TABLE OF CONTENTS

1. EXECUTIVE SUMMARY

Comparisons by Population

Comparisons Over Time

About the CAHPS Database

2. DATA SOURCES

3. COMPARATIVE RESULTS BY ENROLLEE POPULATION

Adult Medicaid

Adult Medicaid 2016 Results

Adult Medicaid Trends

Child Medicaid

Child Medicaid 2016 Results

Child Medicaid Trends

Children’s Health Insurance Program (CHIP)

CHIP 2016 Results

CHIP Trends

Medicare

Medicare 2016 Results

Medicare Trends

Appendix A. 2016 SURVEY RESPONDENTS AND HEALTH PLAN SAMPLES BY STATE

Appendix B. DEFINITION OF COMPOSITES AND ITEMS AND RATINGS

1. EXECUTIVE SUMMARY

The Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) Health Plan Survey Database receives data voluntarily submitted by survey users that have administered the CAHPS Health Plan Survey. The CAHPS Database aggregates the data to facilitate comparisons of CAHPS survey results by users, researchers, and other interested organizations.

This Chartbook presents summary-level results submitted in 2016 for the CAHPS Health Plan Survey 5.0 version for the following health plan enrollee populations:

• Adult Medicaid
• Child Medicaid
• CHIP (Children's Health Insurance Program)
• Medicare Managed Care

Results for the core survey composites, individual question items, and ratings are presented in the form of comparative bar charts. In addition, selected trend results for 9 years during the period from 2007-2016 are presented for the Adult and Child Medicaid and Medicare populations. (Note that no results are available for 2012 because of a lapse in the support contract for the CAHPS Database.)

Comparisons by Population

Table 1. presents a comparison of top-box scores (the most positive survey response option) for the composites and ratings across the four health plan enrollee populations included in the 2016 CAHPS Health Plan Survey Database.

Table 1. Comparison of 2016 Top-Box Scores By Enrollee Population

Composite/Rating	Adult Medicaid	Child Medicaid	CHIP	Medicare
Composites
Getting Needed Care	54%	61%	62%	63%
Getting Care Quickly	58%	74%	75%	65%
How Well Doctors Communicate	74%	78%	79%	78%
Health Plan Information and Customer Service	67%	68%	64%	68%
Ratings
Rating of Personal Doctor	65%	74%	73%	77%
Rating of Specialist	65%	70%	71%	72%
Rating of Health Care	53%	67%	67%	62%
Rating of Health Plan	57%	68%	67%	61%

Highlights from this comparison include the following:

• The highest scoring composite across all populations is How Well Doctors Communicate. The lowest scoring composite is Getting Needed Care.
• The highest scoring rating across all populations is Personal Doctor. The lowest scoring overall rating for Medicaid and CHIP populations is Health Care. The lowest scoring overall rating for Medicare is Health Plan.
• Scores for the Child Medicaid and CHIP populations are higher than those for the Adult Medicaid population for all composites and ratings except for the CHIP Health Plan Information and Customer Service composite.
• Scores for the Medicare population are higher than those for the other populations for the Getting Needed Care composite and the ratings for Personal Doctor and Specialist.

Comparisons Over Time

As shown in the trend graphs following the comparative results presented for each enrollee population, there has been a steady improvement in scores for most composites and ratings across each population for the years available for reporting .

About the CAHPS Database

The summary results presented in this Chartbook are compiled from data reported in the CAHPS Database Online Reporting System (ORS) at https://www.cahpsdatabase.ahrq.gov/CAHPSIDB/Public/about.aspx.

The CAHPS Database ORS consists of both a public site and a private submitter’s site available only to survey users that contribute data. Survey users that submit data to the CAHPS Health Plan Survey Database are provided access to a secure, password-protected area of the online reporting system that allows them to compare their own results to selected comparative results.

Both the ORS public site and the submitter’s site present CAHPS Health Plan Survey results for composite measures, ratings, and individual survey items, organized according to survey version and field period. Displays available through the various tabs include “top-box” scores, frequencies, bar charts, and percentiles. The “report builder” feature allows users to create and download custom reports on demand.

Research files for the CAHPS Health Plan Survey data presented in this Chartbook, as well as from the 2000-2015 CAHPS Health Plan Databases, are available upon request according to the CAHPS Database Data Release Policy. (To learn more, visit https://cahpsdatabase.ahrq.gov/DataResearchers.aspx.)

The CAHPS Health Plan Database Online Reporting System (ORS) is updated annually with new data submitted by CAHPS Health Plan survey users. Questions or comments regarding this Chartbook or any aspect of the CAHPS Health Plan Survey Database may be directed to the CAHPS Database toll-free help line at 888-808-7108 or by email to CAHPSDatabase@westat.com.

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2. DATA SOURCES

The data presented in this Chartbook were compiled from CAHPS Health Plan Survey results submitted to the CAHPS Database by various survey sponsors, including State Medicaid agencies, CHIP programs, individual health plans, and the Medicare program. The number and mix of sponsors contributing data vary slightly from year to year, and therefore comparisons over time should be made with these variations in mind. Comparison of results across populations should also take into account variations in benefit design and other factors that might affect survey responses across populations.

• Medicaid Data and CHIP Data: The survey results for the Medicaid and CHIP populations were obtained from data submitted directly to the CAHPS Database by State Medicaid agencies and individual health plans. The 2016 results are based on survey data collected between September 2015 and June 2016.
• Medicare Data: Each year, the CAHPS Database receives the CAHPS Medicare Managed Care survey data collected by the Centers for Medicare & Medicaid Services (CMS). These results are for survey participants enrolled in a managed care health plan including both enrollees receiving prescription drug coverage through their health plan and those that do not receive prescription drug coverage through their health plan. The Medicare results presented here may differ from other reports because of the inclusion or exclusion of certain beneficiary groups and/or the use of case-mix adjustment variables. The survey data were collected from February through August 2016.

Appendix A presents the number of Medicaid, CHIP, and Medicare survey respondents and health plans by State included in the 2016 CAHPS Health Plan Survey Database .

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3. COMPARATIVE RESULTS BY ENROLLEE POPULATION

This section presents a summary of comparative results for each of the health plan enrollee populations included in the 2016 CAHPS Health Plan Survey Database. Results are presented in the form of bar charts that graphically show the distribution of scores for the four composites, the individual question items that compose each composite, and the four ratings. Appendix B lists the composites, individual items, and ratings for the 5.0 version of the CAHPS Health Plan Survey.

The bar charts are composed of colored segments that show the percentage of responses in each of the response categories. For questions and composites based on 4-point response scales (i.e., "always", "usually", "sometimes", "never"), the left-most segment combines the two lowest response categories (i.e., "sometimes" and "never").

All results presented in these charts are calculated at the respondent level. Survey results are presented in the following order:

• Adult Medicaid
• Child Medicaid
• CHIP
• Medicare

Trend data for the Adult and Child Medicaid and Medicare enrollee populations are presented for 2007 to 2016. Trend data for the CHIP enrollee population are presented for 2011 to 2016. Although the number and mix of health plans within each enrollee population vary slightly from year to year, there has been a fairly consistent level of participation during this time span within the Adult Medicaid, Child Medicaid, and Medicare populations. The number of plans and respondents shown in each table provides some indication of the variation in the data sources from year to year. And although the CAHPS Health Plan Survey instrument changed slightly during this period with the transition from the 4.0 to the 5.0 version, changes to individual question items were very minor, and there were no changes in the rating questions or the definition of the composites.¹

¹ The contract that supports the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program expired during 2012, and a new contract was awarded in 2013; therefore, the CAHPS Database does not include CAHPS Health Plan Survey data for 2012.

As noted earlier, detailed results for each question item are available through the CAHPS Database Online Reporting System at https://www.cahpsdatabase.ahrq.gov/CAHPSIDB/Public/about.aspx?t=hp.

Adult Medicaid

Adult Medicaid 2016 Results

Composite/Item Never + Sometimes Usually Always    N Getting Needed Care Composite 19% 27% 54% 55,589

How often was easy to get needed care, tests, or treatment 16% 28% 55% 52,789

Got appointments with specialists as soon as needed 22% 26% 52% 28,932

N Getting Care Quickly Composite 19% 22% 58% 55,263

Got urgent care for illness, injury or condition as soon as needed 16% 21% 63% 28,397

Got routine appointment at doctor's office or clinic as soon as needed 22% 24% 54% 50,085

N How Well Doctors Communicate Composite 9% 17% 74% 45,802

Personal doctor explained things clearly 9% 18% 73% 45,612

Personal doctor listened carefully 9% 17% 75% 45,515

Personal doctor respected consumer comments 7% 14% 79% 45,449

Personal doctor spent enough time with consumers 11% 21% 68% 45,420

Adult Medicaid 2016 Results (continued)

Composite/Item Never + Sometimes Usually Always    N Health Plan Information and Customer Service Composite 13% 20% 67% 23,130

Customer service gave necessary information or help 19% 24% 56% 22,957

Customer service staff courteous and respectful 7% 16% 77% 22,936

Rating 0-6 7-8 9-10    N Overall Rating of Personal Doctor 12% 23% 65% 55,959

Overall Rating of Specialist 12% 23% 65% 27,205

Overall Rating of Health Care 16% 31% 53% 52,902

Overall Rating of Health Plan 16% 28% 57% 68,491

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Adult Medicaid Trends

Figure 1. Adult Medicaid Top-Box Composite Scores 2007-2016

Line graph depicting Adult Medicaid top-box composite scores over time.

Adult Medicaid Trends (continued)

Figure 2. Adult Medicaid Top-Box Rating Scores 2007-2016

Line graph depicting Adult Medicaid top-box rating scores over time.

Table 2. Adult Medicaid Composition of the CAHPS Health Plan Survey Database 2007-2016

	Adult Medicaid Composition
	2007	2008	2009	2010	2011	2013	2014	2015	2016
Number of Plans	109	120	126	186	148	124	149	133	157
Number of Respondents	45,979	59,840	63,391	97,626	73,820	60,249	68,234	61,369	73,155

Notes: (1) From 2007-2011, the Database reported Adult Medicaid version 4.0. (2) From 2013-2016, the Database reported version 5.0 for Adult Medicaid.

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Child Medicaid

Child Medicaid 2016 Results

Composite/Item Never + Sometimes Usually Always    N Getting Needed Care for a Child Composite 16% 24% 61% 59,360

How often was easy to get needed care, tests or treatment for child 11% 24% 65% 57,276

Got appointments with specialists for child as soon as needed 20% 24% 56% 16,857

N Getting Care Quickly for a Child Composite 11% 16% 74% 61,004

Child got urgent care for illness, injury or condition as soon as wanted 9% 12% 79% 26,989

Got routine appointment at doctor's office or clinic for child as soon as needed 12% 20% 68% 55,713

N How Well the Child's Doctors Communicate Composite 7% 16% 78% 52,936

Child's personal doctor explained things clearly 6% 14% 80% 52,754

Child's personal doctor listened carefully 5% 13% 81% 52,634

Child's personal doctor respected consumer comments 4% 11% 85% 52,585

Child's personal doctor explained things in a way that was easy for child to understand 8% 18% 74% 35,441

Child's personal doctor spent enough time with child 11% 21% 68% 52,052

Child Medicaid 2016 Results (continued)

Composite/Item Never + Sometimes Usually Always    N Health Plan Information and Customer Service Composite 12% 20% 68% 21,859

Customer service at child's health plan gave information or help needed 18% 24% 58% 21,720

Customer service staff at child's health plan courteous and respectful 7% 16% 78% 21,664

Rating 0-6 7-8 9-10    N Overall Rating of Child's Personal Doctor 7% 19% 74% 66,039

Overall Rating of Child's Specialist 9% 21% 70% 15,570

Overall Rating of Child's Health Care 8% 26% 67% 57,404

Overall Rating of Child's Health Plan 9% 23% 68% 70,434

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Child Medicaid Trends

Figure 3. Child Medicaid Top-Box Composite Scores 2007-2016

Line graph depicting Child Medicaid top-box composite scores over time.

Child Medicaid Trends (continued)

Figure 4. Child Medicaid Top-Box Rating Scores 2007-2016

Line graph depicting Child Medicaid top-box rating scores over time.

Table 3. Child Medicaid Composition of the CAHPS Health Plan Survey Database 2007-2016

	Child Medicaid Composition
	2007	2008	2009	2010	2011	2013	2014	2015	2016
Number of Plans	16	29	107	132	129	105	100	136	132
Number of Respondents	4,647	9,755	68,697	88,694	85,003	66,804	60,153	91,049	79,058

Notes: (1) From 2007-2011, the Database reported Child Medicaid version 4.0. (2) From 2013-2016, the Database reported version 5.0 for Child Medicaid.

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Children’s Health Insurance Program (CHIP)

CHIP 2016 Results

Composite/Item Never + Sometimes Usually Always    N Getting Needed Care for a Child Composite 14% 24% 62% 10,927

How often was easy to get needed care, tests or treatment for child 9% 25% 66% 10,520

Got appointments with specialists for child as soon as needed 19% 24% 57%   3,008

N Getting Care Quickly for a Child Composite 9% 16% 75% 10,940

Child got urgent care for illness, injury or condition as soon as wanted 8% 12% 80%   4,793

Got routine appointment at doctor's office or clinic for child as soon as needed 10% 21% 69%   9,790

N How Well the Child's Doctors Communicate Composite 5% 16% 79%   9,611

Child's personal doctor explained things clearly 5% 14% 81%   9,576

Child's personal doctor listened carefully 4% 14% 82%   9,574

Child's personal doctor respected consumer comments 3% 11% 86%   9,552

Child's personal doctor explained things in a way that was easy for child to understand 6% 20% 74%   7,065

Child's personal doctor spent enough time with child 8% 22% 70%   9,500

CHIP 2016 Results (continued)

Composite/Item Never + Sometimes Usually Always    N Health Plan Information and Customer Service Composite 13% 23% 64%   4,152

Customer service at child's health plan gave information or help needed 19% 27% 54%   4,128

Customer service staff at child's health plan courteous and respectful 7% 19% 74%   4,120

Rating 0-6 7-8 9-10    N Overall Rating of Child's Personal Doctor 6% 21% 73% 12,494

Overall Rating of Child's Specialist 8% 22% 71%   2,817

Overall Rating of Child's Health Care 7% 27% 67% 10,556

Overall Rating of Child's Health Plan 9% 24% 67% 14,175

CHIP Trends

Figure 5. CHIP Top-Box Composite Scores 2011-2016

Line graph depicting chip top-box composite scores over time.

CHIP Trends (continued)

Figure 6. CHIP Top-Box Rating Scores 2011-2016

Line graph depicting chip top-box rating scores over time.

Table 4. CHIP Composition of the CAHPS Health Plan Survey Database 2011-2016

	CHIP Medicaid Composition
	2011	2013	2014	2015	2016
Number of Plans	41	12	15	19	21
Number of Respondents	26,232	9,149	11,762	13,466	14,999

Notes: (1) In 2011, the Database reported CHIP Medicaid version 4.0. (2) From 2013-2016, the Database reported version 5.0 for CHIP Medicaid.

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Medicare

Medicare 2016 Results

Composite/Item Never + Sometimes Usually Always    N Getting Needed Care Composite 11% 26% 63% 99,058

How often was easy to get appointments with specialists 12% 26% 62% 66,969

How often was easy to get needed care, tests, or treatment through health plan 11% 26% 64% 80,507

N Getting Appointments and Care Quickly Composite 13% 23% 65% 113,890

Got urgent care for illness, injury or condition as soon as needed 11% 20% 69% 48,055

Got non-urgent appointment at doctor's office or clinic as soon as thought needed 14% 26% 60% 106,851

N Doctors Who Communicate Well Composite 5% 17% 78% 116,636

Personal doctor explained things clearly 5% 18% 76% 115,983

Personal doctor listened carefully 5% 16% 79% 115,911

Personal doctor respected consumer comments 4% 13% 83% 115,960

Personal doctor spent enough time with consumers 6% 20% 74% 115,754

Medicare 2016 Results (continued)

Composite/Item Never + Sometimes Usually Always    N Customer Service Composite 12% 20% 68% 42,817

Customer service gave information or help needed 19% 24% 56% 42,054

Customer service staff courteous and respectful 6% 15% 79% 42,450

Rating 0-6 7-8 9-10    N Overall Rating of Personal Doctor 6% 16% 77% 115,705

Overall Rating of Specialist 8% 20% 72%   78,376

Overall Rating of Health Care Quality 12% 25% 62% 142,005

Rating of Health Plan 13% 27% 61% 140,369

Medicare Trends

Figure 7. Medicare Top-Box Composite Scores 2007-2016

*Data not available for 2007 Health Plan Information and Customer Service

Line graph depicting Medicare top-box composite scores over time.

Medicare Trends (continued)

Figure 8. Medicare Top-Box Rating Scores 2007-2016

Line graph depicting Medicare top-box rating scores over time.

Table 5. Medicare Composition of the CAHPS Health Plan Survey Database 2007-2016

	Medicare Composition
	2007	2008	2009	2010	2011	2013	2014	2015	2016
Number of Plans	296	343	405	431	445	451	443	431	382
Number of Respondents	115,910	207,366	206,647	221,120	163,182	198,350	195,748	155,095	147,908

Note: (1) From 2007-2016, the Database collected Medicare version 4.0 only

Appendix A. 2016 SURVEY RESPONDENTS AND HEALTH PLAN SAMPLES BY STATE

Table A-1 shows data submissions to the CAHPS Health Plan Survey Database by State for 2016. The total number of respondents and plans by state are presented by population.

Table A-1. 2016 Survey Respondents and Health Plans by State

State	Adult Medicaid		Child Medicaid		CHIP		Adult Medicare
	Respondents	Plans	Respondents	Plans	Respondents	Plans	Respondents	Plans
Alabama	423	1	437	1	909	1	1,702	4
Arizona	-	-	-	-	-	-	3,136	12
Arkansas	-	-	-	-	303	1	872	3
California	1,282	4	1,858	3	-	-	9,185	24
Colorado	624	2	3,887	10	2,380	5	2,209	6
Connecticut	-	-	-	-	-	-	1,523	5
Delaware	237	1	303	1	-	-	-	-
District Of Columbia	437	1	520	1	-	-	-	-
Florida	1,876	5	2,381	5	-	-	9,153	23
Georgia	1,340	3	2,504	4	-	-	3,638	11
Hawaii	2,737	5	341	1	724	1	2,335	5
Idaho	-	-	-	-	-	-	1,755	5
Illinois	1,719	4	1,252	2	-	-	4,207	11
Indiana	2,987	4	2,385	3	-	-	1,916	5
Iowa	-	-	-	-	-	-	1,074	3
Kansas	1,691	3	4,318	3	1,598	1	-	-
Kentucky	1,408	3	1,849	4	363	1	847	3
Louisiana	1,195	3	1,493	2	1,349	1	2,305	4
Maine	-	-	-	-	-	-	2,358	4
Maryland	5,183	9	9,403	9	-	-	1,255	3
Massachusetts	1,569	4	332	1	-	-	4,040	9
Michigan	7,699	13	5,145	12	-	-	5,532	11
Minnesota	6,114	9	-	-	-	-	3,654	10
Mississippi	-	-	-	-	-	-	2,225	2
Missouri	-	-	2,049	6	-	-	2,473	8
Montana	-	-	-	-	-	-	990	2
Nebraska	290	1	799	1	-	-	292	1
Nevada	483	1	1,145	1	-	-	2,091	6
New Hampshire	333	1	812	1	-	-	843	3
New Jersey	1,577	3	1,769	3	751	1	2,407	8
New Mexico	906	2	1,586	2	-	-	2,071	5
New York	8,323	20	1,354	2	-	-	12,014	32
North Carolina	-	-	-	-	-	-	1,534	5
Ohio	2,342	5	5,404	6	-	-	5,733	18
Oklahoma	487	1	-	-	454	1	2,411	7
Oregon	5,665	17	5,574	17	-	-	6,278	17
Pennsylvania	3,707	9	4,160	9	2,173	3	12,876	21
Puerto Rico	-	-	-	-	-	-	2,113	7
Rhode Island	977	2	404	1	-	-	442	2
South Carolina	1,253	3	1,407	3	-	-	914	3
Tennessee	1,200	1	3,284	1	-	-	3,816	9
Texas	1,586	4	4,109	7	858	2	7,219	24
Utah	-	-	-	-	-	-	3,347	8
Vermont	-	-	-	-	-	-	-	-
Virginia	2,093	5	2,379	5	952	1	2,419	6
Washington	2,177	5	2,449	2	2,185	2	4,280	13
West Virginia	749	2	871	2	-	-	2,271	2
Wisconsin	486	1	1,095	1	-	-	4,153	12
Totals	73,155	157	79,058	132	14,999	21	147,908	382

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APPENDIX B. DEFINITION OF COMPOSITES, ITEMS AND RATINGS

Table B-1 presents the composites and individual items and ratings items for the 5.0 version of the CAHPS Health Plan Survey.

Table B-1. Composites and Rating Items for 5.0 Version of CAHPS Health Plan Survey

Question Text	Response Option
Getting Needed Care
In the last 6 months, how often did you get an appointment to see a specialist as soon as you needed?	Response Options Never Sometimes Usually Always
In the last 6 months, how often was it easy to get the care, tests, or treatment you needed?
Getting Care Quickly
In the last 6 months, when you needed care right away, how often did you get care as soon as you needed?	Response Options Never Sometimes Usually Always
In the last 6 months, how often did you get an appointment for a check-up or routine care at a doctor's office or clinic as soon as you needed?
How Well Doctors Communicate
In the last 6 months, how often did your personal doctor explain things in a way that was easy to understand?	Response Options Never Sometimes Usually Always
In the last 6 months, how often did your personal doctor listen carefully to you?
In the last 6 months, how often did your personal doctor show respect for what you had to say?
In the last 6 months, how often did your personal doctor spend enough time with you?
Health Plan Information & Customer Service
In the last 6 months, how often did your health plan’s customer service give you the information or help you needed?	Response Options Never Sometimes Usually Always
In the last 6 months, how often did your health plan’s customer service staff treat you with courtesy and respect?
Overall Ratings
Overall Ratings Using any number from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible, what number would you use to rate all your health care in the last 6 months?	Response Options 0-10
Using any number from 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor possible, what number would you use to rate your personal doctor?
Using any number from 0 to 10, where 0 is the worst specialist possible and 10 is the best specialist possible, what number would you use to rate the specialist?
Using any number from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible, what number would you use to rate your health plan?

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