Article | 03/09/22

Why Caregiver Support Should Be Front and Center in Your CAHPS Strategy

Healthcare decision-making is often a family affair. From the time we’re born, family members and other loved ones influence the decisions that help us grow healthy and strong, both physically and mentally. 

This need for support may ebb and flow over time, but once we turn 65, chances are we’re either providing care to a loved one or receiving care ourselves. According to the AARP, half of Medicare beneficiaries receive support from a caregiver, while 25% serve as a caregiver themselves. 

Traditionally, Medicare Advantage plans have overlooked the role of the caregiver. Even though caregivers provide an average of 24 hours of support per week, perform about 80% of all home-based care, and have been linked to improved clinical outcomes such as a 50% drop in hospital utilization and a 25% reduction in 90-day hospital readmissions, they are often an afterthought as MA plans explore supplemental benefit options. 

As the Consumer Assessment of Healthcare Providers and Systems (CAHPS) continues to increase the weight of member experience metrics in determining MA Stars ratings – and handing out health plan bonuses – addressing the needs of caregivers becomes a strategic imperative, not just an add-on service.

For CAHPS and Stars, member experience matters more than ever

To get to the bottom of why caregiver support is so important for health plans, we need to walk through three sets of data points about CAHPS and Star Ratings. Bear with us.

First, CAHPS measures related to member experience will determine 57% of a MA plan’s Stars ratings by 2023. We may not know exactly which metrics will be used, but we do know that CAHPS has consistently included several patient experience measures, such as getting needed care, getting care quickly, getting needed prescriptions, and overall customer service. That gives plans a good starting point.

Next, the number of Medicare Advantage plans with 4 or more Stars is growing considerably, from 49% of all plans in 2021 to 70% in 2022. These plans cover roughly 90% of all Medicare Advantage enrollees. And remember, the Centers for Medicare & Medicaid Services (CMS) grades plans on a curve and develops cut points based on the performance of all plans for each measure over the previous year. In other words, if a plan’s performance stays the same, it will actually fall behind.

Finally, MA plans with a rating of 4 or more Stars add members at twice the rate of plans with lower Stars ratings. What’s more, members who are satisfied with their customer experience are five times more likely than unsatisfied members to renew their coverage. Higher Stars ratings improve prevention and reduce churn – and, with Stars rebates averaging $446 per enrollee in 2021, there’s a clear financial incentive to improve performance.

How caregivers address core member experience metrics

Caregivers play a critical role in the MA member experience. At a pragmatic level, many are likely to open the mail and fill out CAHPS surveys on behalf of their loved ones. More importantly, though, much of the work that caregivers do – instrumental activities of daily living such as managing finances, giving medicines, or providing transportation to and from medical care – is directly related to member satisfaction metrics. 

Supporting caregivers, then, sounds like a no-brainer for MA plans. But it’s not easy, especially when plans are used to focusing on the member experience as a series of transactions as opposed to a longitudinal relationship. Even though one in five adults is a caregiver, no two caregiver journeys are alike. 

Plans need to build longstanding and trusting relationships with caregivers, giving them the right information and support at the right time with a dose of high-touch engagement when necessary. And with caregivers suffering from depression at twice the rate of the general population, that support should be holistic, not just directly related to healthcare and health insurance. 

With CAHPS and Stars increasing the weight of member experience metrics in rating plans and delivering reimbursements, MA plans need to work harder than ever to stand out. Supporting caregivers – the largest workforce in healthcare, yet one that’s largely forgotten – has the dual benefit of improving member outcomes and the member experience. 

Now’s the time for plans to bring caregivers to the forefront of their member experience improvement work.

Contact Carallel if you’re ready to take the next step toward supporting caregivers, or watch the webinar below to learn more about the role caregivers play in improving CAHPS and Stars performance.

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