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ACA and QRS – Shoot for the Stars Part 3

In ACA and QRS – Shoot for the Stars Part 1, I laid out the overall domains that are going to be used to score QHP plans offered through the Marketplace. In Part 2, I discussed some factors to consider for the data derived measures. In this blog, we will take a closer look at the survey derived measures and what factors a QHP issuer should consider to achieve high scores.

surveyAgain, for reference all 43 of the required measures can be found on the CMS website (click here).

Now let’s take a look at some factors to keep in mind when dealing with the Enrollee Satisfaction Survey (ESS) derived measures:

Leverage CAHPS Processes
As mentioned in Part 2, it was required to get Health Plans Accredited to offer on-market. In addition, CMS aligned required QRS ESS measures with current CAHPS measures that are typically required during accreditation. And just as an organization should leverage HEDIS for data, make sure to leverage current investments in CAHPS to keep initial costs low while jump starting ESS efforts.

Guide Provider Interactions
A good number of the ESS questions revolve around services performed by providers. These questions cover domains like access to care, provider communication, care coordination, etc. Questions in these domains are related to specific interactions between providers and members. Therefore, an issuer must understand how providers within the QHP network are meeting the criteria being measured by the survey. Having a strong provider programs aimed at improving areas covered in the ESS is key. An issuer must work with its Providers to understand gaps and create initiatives that drive more positive interactions to improve scoring.

Tailor Communications
Let’s face it, understanding Healthcare is not easy for the average consumer. Most consumers are worried about addressing an immediate need and are not thinking about some of the longer term objectives that are represented in the ESS. To that end, an issuer should develop communications that make it easy to understand what the consumer should expect and what to ask if they are not being delivered information or services. Effective communications can help turn the consumer into an advocate for an issuers requirements within the network, leading to higher compliance and better scores.

Provide a Robust Portal for Members
In a digital world, having a robust portal for communications and interaction is integral to achieving ESS success. Providing tools and various communications in a tailored format can really help in ESS domains such as cultural competence, care management, and plan services. A good portal provides valuable resources for the consumer while accommodating language and communication style differences.

Make it Mobile
And don’t forget Mobile! In addition to having a good portal, issuers should also look to have a suite of mobile products to provide tools and communications to consumers. Mobile can provides access to information when it is not feasible to log in to a portal. Not to mention that mobile can be used to remind consumers of key action items related to requirements.

To recap, in my short ACA and QRS – Shoot for the Stars series, we took a look at some factors to consider to improve QRS scores. Although it is not an exhaustive list of items to consider, I hope you have found this information helpful.

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