• CAHPS® health plan survey and reporting kit 2008. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2009 Jan. various p.

Does not apply to this measure

This measure is used to assess adult enrollees' perceptions of all the health care they received from their health plan. Enrollees rate care on a scale from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible. Responses are grouped by rating: percentages are reported for ratings of 9 and 10, 7 and 8, and 6 and lower.

Note: The percentage of ratings for the group 9 and 10 (or sometimes 8, 9, and 10) is used for consumer-level reporting; higher percentages indicate better quality. Additionally, frequency distributions encompassing all groups of ratings (i.e., 9 and 10, 7 and 8, 6 or lower) are available for plans or providers to use for quality improvement purposes.

The Agency for Healthcare Research and Quality (AHRQ) (then called the Agency for Health Care Policy and Research, or AHCPR) initiated the CAHPS program in October 1995 to develop standardized survey tools for obtaining and reporting information on consumers' experiences with health care. The CAHPS consortium began by developing the CAHPS Health Plan Survey, an integrated set of carefully tested and standardized questionnaires and report formats that can be used to produce meaningful, reliable, and comparable information about the experiences of consumers enrolled in health plans.

The CAHPS Health Plan Survey is designed to generate information that consumers can use to choose health plans, that purchasers can use to assess the value of services they buy, and that health plans can use to assess their performance and improve their products and services. As AHRQ had intended, the survey can be used with all types of health insurance consumers--including Medicaid recipients, Medicare beneficiaries, and those who are commercially insured--and across the full range of health care delivery systems, from fee-for-service to managed care plans. The instruments also capture information about special groups, including individuals with chronic conditions and disabilities and families with children.

The National Committee for Quality Assurance (NCQA) requires health plans to submit measures from the CAHPS Health Plan Survey as part of their HEDIS submission and for accreditation purposes.

Health care; members' satisfaction

Health plan members age 18 years and older who answered the "Rating of All Health Care" question on the CAHPS Health Plan Survey 4.0 (Adult Questionnaire) (see the "Description of Case Finding" and the "Denominator Inclusions/Exclusions" fields in the Complete Summary)

Member's ratings of all the health care they received on a scale from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible (see the related "Numerator Inclusions/Exclusions" field in the Complete Summary)

• A formal consensus procedure involving experts in relevant clinical, methodological, and organizational sciences
• One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Use of this measure to improve performance
Variation in quality for the performance measured

• What consumers say about the quality of their health plans and medical care: The National CAHPS Benchmarking Database. CAHPS health plan survey chartbook. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2008 Oct. 43 p.

Current routine use

Accreditation
Decision-making by businesses about health-plan purchasing
Decision-making by consumers about health plan/provider choice
External oversight/Department of Defense/TRICARE
External oversight/Medicaid
External oversight/Medicare
External oversight/State government program
Internal quality improvement
National reporting
Quality of care research

Managed Care Plans

Measure is not provider specific

Single Health Care Delivery Organizations

Age greater than or equal to 18 years

Either male or female

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

End of Life Care
Getting Better
Living with Illness
Staying Healthy

Patient-centeredness

Both users and nonusers of care

Health plan members age 18 years and older, who have been enrolled in:

• the commercial plan for 12 months or longer, with no more than one 45-day break in enrollment during the 12 months

  OR

• a Medicaid plan or product for 6 months or longer, with no more than one 30-day break in enrollment during the 6 months.

Enrollees or beneficiaries

Inclusions
Health plan members age 18 years and older who answered the "Rating of All Health Care" question on the CAHPS Health Plan Survey 4.0 (Adult Questionnaire). Include refusals, non-response, and bad addresses/phone numbers.

Exclusions

• Individuals with coverage other than primary health coverage, such as a dental-only plan
• Deceased
• Ineligible (not enrolled in the plan)

All cases in the denominator are equally eligible to appear in the numerator

Patient Characteristic

Time window precedes index event

Inclusions
Member's ratings of all health care they received on a scale from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible

Responses are grouped by rating: percentages are reported for ratings of 9 and 10, 7 and 8, and 6 and lower. The higher the percentage of ratings for the group 9 and 10 is associated with better quality.

Note: Include all completed questionnaires. A questionnaire is considered complete if responses are available for 10 or more of a selected list of key CAHPS items. Refer to the original measure documentation for more information.

Exclusions
Unspecified

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Fixed time period

Administrative data
Patient survey

Not Individual Case

Unspecified

Non-weighted Score/Composite/Scale

Better quality is associated with a higher score

Analysis by subgroup (stratification on patient factors, geographic factors, etc.)
Case-mix adjustment

CAHPS recommends adjusting the data for respondent age, education, and general health status.

If the sample size is sufficient, responses may be analyzed for specific sub-populations, such as respondents with chronic conditions.

External comparison at a point in time
External comparison of time trends
Internal time comparison

The CAHPS Health Plan Survey has probably been tested more completely than any previously used consumer survey.

There are two different and complementary approaches to assessing the reliability and validity of a questionnaire (1) cognitive testing, which bases its assessments on feedback from interviews with people who are asked to react to the survey questions, and (2) psychometric testing, which bases its assessments on the analysis of data collected by using the questionnaire. Although many existing consumer questionnaires about health care have been tested primarily or exclusively using a psychometric approach, the CAHPS team views the combination of cognitive and psychometric approaches as essential to producing the best possible survey instruments. Consequently, both methods have been included in the development of the CAHPS survey.

The cognitive testing method provided useful information on respondents' perceptions of the response task, how respondents recalled and reported events, and how they interpreted specified reference periods. It also helped identify words that could be used to describe health care providers accurately and consistently across a range of consumers (e.g., commercially insured, Medicaid, fee-for-service, managed care, lower socioeconomic status [SES], middle SES, low literacy, higher literacy) and helped explore whether key words and concepts included in the core questions worked equally well in both English and Spanish.

The CAHPS consortium also tested each CAHPS reporting composite in focus groups with plan members. Cognitive interviews with consumers were conducted to ensure that the reporting composites and their labels were easily understood. Psychometric analyses using data collected during pilot tests were also conducted. These analyses indicated that both the composites and the items in each composite were reliable and valid measures of members' experiences. In addition, items in each reporting composite were tested and found to be internally consistent. For example, reliability coefficients (Cronbach's alpha) in one pilot test involving four health plans using the instrument that most resembled the final CAHPS 2.0 instrument ranged from a low of 0.68 for the "Getting Needed Care" composite to a high of 0.90 for the "How Well Doctors Communicate" composite. These composites are positively associated with members' ratings of overall care provided by doctors and nurses and ratings of health plans.

In addition, the CAHPS development team, together with researchers from the National Committee on Quality Assurance (NCQA), conducted a detailed comparative analysis of the items in the CAHPS questionnaire and NCQA's Member Satisfaction Survey (MSS) from the fall of 1997 to the spring of 1998. These questionnaires were merged to form the 2.0 version of the CAHPS questionnaire. This testing is noteworthy because it was so extensive and because of the wide array of techniques used. These included focus groups, in-depth cognitive testing, pilot studies, methodological experiments, and large demonstration studies, such as the demonstrations in Washington State, Kansas, and New Jersey. NCQA also worked with the CAHPS consortium to conduct field tests of the 4.0 instrument with six health plans in spring 2005.

• CAHPS®: Surveys and tools to advance patient-centered care [https://www.cahps.ahrq.gov/default.asp]. [internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); [updated 2008 Feb 21]; [accessed 2007 Sep 05]. [3 p].

Rating of all health care.

Agency for Healthcare Research and Quality

Agency for Healthcare Research and Quality
CAHPS Consortium
Centers for Medicare & Medicaid Services

Agency for Healthcare Research and Quality (AHRQ)

• Agency for Healthcare Research and Quality (AHRQ)
• American Institutes for Research (AIR)
• Harvard Medical School
• National Committee for Quality Assurance
• RAND
• Westat

None

National Quality Forum

Measure was not adapted from another source.

1997 Mar

2009 Jan

This is the current release of the measure.

This measure updates a previous version: CAHPS® health plan survey and reporting kit 2007. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2006 Nov 14. Various p.

• CAHPS® health plan survey and reporting kit 2008. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2009 Jan. various p.

This NQMC summary was completed by ECRI on April 24, 2007. The information was verified by the measure developer on June 15, 2007. This NQMC summary was updated by ECRI Institute on May 18, 2009. The information was verified by the measure developer on August 14, 2009.

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