Patient Experience
At HPSM, we care deeply for our members and their health care experience. We strive to ensure all members feel informed, supported, and integrated. We ensure this happens by creating checks and balances for our programs, performing member feedback surveys and by working with community stakeholders for outside perspectives.
Use the information on this page to understand how HPSM defines patient experience terms, our member experience framework, and learn more about the tools we’re using to gauge how well we are doing in meeting our members’ needs.
Definitions
Before we dive into this work, it’s important to make sure we’re operating from the same place of understanding. Here is how HPSM defines some of these terms:
- Member Experience: Member’s perceptions and related feelings caused by the cumulative interactions with HPSM’s employees, systems, channels, and services.
- Community Engagement: Collaboration of the health plan and the larger communities (local, regional/state, national, global) for the mutually beneficial exchange of knowledge and resources.
- Member’s Perspective: The way a member views HPSM. We use this perspective to gain insight into how they understand and interpret HPSM’s systems and services.
Member Experience Framework
HPSM’s Member Experience Framework includes three key components. HPSM strives to ensure all members are:
Informed
Members feel informed in their relationship with the organization and the provider network.
Informing HPSM members is imperative in creating a strong framework for building trust and willingness to engage. HPSM works to ensure that members are:
- Making informed decisions about their health.
- Know the pathway to information if there are questions or concerns.
Methods and programs currently in place to inform members:
- HPSM website
- Member education materials
- Community partnerships
- Benefits information materials
- Language access
- Social media
Supported
Members feel supported in their relationship with the organization and the provider network within many different units and methods. Support focuses on a member's health and wellbeing within their body, their family, the community.
Methods and programs currently in place to support members:
- Call centers
- Nurse Advice Line
- Interpreter services
- Community engagement and partnerships
- Consumer Advisory Committee
Integrated
Members feel heard and integrated in their relationship with the organization and the provider network.
Integrating members into HPSM’s decision making helps to assure services align with the members perspective and capabilities. Integration can be described as a member or member group coming together with the health plan to share information, thoughts, and experiences through a mutually beneficial partnership.
Methods and programs to integrate members:
- Community partnerships
- Committee participation
- Surveys
- Call center reporting
CAHPS
One of the ways a Member’s Experience is measured is through the CAHPS (Consumer Assessment of Healthcare Providers and Systems) Survey:
About the CAHPS Survey
Consumer Assessment of Healthcare Providers and Systems (CAHPS) launched in 1995 and is intended to advance our scientific understanding of patient experience with healthcare. The CAHPS survey is led by the Agency for Healthcare Research and Quality (AHRQ), which is a public-private initiative to develop and maintain standardized surveys of patients' experiences with ambulatory and facility-level care.
Every year starting in March, the CAHPS survey is conducted to ask members about their experiences with health care services they’ve received over the past six months. The survey is conducted for both CareAdvantage and Medi-Cal members.
In addition to deepening our understanding of member experience, CareAdvantage results are also used as part of the Star Rating Program to rate how well health plans and their network providers are meeting the needs of members across various metrics.
This survey gives HPSM members the opportunity to share their experience both with HPSM and our network providers. In the past, some HPSM members have asked their provider about the survey so if members come to you with questions, please direct them to our survey vendor, SPH Analytics, rather than calling HPSM. They can find the phone number to SPH Analytics in their survey packet.
Please continue to check back here on progress of the CAHPS survey and offer opportunities for providers to improve their scores.
Adult Medi-Cal Survey Results and Analysis
Rating of Health Plan
This measure consists of a single question asking respondents to rate the overall Health Plan. Ratings climbed to a peak of 63% in the past survey cycle of 2021. Rates have increased by an average of 3% over the past four survey cycles. Some methods to increase this rating for the health plan may include increasing access to the health plan or ensuring appropriate services.
Q26 - Rating of health plan
Chart shows the percentage of enrollees who responded with '9-10' (Top Box Results) on a scale of 0 to 10.
| 2013 | 2016 | 2019 | 2021 | |
| Rating of Health Plan | 56.50% | 59.20% | 58.23% | 63.06% |
Rating of All Health Care
This measure consists of a single question asking respondents to rate the overall Health Care. Ratings climbed to a peak of 60% in the past survey cycle of 2021. Rates have increased by 10% since the previous survey cycles. Some methods likely attributing to this large increase may be, increased need for medical care in a COVID world or even more knowledge about one’s plan as members navigate their needs during the pandemic.
Q8 - Rating of all health care
Chart shows the percentage of enrollees who responded with '9-10' (Top Box Results) on a scale of 0 to 10.
| 2013 | 2016 | 2019 | 2021 | |
| Rating of All Health Care | 52.70% | 52.00% | 50.18% | 60.27% |
Health Plan Customer Service
Health Plan Customer Services consists of a question asking respondents to rate customer service quality they receive. Ratings have remained steady in the upper 80% over the past few survey cycles. Many of the Health Plan’s teams work day to day with members to ensure quality of service and access to care.
Q22 - Customer service gave necessary information/help
Q23 - Customer service was courteous and respectful
Chart shows the average percentage of 'Always' responses (Top Box Results) on a scale of 'Never', 'Sometimes', 'Usually', or 'Always'.
| 2013 | 2016 | 2019 | 2021 | |
| Health Plan Customer Service | 82.90% | 88.80% | 88.70% | 86.39% |
Rating of Personal Doctor
This measure consists of a single question asking respondents to rate their personal doctor. Ratings climbed to a peak of 68% in 2019 with a slight dip in 2021. Some methods to increase this rating may include relationships between the provider and patient, ease of access, and comfortability with a practice.
Q16 - Rating of personal doctor
Chart shows the percentage of '9-10' responses (Top Box Results) on a scale of 0 to 10.
| 2013 | 2016 | 2019 | 2021 | |
| Rating of Personal Doctor | 64.60% | 66.50% | 68.65% | 65.27% |
Rating of Specialist seen most often
This measure consists of a single question asking respondents to rate the specialist they see most often. This measure has remained at 71% for the past three survey cycles. Specialists can see patients with specific needs and are ranked on their abilities and relationships with their patients
Q20 - Rating of specialist
Chart shows the percentage of '9-10' responses (Top Box Results) on a scale of 0 to 10.
| 2013 | 2016 | 2019 | 2021 | |
| Rating of Specialist Seen Most Often | 68.50% | 71.60% | 71.20% | 71.54% |
Getting Needed Care
The questions in this section, Getting Needed Care, relate to the simplicity and ease for a patient to see their provider for care, tests, and treatment. This section also questions a patient’s ability to get an appointment with a needed specialist with ease. The graph shows a pre-pandemic high with a dip in accessibility during the pandemic. Rates during the last cycle in 2021 have returned to above 80%. This may be due to an increase in appointment availability or an increase in patient’s ability or willingness to see a doctor during the pandemic.
Q9 - Easy for respondent to get necessary care, tests, or treatment
Q18 - Respondent got appointment with specialists as soon as needed
Chart shows the average percentage of 'Always' responses (Top Box Results) on a scale of 'Never', 'Sometimes', 'Usually', or 'Always'.
| 2013 | 2016 | 2019 | 2021 | |
| Getting Needed Care | 81.20% | 73.60% | 77.60% | 80.45% |
Getting Care Quickly
Getting Care Quickly asks the patient about if they got care for an illness, injury, or non-urgent matter as soon as it was needed. Rates have steadily increased despite a dip in 2016. We acknowledge providers work to increase availability, ensure appointments can be made with ease, and other key factors you are implementing to support your patients.
Q4 - Respondent got care for illness/injury as soon as needed
Q6 - Respondent got non-urgent appointment as soon as needed
Chart shows the average percentage of 'Always' responses (Top Box Results) on a scale of 'Never', 'Sometimes', 'Usually', or 'Always'.
| 2013 | 2016 | 2019 | 2021 | |
| Getting Care Quickly | 75.80% | 69.00% | 79.30% | 80.15% |
How Well Doctors Communicate
Questions asked to patient in the section of Communication with Doctors include; if doctors explained things in a way that was easy to understand, the doctor listened carefully, the Doctor showed respect, and if the Doctor spent adequate time with the patient. Rates for this measure continue to be high. We champion providers for their continued training and commitment to ensuring their patients feel heard and respected.
Q12 - Doctor explained things in a way that was easy to understand
Q13 - Doctor listened carefully to enrollee
Q14 - Doctor showed respect for what enrollee had to say
Q15 - Doctor spent enough time with enrollee
Table shows the average percentage of 'Always' responses (Top Box Results) on a scale of 'Never', 'Sometimes', 'Usually', or 'Always'.
| 2013 | 2016 | 2019 | 2021 | |
| How Well Doctors Communicate | 87.40% | 88.30% | 93.10% | 91.99% |