Implementing CG-CAHPS: Issues and Strategies (Text Version)

On September 18, 2011, Dale Shaller made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (470 KB). Plugin Software Help.

Slide 1

Implementing CG-CAHPS: Issues and Strategies

Dale Shaller, MPA
Shaller Consulting Group

September 18, 2011

Slide 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.

Slide 3

Profile of CG-CAHPS Users

12-Month Version

• Public reporting initiatives in CA, MA, and other markets.
• Some health plans and systems (CA, MI, WI, MA).
• Medical home evaluations.
• Department of Defense.

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).

Slide 4

CG-CAHPS Database Composition (as of December 2010)

Slide 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.

Slide 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.

Slide 7

Patient Populations and Languages

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

Slide 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.

Slide 9

Sample Size

CAHPS guidelines:

• 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.

NCQA recommendations for PCMH survey at site level:

Slide 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.
• E-mail distribution.

Slide 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.

Slide 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.

Slide 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.

Slide 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.

Slide 15

Implementation Models: Pros and Cons

Slide 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.