The Applicability of the Consumer Assessments of Health Plans Survey (CAHPS) to Preferred Provider Organizations in the United States

A Discussion of Industry Concerns

Published in: International Journal For Quality in Health Care, v. 16, no. 3, May 2004, p. 219-227

Posted on RAND.org on December 31, 2003

by Leo S. Morales, Marc N. Elliott, Julie A. Brown, Christina Rahn, Ron D. Hays

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OBJECTIVE: This paper examines the applicability of a leading patient survey, the Consumer Assessments of Health Plans Study (CAHPS), to Preferred Provider Organizations (PPOs) in the United States. DESIGN: Elite interviews were conducted with users of the CAHPS survey in PPO settings. STUDY PARTICIPANTS: Study participants attended either the California Healthcare Foundation Quality Performance Measurement in Preferred Provider Organizations Forum or the National Conference to Examine PPO Quality. Eleven representatives of state and federal government health care purchasers, commercial PPO plans, and survey vendors were included. MAIN OUTCOME MEASURES: The interview included 21 questions addressing experiences with and concerns about using the CAHPS survey in PPO settings. RESULTS: Respondents raised concerns about the influence of out-of-network care on CAHPS reports and ratings of PPO health plans. Suggestions were made for additional PPO-relevant items such as after-hours care, numbers and types of specialists in the PPO network, and disease management. CONCLUSIONS: Modifications to some of the CAHPS survey items are needed to address concerns of users about their applicability in PPO settings.

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