TABLE OF CONTENTS

1. EXECUTIVE SUMMARY

Comparisons by Population

Comparisons Over Time

About the CAHPS Database

2. DATA SOURCES AND LIMITATIONS

Data Sources

Data Limitations

3. RESULTS BY ENROLLEE POPULATION

Adult Medicaid

Adult Medicaid 2017 Results

Adult Medicaid Trends

Child Medicaid

Child Medicaid 2017 Results

Child Medicaid Trends

Children’s Health Insurance Program (CHIP)

CHIP 2017 Results

CHIP Trends

Medicare

Medicare 2017 Results

Medicare Trends

Appendix A. 2017 SURVEY RESPONDENTS BY STATE

Appendix B. DEFINITION OF COMPOSITES, 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 2017 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 bar charts. In addition, selected trend results for 10 years during the period from 2007-2017 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.) CHIP results are presented for six years.

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 2017 CAHPS Health Plan Survey Database.

Table 1. Comparison of 2017 Top-Box Scores By Enrollee Population

Composite/Rating	Adult Medicaid	Child Medicaid	CHIP	Medicare
Composites
Getting Needed Care	55%	61%	62%	63%
Getting Care Quickly	59%	73%	74%	69%
How Well Doctors Communicate	74%	78%	79%	79%
Health Plan Information and Customer Service	68%	67%	66%	73%
Ratings
Rating of Personal Doctor	65%	75%	76%	78%
Rating of Specialist	66%	72%	72%	74%
Rating of Health Care	54%	68%	69%	62%
Rating of Health Plan	58%	69%	69%	62%

Highlights from Table 1 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 is:
  • Personal Doctor for the Child Medicaid, CHIP, and Medicare populations.
  • Specialist for the Adult Medicaid population
• The lowest scoring overall rating is:
  • Health Care for the Adult and Child Medicaid populations
  • Health Care and Health Plan for the CHIP and Medicare populations,
• 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 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 Health Plan Information and Customer Service composite and the ratings for Personal Doctor and Specialist.

Comparisons Over Time

As shown in the trend graphs following the 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.

De-identified research files for the CAHPS Health Plan Survey data presented in this Chartbook, as well as from the 2000-2016 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 AND LIMITATIONS

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.

Data Sources

• 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 2017 results are based on survey data collected between September 2016 and June 2017.
• 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 March through June 2017.

Appendix A presents the number of Medicaid, CHIP, and Medicare survey respondents by State included in the 2017 CAHPS Health Plan Survey Database.

Data Limitations

Because the organizations that voluntarily contribute data to the CAHPS Database are not from a statistically representative sample of all U.S. health plans, and a limited number of plans may choose to participate, the submitting organizations are not representative of all U.S. health plans or enrollee populations¹. Estimates based on these voluntarily submitted data sets may produce biased estimates of the U.S. health plan and enrollee populations; it is not possible to compute estimates of precision from these data. In addition, the number and mix of sponsors contributing data vary slightly from year to year, and therefore comparisons over time should be made with these limitations and variations in mind. Comparisons of results across populations should also take into account that variations in benefit design and other factors might affect survey responses across populations.

¹ The Medicare results are based on a representative sample of all Medicare Advantage health plans.

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3. RESULTS BY ENROLLEE POPULATION

This section presents a summary of results for each of the health plan enrollee populations included in the 2017 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

To provide context for the 2017 results, the percentage distribution of survey respondents by State for each population is shown graphically at the beginning of each section. The actual number of respondents by State is shown in Appendix A.

Trend data for the Adult and Child Medicaid and Medicare enrollee populations are presented for 2007 to 2017. Trend data for the CHIP enrollee population are presented for 2011 to 2017. 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.

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.

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

Adult Medicaid

Percentage Distribution of 2017 Survey Respondents by State

Adult Medicaid

Heat map showing percentage distribution of 2017 Adult Medicaid respondents by state in descending order.

Adult Medicaid 2017 Results

Composite/Item Never + Sometimes Usually Always    N Getting Needed Care Composite 18% 27% 55%   49,957

How often was easy to get needed care, tests, or treatment 16% 28% 57%   47,373

Got appointments with specialists as soon as needed 20% 26% 54%   26,274

N Getting Care Quickly Composite 19% 22% 59%   49,381

Got urgent care for illness, injury or condition as soon as needed 16% 21% 63%   25,789

Got routine appointment at doctor's office or clinic as soon as needed 21% 23% 56%   44,652

N How Well Doctors Communicate Composite 9% 17% 74%   40,846

Personal doctor explained things clearly 8% 17% 74%   40,669

Personal doctor listened carefully 8% 16% 75%   40,588

Personal doctor respected consumer comments 7% 13% 79%   40,565

Personal doctor spent enough time with consumers 11% 21% 68%   40,494

Adult Medicaid 2017 Results (continued)

Composite/Item Never + Sometimes Usually Always    N Health Plan Information and Customer Service Composite 12% 20% 68%   20,380

Customer service gave necessary information or help 18% 25% 56%   20,249

Customer service staff courteous and respectful 6% 15% 79%   20,207

Rating 0-6 7-8 9-10    N Overall Rating of Personal Doctor 12% 22% 65%   49,723

Overall Rating of Specialist 11% 23% 66%   24,794

Overall Rating of Health Care 16% 31% 54%   47,534

Overall Rating of Health Plan 15% 27% 58%   61,459

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Adult Medicaid Trends

Figure 1. Adult Medicaid Top-Box Composite Scores 2007-2017

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

Adult Medicaid Trends (continued)

Figure 2. Adult Medicaid Top-Box Rating Scores 2007-2017

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

Table 2. Adult Medicaid Composition of the CAHPS Health Plan Survey Database 2007-2017

	Adult Medicaid Composition
	2007	2008	2009	2010	2011	2013	2014	2015	2016	2017
Number of Plans	109	120	126	186	148	124	149	133	157	152
Number of Respondents	45,979	59,840	63,391	97,626	73,820	60,249	68,234	61,369	73,155	65,053

Notes: (1) From 2007-2011, the Database reported Adult Medicaid version 4.0. (2) From 2013-2017, the Database reported version 5.0 for Adult Medicaid.

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Child Medicaid

Percentage Distribution of 2017 Survey Respondents by State

Child Medicaid

Heat map showing percentage distribution of 2017 Child Medicaid respondents by state in descending order .

Child Medicaid 2017 Results

Composite/Item Never + Sometimes Usually Always    N Getting Needed Care for a Child Composite 15% 24% 61%   77,803

How often was easy to get needed care, tests or treatment for child 10% 24% 66%   74,883

Got appointments with specialists for child as soon as needed 20% 25% 55%   22,753

N Getting Care Quickly for a Child Composite 11% 16% 73%   80,503

Child got urgent care for illness, injury or condition as soon as wanted 9% 12% 79%   35,441

Got routine appointment at doctor's office or clinic for child as soon as needed 13% 20% 68%   73,872

N How Well the Child's Doctors Communicate Composite 7% 15% 78%   69,360

Child's personal doctor explained things clearly 6% 14% 80%   69,110

Child's personal doctor listened carefully 5% 13% 82%   68,992

Child's personal doctor respected consumer comments 4% 10% 86%   68,913

Child's personal doctor explained things in a way that was easy for child to understand 7% 18% 75%   46,334

Child's personal doctor spent enough time with child 11% 21% 68%   68,323

Child Medicaid 2017 Results (continued)

Composite/Item Never + Sometimes Usually Always    N Health Plan Information and Customer Service Composite 12% 20% 67%   29,989

Customer service at child's health plan gave information or help needed 18% 25% 58%   29,791

Customer service staff at child's health plan courteous and respectful 7% 16% 77%   29,724

Rating 0-6 7-8 9-10    N Overall Rating of Child's Personal Doctor 6% 19% 75%   85,952

Overall Rating of Child's Specialist 8% 20% 72%   21,094

Overall Rating of Child's Health Care 7% 25% 68%   74,996

Overall Rating of Child's Health Plan 8% 23% 69%   96,824

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Child Medicaid Trends

Figure 3. Child Medicaid Top-Box Composite Scores 2007-2017

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

Child Medicaid Trends (continued)

Figure 4. Child Medicaid Top-Box Rating Scores 2007-2017

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

Table 3. Child Medicaid Composition of the CAHPS Health Plan Survey Database 2007-2017

	Child Medicaid Composition
	2007	2008	2009	2010	2011	2013	2014	2015	2016	2017
Number of Plans	16	29	107	132	129	105	100	136	132	169
Number of Respondents	4,647	9,755	68,697	88,694	85,003	66,804	60,153	91,049	79,058	103,283

Notes: (1) From 2007-2011, the Database reported Child Medicaid version 4.0. (2) From 2013-2017, the Database reported version 5.0 for Child Medicaid.

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Children’s Health Insurance Program (CHIP)

Percentage Distribution of 2017 Survey Respondents by State

Children’s Health Insurance Program (CHIP)

Heat map showing percentage distribution of 2017 Children’s Health Insurance Program (CHIP) respondents by state in descending order .

CHIP 2017 Results

Composite/Item Never + Sometimes Usually Always    N Getting Needed Care for a Child Composite 14% 24% 62%   11,317

How often was easy to get needed care, tests or treatment for child 9% 24% 67%   10,951

Got appointments with specialists for child as soon as needed 19% 24% 56%     3,195

N Getting Care Quickly for a Child Composite 10% 16% 74%   11,392

Child got urgent care for illness, injury or condition as soon as wanted 8% 12% 81%     5,228

Got routine appointment at doctor's office or clinic for child as soon as needed 12% 20% 68%   10,134

N How Well the Child's Doctors Communicate Composite 5% 16% 79%     9,833

Child's personal doctor explained things clearly 5% 14% 81%     9,810

Child's personal doctor listened carefully 4% 13% 83%     9,786

Child's personal doctor respected consumer comments 3% 11% 86%     9,775

Child's personal doctor explained things in a way that was easy for child to understand 6% 20% 74%     7,193

Child's personal doctor spent enough time with child 9% 22% 69%     9,699

CHIP 2017 Results (continued)

Composite/Item Never + Sometimes Usually Always     N Health Plan Information and Customer Service Composite 13% 21% 66%     4,112

Customer service at child's health plan gave information or help needed 20% 25% 56%     4,097

Customer service staff at child's health plan courteous and respectful 7% 18% 75%     4,087

Rating 0-6 7-8 9-10    N Overall Rating of Child's Personal Doctor 6% 19% 76%   12,617

Overall Rating of Child's Specialist 8% 20% 72%     2,997

Overall Rating of Child's Health Care 6% 25% 69%   10,983

Overall Rating of Child's Health Plan 8% 23% 69%   14,447

CHIP Trends

Figure 5. CHIP Top-Box Composite Scores 2011-2017

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

CHIP Trends (continued)

Figure 6. CHIP Top-Box Rating Scores 2011-2017

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

Table 4. CHIP Composition of the CAHPS Health Plan Survey Database 2011-2017

	CHIP Medicaid Composition
	2011	2013	2014	2015	2016	2017
Number of Plans	41	12	15	19	21	23
Number of Respondents	26,232	9,149	11,762	13,466	14,999	15,221

Notes: (1) In 2011, the Database reported CHIP Medicaid version 4.0. (2) From 2013-2017, the Database reported version 5.0 for CHIP Medicaid.

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Medicare

Percentage Distribution of 2017 Survey Respondents by State

Medicare

Graph Depicting Percentage Distribution of 2017 Survey Respondents by Statee.

Medicare 2017 Results

Composite/Item Never + Sometimes Usually Always    N Getting Needed Care Composite 11% 27% 63% 188,565

How often was easy to get needed care, tests, or treatment through health plan 10% 26% 64% 186,552

How often was easy to get appointments with specialists 12% 27% 61% 115,483

N Getting Appointments and Care Quickly Composite 11% 21% 69% 160,960

Got urgent care for illness, injury or condition as soon as needed 10% 19% 71%   66,143

Got non-urgent appointment at doctor's office or clinic as soon as thought needed 11% 22% 66% 152,574

N Doctors Who Communicate Well Composite 5% 17% 79% 157,809

Personal doctor explained things clearly 5% 17% 78% 157,157

Personal doctor listened carefully 5% 16% 79% 157,142

Personal doctor respected consumer comments 4% 13% 83% 157,151

Personal doctor spent enough time with consumers 6% 20% 74% 156,905

Medicare 2017 Results (continued)

Composite/Item Never + Sometimes Usually Always    N Customer Service Composite 8% 19% 73%   84,422

Customer service gave information or help needed 13% 26% 62%   83,229

Customer service staff courteous and respectful 4% 12% 84%   83,781

Rating 0-6 7-8 9-10    N Overall Rating of Personal Doctor 6% 16% 78% 156,610

Overall Rating of Specialist 8% 18% 74% 115,689

Overall Rating of Health Care Quality 12% 26% 62% 187,581

Rating of Health Plan 11% 26% 62% 185,630

Medicare Trends

Figure 7 Medicare Top-Box Composite Scores 2007-2017

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

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

Medicare Trends (continued)

Figure 8. Medicare Top-Box Rating Scores 2007-2017

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

Table 5. Medicare Composition of the CAHPS Health Plan Survey Database 2007-2017

	Medicare Composition
	2007	2008	2009	2010	2011	2013	2014	2015	2016	2017
Number of Plans	296	343	405	431	445	451	443	431	382	397
Number of Respondents	115,910	207,366	206,647	221,120	163,182	198,350	195,748	155,095	147,908	194,916

Note: (1) From 2007-2017, the Database collected Medicare version 4.0 only

APPENDIX A. 2017 SURVEY RESPONDENTS BY STATE

Table A-1 shows data submissions to the CAHPS Health Plan Survey Database by State for 2017. The total number of respondents by state are presented by population.

Table A-1. 2017 Survey Respondents by State

State	Adult Medicaid	Child Medicaid	CHIP	Adult Medicare
	Adult	Child	Child	Adult
Alabama	446	445	922	1,857
Arizona	-	-	-	4,293
Arkansas	410	404	479	2,107
California	3,752	5,116	-	13,440
Colorado	613	364	2,412	3,256
Connecticut	-	-	-	2,350
Delaware	584	421	-	-
District Of Columbia	790	2,312	-	-
Florida	1,723	4,083	-	10,514
Georgia	1,387	2,847	-	5,076
Hawaii	652	2,510	659	3,006
Idaho	-	-	-	2,140
Illinois	1,591	4,131	-	4,451
Indiana	3,320	3,336	-	4,420
Iowa	-	-	-	1,286
Kansas	1,590	4,684	1,294	-
Kentucky	1,619	1,806	1,226	2,385
Louisiana	1,692	2,885	1,416	2,947
Maine	-	-	-	2,878
Maryland	4,895	9,952	-	2,361
Massachusetts	1,931	314	-	5,861
Michigan	5,937	4,881	-	6,007
Minnesota	5,093	-	-	4,481
Mississippi	-	-	-	602
Missouri	-	1,439	-	3,192
Montana	-	-	-	663
Nebraska	-	-	-	653
Nevada	481	1,274	-	3,021
New Hampshire	374	926	-	1,972
New Jersey	1,353	1,583	758	2,882
New Mexico	1,300	2,606	-	2,498
New York	2,260	8,974	-	15,264
North Carolina	-	-	-	2,601
Ohio	2,372	4,688	-	6,661
Oklahoma	-	-	501	2,945
Oregon	4,906	5,149	-	8,424
Pennsylvania	3,771	4,365	1,817	13,777
Puerto Rico	-	-	-	4,524
Rhode Island	1,050	1,274	-	972
South Carolina	1,160	2,712	-	1,803
Tennessee	1,045	2,791	-	4,576
Texas	1,387	3,154	1,491	11,630
Utah	-	-	-	3,031
Vermont	-	-	-	-
Virginia	1,971	3,091	908	2,614
Washington	1,793	6,195	1,338	6,730
West Virginia	1,111	1,273	-	1,112
Wisconsin	694	1,298	-	7,653
Totals	65,053	103,283	15,221	194,916

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APPENDIX B. DEFINITION OF COMPOSITES, ITEMS AND RATINGS

The following tables present the composites and individual items and ratings for the 5.0 Adult Medicaid and Child versions of the CAHPS Health Plan Survey.

Table B-1. Adult Medicaid 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
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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Table B-2. Child Medicaid and CHIP 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 was it easy to get the care, tests, or treatment your child needed?	Response Options Never Sometimes Usually Always
In the last 6 months, how often did you get an appointment for your child to see a specialist as soon as you needed?
Getting Care Quickly
In the last 6 months, when your child needed care right away, how often did your child get care as soon as he or she needed?	Response Options Never Sometimes Usually Always
In the last 6 months, when you made an appointment for a check-up or routine care for your child at a doctor's office or clinic, how often did you get an appointment as soon as your child needed?
How Well Doctors Communicate
In the last 6 months, how often did your child’s personal doctor explain things about your child’s health in a way that was easy to understand?	Response Options Never Sometimes Usually Always
In the last 6 months, how often did your child’s personal doctor listen carefully to you?
In the last 6 months, how often did your child’s personal doctor show respect for what you had to say?
In the last 6 months, how often did your child’s personal doctor explain things in a way that was easy for your child to understand?
In the last 6 months, how often did your child’s personal doctor spend enough time with your child?
Health Plan Information & Customer Service
In the last 6 months, how often did customer service at your child’s health plan give you the information or help you needed?	Response Options Never Sometimes Usually Always
In the last 6 months, how often did customer service staff at your child’s health plan treat you with courtesy and respect?
Overall Ratings
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 child’s personal doctor?	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 child’s specialist?
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 child’s health care in the last 6 months?
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 child’s health plan?

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