Closing CAHPS Gaps

Prioritizing provider data accuracy to avoid negative impact

In today’s healthcare landscape, patients not only want more accurate data about their healthcare providers, but more personalized information so they can select the right one for their needs. With so many choices, patient experience must be a crucial focus for healthcare organizations.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) annual survey measures member perceptions of their health plan by asking patients to rate their experiences with healthcare providers. Starting out with inaccurate provider data can have a significant impact on CAHPS scores.

But it’s not just CAHPS scores that matter, they are an important performance measure of the Medicare Advantage Star program. And with the recent quadrupled-weighting – CAHPS scores currently account for 32% of the overall Star Rating for 2023. These recent changes put an ever-greater burden on health plans to get their provider directories right. 

And the problem isn’t small – CMS found that 52% of Medicare Advantage online directories included at least one inaccuracy. This can lead to incomplete survey responses or inaccurate scoring, potentially harming a healthcare organization’s reputation. In addition, if a directory has inaccurate location, specialty or contact information, patients may not find or reach that provider, which can end up in missed appointments or difficulty accessing care – not to mention a negative experience and member dissatisfaction.

The impact can also result in penalties that impact your organization’s bottom line. CMS is paying closer attention to health plans that don’t place enough importance on accurate data – imposing up to a $25,000 fine per beneficiary for inaccuracies in Medicare Advantage directories. Insurance agencies are also getting in on the act, only last year the Georgia Insurance Commissioner levied a $5 million fine for violation of state regulations, which included persistent “inaccurate provider directories”.  

To combat the impact of inaccurate provider data on CAHPS scores and your Medicare Advantage Star rating scores, healthcare organizations should prioritize data accuracy and invest in technology solutions that streamline data management processes. This includes regularly updating provider information and leveraging processes to verify provider data and flag any inaccuracies.

See how HealthSparq’s Validated Provider Profiles solution can help you implement a compliant provider directory that tracks every provider engagement while giving providers a fast and easy way to verify their data and members a trusted and accurate representation of available care.