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THE CAHPS DATABASE


2016 CAHPS Health Plan Survey Database


2016 Chartbook: What Consumers Say About Their Experiences With Their Health Plans and Medical Care




AHRQ Contract No.: HHSA290201300003C

Managed and prepared by:

Westat, Rockville, MD

John Rauch
Dale Shaller
Naomi Yount
Teresa Dodson

AHQR Publication No. 17-CAHPS001 -EF
October 2016




The content of this document may be used and reprinted without permission except for the following: Federal Government logos, items noted with specific restrictions, and those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of copyright holders.

No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in this report.


The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.


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 + SometimesUsuallyAlways


Scale
   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 + SometimesUsuallyAlways


Scale
   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
0-67-89-10


Scale
   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

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

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 + SometimesUsuallyAlways


Scale
   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 + SometimesUsuallyAlways


Scale
   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
0-67-89-10


Scale
   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

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

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 + SometimesUsuallyAlways


Scale
   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 + SometimesUsuallyAlways


Scale
   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
0-67-89-10


Scale
   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

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

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 + SometimesUsuallyAlways


Scale
   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 + SometimesUsuallyAlways


Scale
   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
0-67-89-10


Scale
   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

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

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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