QHP Enrollee Survey: Proposed 2021 Survey Tool Updates to Address Telehealth

CMS recently posted proposed updates to the QHP Enrollee Survey. This survey is required for health plan issuers operating as Qualified Health Plans on the Marketplace. It provides data about member experience to the Quality Rating System to inform consumers about the quality of plan performance. 

To address the surge in telehealth adoption during the pandemic, CMS has proposed a number of modifications. Here are the changes to the survey tool proposed for the 2021 survey administration:

  • Two new questions will be added:
    • 17. In the last 6 months, how often did you need medical care but could not get it because you were concerned about a public health emergency (such as the coronavirus outbreak)? 
    • 21. In the last 6 months, did your usual doctor or primary care provider offer telephone or video appointments, so that you did not need to physically visit their office or facility?
  • CMS updated the instructions at the beginning of the “Your Health Care in the Last 6 Months” section to clarify that health care includes in person as well as telephone or video appointments. The instructions now state: 
    • “These questions ask about your own health care. This includes care you got in a clinic, emergency room, doctor’s office, or by telephone or video appointments. Do not include care you got when you stayed overnight in a hospital. Do not include the times you went for dental care visits. Please answer the questions based on your experience with the health plan you had from July through December 2020.”
  • In addition, CMS updated questions 22, 23, 24, 25, 26, 27, 28, 33, 37, 41, and 42 to instruct enrollees to “include in person, telephone, or video appointments” when responding to the question. These questions pertain to enrollee experience with their health care providers and adding this clarification ensures both in person and telehealth appointments experiences are captured in the QHP Enrollee Survey.

While these are technically proposed changes, they are quite likely to be finalized for 2021. CMS doesn’t plan to make any changes to sample sizes or survey administration protocols. SPH will be able to confirm any final changes after survey vendor training in the fall. Check back for a summary of updates on all the health plan CAHPS after SPH participates in survey vendor training in October/November.

About the Author

Esther Turner, Principal, Product Management for SPH Analytics, has been with SPH Analytics for more than eight years. She is an expert in member experience, and her responsibilities focus on our health plan products and survey solutions. Esther monitors requirements and updates from both NCQA and CMS. Her graduate work at Emory University included public policy and both qualitative and quantitative analysis.

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