| | Member Satisfaction With Gundersen Lutheran Health Plan (Commercial CAHPS® 2007)
Impact
Gundersen Lutheran Health Plan provides information to the public about member satisfaction with the experience of care in the Health Plan network to aid in making decisions about their healthcare.
Aim
Gundersen Lutheran Health Plan member satisfaction ratings will be comparable to or exceed state and national benchmarks.
Results:
| Green means GL Health Plan’s rate is significantly better than benchmark (p < .05). |
| Yellow means GL Health Plan’s rate is significantly lower than benchmark (p < .05). |
| Measure | Gundersen Lutheran Health Plan 2006 | WI HMO Avg 2006 | Nat’l HMO Avg 2006 |
| Health Plan |  | | |
| Overall Health Plan Rating | 66.6% | 68.6% | 64.8% |
| Health Plan Claims Processing Composite | 86.9% | 89.0% | 86.6% |
| Health Plan Customer Service | 81.6% | NA* | NA* |
| Health Care | | | |
| Overall Health Care Rating | 74.4% | 75.9% | 72.2% |
| Rating of Personal Doctor | 88.0% | 83.8% | 80.1% |
| Rating of Specialist Seen Most Often | 75.9% | 78.7% | 79.1% |
| How Well Doctors Communicate Composite | 93.4% | 93.3% | 91.8% |
| Getting Care Quickly Composite | 83.9% | 86.3% | 84.7% |
| Getting Needed Care Composite | 81.2% | 83.9% | 83.3% |
Links to Graphic Displays of Data
Health Plan
Health Care
Conclusions
1. Gundersen Lutheran Health Plan’s 2006 rates were similar to the 2006 National HMO averages in the majority of the measures. Measures in which we were significantly better (p < .05) than the 2006 National HMO averages included: Rating of Personal Doctor and composite of How Well Doctors Communicate.
2. Gundersen Lutheran Health Plan’s 2006 rates were similar to the 2006 Wisconsin HMO averages in the majority of the measures. The measure in which we were significantly better (p < .05) than the 2006 Wisconsin HMO average was Rating of Personal Doctor. The measure in which we were significantly lower (p < .05) than the 2006 Wisconsin HMO average was the composite of Getting Care Quickly.
3. Our rates showed a significant increase from 2005 to 2006 for the overall Rating of Personal Doctor. Our rates also showed a significant decrease from 2005 to 2006 for Overall Rating of Health Care. (See graphs)
4. Statistical analysis conducted by Decision Support Systems identified six areas to be our best opportunities for improvement. These were: customer service staff treated you with courtesy/respect (part of the Customer Service Composite score), rating of specialist overall, claims handled correctly (part of the Claims Processing Composite score), claims handled quickly (part of the Claims Processing Composite score), rating of health care overall, customer service staff gave information or help needed (part of the Customer Service Composite score).
Next Steps
1. Expand outbound call program to include welcome calls to new members.
2. Develop and distribute member brochure.
3. Utilize member newsletter to update members on service initiatives.
4. In conjunction with Patient Business Services (PBS) management, develop and monitor claims billed more than 30 days after the date of service. PBS Management will work with departments with delayed submissions.
5. Develop member letter that will explain why a claim is being adjusted, and address the PBS policy on writing off balances on claims adjusted more than one year after the date of service.
6. Expand outbound call program to expedite claims processing when subrogation or Coordination of Benefits information is needed.
7. Expand audit program to include a higher sample of random audits and more focused audits.
Leader: You may contact the activity leader for more information if desired:
Andy Kyser, RN at ATKyser@gundluth.org
Charles Schauberger, MD at CWSchaub@gundluth.org
Background
Measuring member satisfaction with Managed Care Organizations (MCOs) has become a standard practice. NCQA utilizes the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) health plan survey to measure member satisfaction. The CAHPS program is overseen by the Agency for Health Care Research and Quality (AHRQ) and includes numerous survey products designed to capture consumers’ and patients’ perspectives on health care quality. For HEDIS®, MCOs must contract with an NCQA-certified vendor to administer the CAHPS® survey according to the HEDIS survey protocol which is designed to produce standardized results. The survey is based on a randomly selected sample of members, and summarizes member satisfaction with the experience of care through ratings, composites, and question summary rates1.
For CAHPS 2007, AHRQ replaced the CAHPS 3.0 Adult Survey with the CAHPS Health Plan Survey 4.0, Adult Version. Revisions include changes to the number, order, wording of survey questions, changes to composites, and new composites were added.
Methods
Decision Support Systems (DSS), an independent research firm, was contracted to administer the survey for 2007. DSS was responsible for sampling, survey administration, data collection, statistical analysis, and summary reporting. The 2007 Commercial CAHPS 4.0H Adult Survey was sent to a random sample of our fully insured HMO Gundersen Lutheran Health Plan members, age eighteen years or older, who had been continuously enrolled throughout 2006. (CAHPS® results for a given year are based on the previous year’s Health Plan membership). The survey is conducted from March to May every year. Providers of care to these members include the entire Gundersen Lutheran system, and a number of non-Gundersen Lutheran providers who participate in the health plan network by contractual agreement.
For CAHPS® 2007, our survey methodology consisted of a four-wave mail protocol (three questionnaires and two reminder postcards) with telephone follow-up of at least two attempts. The sample size consisted of 1100 members; our response rate for CAHPS 2007 (2006 membership) was 59.7%.
Decision Support Systems conducted statistical analysis comparing our CAHPS 2007 rates to our CAHPS 2006 rates. Jeff Falk, statistician, Gundersen Lutheran, conducted confidence interval analysis comparing our CAHPS 2007 rates to National and Wisconsin HMO averages.
Benchmark
NCQA’s Quality Compass® 2007 data was used for comparison2. The benchmarks consist of HMOs that submitted their audited data to NCQA’s Quality Compass.
References
1. National Committee for Quality Assurance, HEDIS® 2007 Specifications for Survey Measures, Volume 3, Washington, DC.
2. National Committee for Quality Assurance, Quality Compass® 2007.
Acknowledgments
Andrea Kyser, RN; Ann Kiel; Jeff Falk, MS
The source for data contained in this publication is Quality Compass2007 and is used with the permission of the National Committee for Quality Assurance (NCQA). Any analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such analysis, interpretation, or conclusion. Quality Compass® and HEDIS® is a registered trademark of the NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
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