CAHPS Overview – Adult

Utah Health Plan Patient Experiences Report – Adult Enrollees

The Utah Health Data Committee is pleased to present the Utah Health Plan Patient Experiences Report. This report describes how satisfied health plan members are with their experiences with the care provided to their members. These data come from an annual survey entitled the Consumer Assessment of Healthcare Providers and Systems (CAHPS). The purpose of the report is to give consumers and purchasers information they can use to make an informed decision when selecting a health plan.

About the Survey

The survey used to gather information about how Utahns feel about their experiences with health plans comes from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. This survey measures what members thought about their experiences with health care and services they received from their health plan in the past year. Issues coved by the survey include whether the member had a problem getting care when needed, or if their customer service needs were met. The survey also has overall ratings about the members’ health plan, health care, doctor, and specialist.

Since 2016, Utah has contracted with DataStat Inc. to independently conduct the surveys. DataStat Inc. is an NCQA-certified vendor, which was chosen from several vendors that submitted bids to the State of Utah. Health plans had the choice of using their own NCQA-certified vendor, and some of the plans did use a vendor other than DataStat Inc. This survey contains responses from members about the care they received over the past year. The survey vendors selected a random sample from each health plan’s enrollment database. Selected members were mailed a survey in January of the survey year and sent a reminder if they did not return the survey within two weeks. Follow-up phone calls with members who did not return a survey were conducted in March of the survey year.

The State of Utah averages are calculated using the health plans that have participated in the survey.

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Medicaid

Medicaid is a source of health insurance coverage for Utah’s vulnerable populations. Medicaid is a state and federal program that pays for medical services for low-income pregnant women, children, individuals who are elderly or have a disability, parents, and women with breast or cervical cancer. To qualify, these individuals must meet income and other eligibility requirements. The financial requirements are stricter than for CHIP.

Commercial

Commercial health insurance is defined as any type of health benefit not obtained from Medicare or Medicaid plans. The insurance may be employer-sponsored or privately purchased. Commercial health insurance may be provided on a fee-for-service basis or through a managed care plan.

Dental

Dental plans offer Dental insurance which is designed to pay a portion of the costs associated with dental care. There are several different types of individual, family, or group dental insurance plans grouped into three primary categories: (1) Indemnity (generally called: dental insurance) that allows members to see any dentist they want who accepts this type of coverage; (2) Preferred Provide Network dental plans (PPO); and (3) Dental Health Managed Organizations (DHMO) in which members are assigned or select an in-network dentist and/or in-network dental office and use the dental benefits in that network.

Qualified Health Plan Enrollee Experience Survey (QHP)

Under the Affordable Care Act (ACA) a Qualified Health Plan (QHP) is an insurance plan that is certified by the Health Insurance Marketplace, and meets ACA requirements such as coverage of essential health benefits. QHPs are insurance plans that: (1) Have been certified by the state Health Insurance Marketplace (“Exchange”); (2) Provide coverage of essential health benefits; and (3) Follow established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts). All QHPs offer the same core set of benefits, including preventive services, mental health and substance abuse services, emergency services, prescription drugs and hospitalization. Some plans include benefits beyond the core set.

Participating Health Plans

All health and dental plan carriers operating in the State of Utah,are required to provide CAHPS survey data to the Utah Department of Health, Office of Health Care Statistics (OHCS) as is detailed in Utah Administrative Code Rule R428-12. Health plan participation in the CAHPS and QHP surveys membership enrollment varies by month.

Resources


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Content updated October 2020