Make a Quick Impact on CAHPS or Medicare CAHPS Scores, Part 1

August 3, 2015

Member Outreach Agent

Is your plan thinking about embarking on an organization-wide quality improvement and member/patient satisfaction program? If so, you may be looking for some quick solutions to keep leadership committed while you implement more structured, long-term improvement initiatives. What can you do?

Member Outreach Campaigns

One of the most efficient and effective tactics is member outreach campaigns. While these campaigns are not always easy and/or inexpensive, compared to longer-term initiatives – such as process redesign and brand enhancement – outreach campaigns are relatively fast and simple. Additionally, outreach campaigns can support process redesign and brand enhancement initiatives that are in process.

Outreach Campaigns as Part of Overall Improvement Strategy

Outreach campaigns are most effective when they are not a one-time tactic, but are integrated into a comprehensive communications plan that is part of an overall member and provider experience improvement strategy.

Any outreach campaign should also support your brand promise. However, if the delivery on your brand promise is ineffective, an outreach campaign or two won’t undo the poor image this causes.

Provide Genuine Assistance and/or Solutions

Outreach campaigns should also provide genuine assistance and/or solutions to members. Warm and fuzzy outreach campaigns that offer no real value or assistance will be of little benefit. However, even as a short-term tactic, reaching out to your members with tangible solutions and valuable assistance can have lasting benefits.

Optimal Times for Member Outreach

If you want to increase CAHPS® or Medicare CAHPS scores, the optimal timing for short-term outreach efforts is fourth quarter and January of first quarter, just prior to the CAHPS start in early to mid-February.

If your organization is more strategic and has a year-long or longer plan, this particular period may still be the most important due to its proximity to the survey initiation. Fourth quarter/first quarter outreach will provide positive health plan contact within a memorable timeframe of the survey.

Meaningful Messaging Considerations

Whether strategic or merely tactical, messaging in outreach campaigns should convey at least one of the following positions to members:

  • Your health plan cares about you and your health
  • Your health plan is responsive to your complaints and concerns
  • Your health plan wants to help you understand and use your health benefits most effectively
  • Your health plan encourages a close relationship with your personal physician.

Effective Outreach Methods

Outreach campaigns can be conducted by phone, mail, IVR, or email.

Telephone calls from live agents are the most personalized, personable, and engaging; they allow the most customization and most flexible messaging. They are the best approach for complex issues but are also the most expensive and take the longest to complete.

Of course, appropriate staffing is necessary for telephone campaigns to be sure the effort provides a positive experience for members.  Telephone agents must be friendly and upbeat, patient (especially with less educated or older members), and knowledgeable. They need to come across as non-aggressive, honest, and sincere. They need to be well-trained for the calls so they can follow different script branches and go off-script appropriately.

Phone outreach campaigns can be designed to target specific member groups. Outreach can be effective among dissatisfied or “at-risk” members, such as those who have filed grievances, submitted appeals that were subsequently denied, were denied treatment related to utilization management or pharmacy, received a non-covered service, filed a formal complaint, or sent a negative letter to the senior management team.

Other members who may benefit from telephone outreach are members whose plans have been terminated or those impacted by a major network, benefit, or cost-sharing change (pharmacy or other).

Important Outreach Campaigns to Educate Members and Improve Satisfaction

According to a 2013 national survey by the American Institutes for Research (AIR) designed to measure health insurance literacy, only about one in five Americans aged 22-64 could correctly calculate how much they owed for a routine doctor visit. Another 2013 study published by the Journal of Economics found that adult health plan decision-makers (aged 25-64) with private insurance have a limited understanding of traditional health insurance. New member education can rarely be overdone.

New Member Outreach and Education

Telephone outreach for new member education, similar to Medicare Advantage OEV (Open Enrollment Verification) calls, is a great way to ensure all members understand their key benefits and how their plan operates in order to minimize surprises when they need to access care.

Emergency Room Utilization and PCP Selection

Through an outreach campaign, an explanation of the plan’s emergency room utilization policies can be provided to members, along with the options available to them for future needs. Members without a Primary Care Physician can be encouraged to pick one.

Heath and Care Management Assessments

Outreach to members by telephone can also be helpful in assessing member health and care management needs, even before their claims have hit your system.

Medication Therapy Management and Medication Adherence

Campaigns can also be developed to acquaint Medicare members with Medication Therapy Management (MTM) programs and can include scheduling appointments for those willing to participate. Another effective use of telephone campaigns is contacting members with diabetes, hypertension, or cholesterol who need medication adherence encouragement and assistance.

The SPHA Solution

SPH Analytics (SPHA) can help you develop short-term and long-term outreach campaign solutions delivering personalized messages via phone, mail, IVR or email. These services are delivered through our state-of-the-art call center and mail fulfillment facilities.

Our call center engagement specialists understand that they are serving as an extension of your health plan. Working with you, our project team will monitor and discuss campaign results and member feedback. The health plan is able to respond to member concerns, initiate quality improvements, and continue to maintain a pulse on member attitudes and perceptions.

Part 2 continues…

Part 2 of this blog series will provides additional information about mail, IVR and email outreach campaigns.

Read Making an Impact on CAHPS Scores – Part 2

We invite you to contact us for additional information or to assist with your member and patient outreach needs.

Additional Resources


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