Cover: Improving Performance for Health Plan Customer Service

Improving Performance for Health Plan Customer Service

A Case Study of a Successful CAHPS Quality Improvement Intervention

Published Aug 28, 2007

by Denise D. Quigley, Shelley H. Wiseman, Donna O. Farley

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This report describes the successful efforts of one full-service health plan to improve customer service for its members. Customer experience ratings provided by the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey indicated that the customer service capabilities of the health plan needed to be improved. The plan adopted a six-step approach to quality improvement based on the well-established Plan-Do-Study-Act (PDSA) cycle: (1) Use CAHPS to flag problems. Confirm CAHPS findings with other plan data. (2) Select performance measures. Develop new ones if needed. (3) Set goals for improvement and write an action plan. (4) Implement the action plan. (5) Assess progress and refine the intervention. (6) Monitor improvements to make sure they hold. The health plan went through the PDSA cycle twice until it developed a mix of intervention strategies that produced results.

The research described in this report was prepared for the Agency for Healthcare Research and Quality and was performed under the auspices of RAND Health.

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