The landscape of Part D prescription coverage frequently mirrors a complex puzzle where every policy change introduces new challenges and opportunities. With recent adjustments like the elimination of the donut hole and the introduction of a $2,000 out-of-pocket maximum, stakeholders are offered financial reprieve yet face fresh operational dilemmas. While these changes are structurally advantageous, they carry underlying complexities that demand strategic foresight.
In this article, we’ll talk about how to take control of Part D from a CAHPS perspective and what the data is telling us; address anomalies our customers are seeing, such as increase in rating for one Part D measure with a decrease in the other; and walk through the last-minute strategies we are personally deploying for our customers to prepare for CAHPS surveys.
Leveraging Data: The Intersection of Analytics and Care
The first step is diagnosing the problem: who is going to rate the plan negatively? Using mPulse’s Artificial Intelligence and Machine Learning capabilities we can look at members, their situation, and the way they respond to CAHPS questions for sample surveys and use that data to make predictions on the likelihood that members with similar attributes and characteristics will respond.
To do this, you need to identify patterns data. By leveraging technology powerful enough to analyze millions of data points including historical member interaction data, claim patterns, eligibility and enrollment data, treatment adherence rates, public census data, and socio-demographic factors, helping paint a portrait of member behavior and potential pain points. Then you compare that to the entire journey of another member and make predictions on what the member will do and the likelihood that they’ll do it – such as responding negatively to a specific Part D measure on the CAHPS survey or whether they’ll respond at all.
And that is where we’re beginning today. With our clients’ permission, we’ve taken these millions of data points and compiled them for R&D purposes to view common patterns seen among members and devise last-minute Part D strategies optimized for success.
Comprehensive Analysis of Part D Member Data
Starting with the members who reported negative experiences regarding accessing prescription drugs, the data suggests these individuals are typically from more socially vulnerable populations. These members also tend to benefit from income-based subsidies, yet these aids are often insufficient, resulting in poorer health outcomes and overall healthcare dissatisfaction.
Interestingly, the data also reveals that these members are less likely to lodge formal grievances despite the difficulties they face in accessing necessary medications. This could reflect a range of issues, from a lack of awareness about how to file complaints to a possible resignation to their circumstances.
Meanwhile, these same groups are shown to have a higher prevalence of chronic conditions which necessitates more frequent and sometimes more complex medication regimens, leading to higher expenditures on prescriptions. These compounded pressures can significantly warp their experience and perception of Part D plans.
In contrast, members who primarily express dissatisfaction with their drug plans — rating them poorly — tend to be relatively newer enrollees. This subset often struggles with initial interactions or understanding the intricate details of their drug coverage, which can lead to frustration and dissatisfaction.
Unpacking data patterns, it becomes clear that their dissatisfaction might largely stem from a lack of familiarity with the system, challenges in navigating plan structures, or initial experiences that did not meet their expectations. These insights are particularly crucial as they suggest different communication and educational strategies might be more effective with this group to improve understanding and satisfaction.
When comparing the intersection and overlap of dissatisfaction between getting needed prescription drugs and rating of the drug plan, the data shows minimal overlap — about a 25% intersection. This indicates that while there are some shared factors contributing to dissatisfaction, requiring targeted solutions. For instance, those struggling mainly with access (getting needed prescription drugs) may benefit more from interventions aimed at simplifying the access pathway and enhancing local support resources, whereas those dissatisfied with the plan’s rating might need clearer information and guidance on plan benefits and usage to alleviate their concerns.
This approach to data analytics not only illuminates the diverse challenges faced by different member segments but also underscores the necessity of tailoring communication and intervention strategies. By addressing the specific root causes of dissatisfaction noted in these analyses, healthcare plans can deploy more precise and impactful measures to enhance member experience and improve outcomes under Part D coverage.
Taking Action on Part D
It just isn’t about having the data, though. You have to use it intelligently. That means deploying engagement programs to those members identified in the data to impact their experience and potentially improve their CAHPS responses.
Plans should adopt a smart mix of both tactical and strategic approaches paired with a clear understanding of who needs to be impacted by these approaches.
Who Needs to be Impacted
But which members should be the primary focus? in the chart below, you know based on calculations that you are aiming to flip 27 responders within specific measures to get to the next cut points. What these advanced predictions can do for you is take your pool of 20,000 CAHPS eligible members and shrink it down to just 2,937 members to focus on. We know based on the data those 27 responders are somewhere in that pool of 2,937, so we can shift focus to trying to target the entire population to putting more resources into the smaller group where we can safely assume our 27 responders.
The Right Tactical Mix
Once you have your targets, delving into both short-term solutions and long-term tactics allows plans to orchestrate a Part D experience that not only addresses current member pain points but also fortifies the system against future challenges. The trick is to balance ‘just in time’ interventions with consistent, year-round programs to maximize impact.
Just in Time CAHPS Outreach, ideally launched in the January – February time frame, has two goals:
- It allows you to target likely negative CAHPS responders and proactively address issues with them in preparation for their potential participation in the CAHPS Survey over the next few months.
- You are targeting likely positive CAHPS responders to encourage survey response.
So, you’re trying to improve the response rate of already positive responders while simultaneously raising the ratings of likely negative responders may give you if surveyed.
For strategic year-round CAHPS outreaches, focus on:
- Key inflection points happening during the year and targeting members specifically to address these point-in-time experiences. For example, a preventable ED visit or a change in risk.
- Creating CAHPS awareness and accountability among your physician partners. Download our playbook for Provider CAHPS Plan to learn more.
This forward-thinking approach means anticipating potential issues before they escalate and integrating preventative measures into the everyday fabric of member interaction. Whether it’s a targeted outreach to a member who might be experiencing a gap in care or adjusting resources during peak times to handle increased inquiries, these predictive insights help transform the reactive cycles into proactive strides towards better care and satisfaction – and ultimately, better CAHPS survey responses.
Final Thoughts: Elevating Part D Strategies with Data-Driven Precision
Navigating the evolving landscape of Part D requires more than just understanding policy changes—it demands strategic foresight, data-driven insights, and targeted engagement. By leveraging advanced analytics, healthcare plans can identify the key drivers of member dissatisfaction and proactively implement tailored outreach strategies to improve CAHPS performance.
The key takeaway? Success in Part D isn’t just about compliance or cost management—it’s about delivering an optimized member experience. Plans that harness predictive analytics to refine their engagement approach will be best positioned to adapt to regulatory shifts, enhance member satisfaction, and ultimately, secure stronger CAHPS results.
By taking action now—balancing timely interventions with year-round engagement—health plans can transform Part D challenges into opportunities, ensuring better outcomes for both members and their bottom line.
