serves. Putting the member first is a choice. But it’s so much more than a choice. It’s more than a mission statement. Or a vision statement. Or tent cards that sit atop the break-room tables telling employees to “remember the member”.

It’s relentless focus and execution on constantly improving the member’s experience. It’s intentionally fostering empathy and accountability throughout the entire organization. And it’s keeping the member at the center of every decision. It’s keeping the member at the center of every change.

It’s keeping the member at the center of our solar system.

When this happens, when health plans allow themselves to be drawn by the gravitational pull of members, it creates a great force of empathy. It keeps the organization in a perpetual orbit around the most important thing.

The member.