Adapting CAHPS for Use in the Health Insurance Marketplace Environment

Transcription

1 Adapting CAHPS for Use in the Health Insurance Marketplace Environment HarmoniJoie Noel, Ph.D., Steven Garfinkel, Ph.D., Elizabeth Frentzel, MPH, Nancy Gay, Brandy Farrar, Ph.D. Coretta Mallery, Ph.D. June 2013 Copyright 2013 American Institutes for Research. All rights reserved.

2 Background The Affordable Care Act (ACA) authorized the creation of Health Insurance Marketplaces to help individuals and small employers shop for, select, and enroll in high quality, affordable private health plans beginning October By 2020, more than 27 million individuals and employees of small firms are expected to obtain their health insurance through Marketplaces (Congressional Budget Office). 2

3 Likely Marketplace Population Previously uninsured Low-income Language preferences other than English Pre-existing conditions Healthy, young adults 3

4 Project Purpose Section 1311(c)(4) of the ACA requires an Enrollee satisfaction survey that assesses consumer experience with the Marketplaces and the qualified health plans (QHPs) offered through the Marketplaces. Develop, test, and implement two surveys 1. Survey for adult Enrollees in Qualified Health Plans (QHPs) 2. Survey for health insurance Marketplace consumers Report QHP ratings to the public for consumer decision making 4

5 Project Overview 5 year project funded by CMS Formative research (2012) Develop surveys in English, Spanish, Chinese (2013) Cognitive testing- respondent comprehension (2013) Field testing- Psychometrics (2014) Beta testing- Survey vendor systems (2015) National implementation for public reporting (2016) 5

6 Presentation Outline 1. QHP Enrollee and Marketplace survey goals 2. Survey development overview 3. Methodological considerations for two surveys 4. Survey development challenges/solutions 6

7 QHP Enrollee and Marketplace Survey Goals Marketplace Survey Provide actionable information that the Marketplaces can use to improve performance QHP Enrollee Survey Provide actionable information that the QHPs can use to improve performance Provide information that regulatory organizations can use for oversight of the Marketplaces Provide information that regulatory and accreditation organizations can use to regulate and accredit plans Provide a longitudinal database for future Marketplace research Provide a longitudinal database for consumer satisfaction research Provide information to consumers so they can choose among competing health plans 7

8 Survey Development Overview Conducted, analyzed, and synthesized the formative research into important domains and constructs The formative research included: (1) an environmental scan and literature review; (2) interviews with 9 stakeholders; and (3) 4 consumer focus groups. Drafted items based on previous Consumer Assessment of Health Providers and Systems (CAHPS) surveys Team meetings to refine the items Cognitive testing Field testing 8

9 Methodological Considerations For Two Surveys Methodological issues led to an early decision to create two separate surveys, one for the Marketplaces and another for the QHPs 1. Distinct domains 2. Comparability with CAHPS surveys 3. Length 4. Different sampling goals 9

10 Methodological Considerations For Two Surveys 1. Distinct domains: Marketplace Survey Application Process Tax Credit Eligibility and Appeals Process Information Seeking/Customer Assistance on the Website, Phone, In-Person Comparing Health Plans/Enrollment Interpreter Services QHP Enrollee Survey Access to Care Provider Communication Plan Administration Access to Information Care Coordination Cultural Competence Claims Processing Cost Prevention 10

11 Methodological Considerations For Two Surveys 2. Comparability with CAHPS surveys: Consumer Assessment of Health Providers and Systems (CAHPS) surveys are validated, standardized instruments that are widely used to ask consumers and patients to report on and evaluate their experiences with health care. QHP Enrollee Survey: Use CAHPS Health Plan 5.0 to ensure consistent questions for health plans in and out of the Marketplaces Marketplace Survey: no existing CAHPS survey 3. Length: Combining the surveys would make it very long, with close to 200 questions, jeopardizing response rates. 11

12 Methodological Considerations For Two Surveys 4. Different sampling goals: The target populations for Marketplaces and QHPs are different. The Marketplace Survey Target population: people who encounter the Marketplace regardless of whether they enroll in a health plan Minimum experience: provided contact info to Marketplace QHP Enrollee Survey Target population: people enrolled in a qualified health plan Minimum experience: encounter with health plan in last 6 months 12

13 QHP Enrollee Survey Challenges Comparability to CAHPS and comprehensive Solution: Included all the CAHPS Health Plan 5.0 Core (Adult Medicaid) items. Added several new domains based on formative research and input from stakeholders but used existing CAHPS supplemental item sets when possible Cost is important but difficult to measure; not in CAHPS surveys Solution: Wrote and tested new questions: In the last 6 months, o o o o how often did you experience unexpected costs associated with your care? did you delay or not visit a doctor because you could not afford it? did you delay or not fill a prescription because you could not afford it? did your health plan refuse to pay for a service that your doctor said you needed? 13

14 Marketplace Survey Challenges The CAHPS family of instruments does not have a survey that assesses entities similar to Marketplaces Solution: The format and language drew from existing CAHPS items to the extent possible Provide actionable information for Marketplaces yet broad enough to cover all types of Marketplaces Solution: Keep items high level, but some drill down more specifically Cognitive testing needed to be done before Marketplaces in existence Solution: Use proxies from Massachusetts Health Connector Enrollees 14

15 Additional Challenges Attribution: Consumers may not always be aware when they are working with the Marketplace versus the QHP and experiences with one may bias their reports of their experience with the other. Lag in data availability: It will be a challenge for QHPs to provide appropriate quality information to consumers in the initial years of the Marketplaces because data from the QHP Enrollee survey will not be publicly available until

16 Next Steps Cognitive testing in English, Spanish, Mandarin Round 1 cognitive testing May-July 2013 Round 2 cognitive testing October 2013 Field/Beta testing In 2014 and 2015 National implementation for public reporting in

17 Questions? HarmoniJoie Noel, Ph.D Thomas Jefferson Street NW Washington, DC