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Implementing CG-CAHPS: Issues and Strategies. Dale Shaller , MPA Shaller Consulting Group September 18, 2011 . Forces Driving Use of CG-CAHPS. Public Reporting AF4Q and CVE initiatives State mandates Possible use in PhysicianCompare ACOs and Value-Based Purchasing

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implementing cg cahps issues and strategies

Implementing CG-CAHPS: Issues and Strategies

Dale Shaller, MPA

Shaller Consulting Group

September 18, 2011

forces driving use of cg cahps
Forces Driving Use of CG-CAHPS
  • Public Reporting
    • AF4Q and CVE initiatives
    • State mandates
    • Possible use in PhysicianCompare
  • ACOs and Value-Based Purchasing
  • Patient-Centered Medical Home
  • HRSA Bureau of Primary Health Care
  • American Board of Medical Specialties
  • Rising consumer and patient expectations
profile of cg cahps users
Profile of CG-CAHPS Users

12-Month Version

Visit Version

Public reporting initiatives in MN, WI, MI, ME, and other markets

Growing numbers of medical practices (including UHC and 6 safety net clinics in CA)

Vendors such as Press Ganey, NRC, Avatar

ABMS for MOC (Doctor Communication items)

  • Public reporting initiatives in CA, MA, and other markets
  • Some health plans and systems (CA, MI, WI, MA)
  • Medical home evaluations
  • Department of Defense
key implementation issues
Key Implementation Issues
  • Survey version
  • Patient populations and languages
  • Unit of sampling and reporting
  • Source of sample frame
  • Sample size
  • Data collection mode
  • Data aggregation, analysis, and reporting
survey version
Survey Version
  • Selection of survey version driven by user objectives, e.g.:
    • Internal improvement
    • External reporting
  • 12-month version
    • Works well for assessing experiences that transcend individual visits
    • Commonly used for external reporting
  • Visit version
    • Preferred by many clinicians for internal improvement
patient populations and languages
Patient Populations and Languages
  • Primary/specialty care
  • Adults/children
  • Commercial/Medicaid/Medicare/Other
  • Patients with chronic conditions
  • English-speaking patients or other
sampling and reporting unit
Sampling and Reporting Unit
  • Units of sampling and reporting include:
    • Individual clinician
    • Clinic or practice site
    • Medical group or health system
    • Community/state/region/other
  • Sampling and reporting units are often not the same
    • Users may sample at clinician level for internal use but report results externally at higher levels
sample size

CAHPS guidelines:

NCQA recommendations for PCMH survey at site level:

  • 45 completes per provider
  • 300 completes per medical group
  • ~ 220 completes per practice site (based on MN pilot)
  • New estimates for site-level samples are under development
data collection modes outbound
Data Collection Modes: Outbound
  • Mail
  • Telephone
    • Landlines
    • Cell phones
  • Interactive Voice Response (IVR)
    • Touchtone IVR
    • Speech-enabled IVR
  • In-office distribution
    • Paper survey
    • Kiosk or other electronic modes
  • Email distribution
field period
Field Period
  • May depend on sampling method
    • Continuous
    • Point in time
  • Same field period needed for comparability of results
    • Ex: 3rd quarter of the year
regional implementation models
Regional Implementation Models
  • Centralized Model
    • Single vendor
    • Sample frame drawn from combined files of health plans or medical groups
    • Examples: MHQP, PBGH, CHECKBOOK
  • Decentralized Model
    • Medical practices use their own vendors
    • Integrate CG-CAHPS into current surveys
    • Aggregation of multiple data sets through a neutral vehicle (CAHPS Database)
    • Examples: MN, Detroit, Maine, and WI
minnesota leveraged model
Minnesota: Leveraged Model
  • 18 medical groups, 110 clinic sites
  • 3 different vendors (PG, NRC, PRC)
  • Common administration protocol
    • Sampling
    • Administration (mail mode)
    • Field period
  • CAHPS Database merged files and produced clinic-level results for reporting
massachusetts centralized model
Massachusetts: Centralized Model
  • Over 500 practice sites
  • Single vendor financed by health plans
  • Results reported privately to systems, then publicly (every two years)
  • Systems collect own data internally more frequently, using same or different survey instruments
challenges ahead
Challenges Ahead
  • Reconciling multiple survey requirements
    • Internal improvement
    • External reporting
  • Reducing cost of implementation to achieve sustainable business models
    • Using one survey and administration for multiple requirements
    • Lowering administration costs through new data collection technologies