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.
Quigley, Denise D., Shelley H. Wiseman, and Donna O. Farley, Improving Performance for Health Plan Customer Service: A Case Study of a Successful CAHPS Quality Improvement Intervention. Santa Monica, CA: RAND Corporation, 2007. https://www.rand.org/pubs/working_papers/WR517.html.
Quigley, Denise D., Shelley H. Wiseman, and Donna O. Farley, Improving Performance for Health Plan Customer Service: A Case Study of a Successful CAHPS Quality Improvement Intervention, Santa Monica, Calif.: RAND Corporation, WR-517-AHRQ, 2007. As of October 06, 2021: https://www.rand.org/pubs/working_papers/WR517.html