Member Experience Surveys (CAHPS^® and EES): We All Play a Role

February 4, 2022

Every year, some Blue Cross and Blue Shield of Illinois (BCBSIL) members receive surveys to collect information about their experiences with both their health care providers and health insurance plans.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and the Enrollee Experience Survey (EES) were developed by the Agency for Healthcare Research and Quality (AHRQ) on behalf of the Centers for Medicare & Medicaid Services (CMS) and the National Center for Quality Assurance (NCQA).

When do members receive the survey?
The CAHPS survey and EES are conducted from February through June. Members are asked to rate their last six months of care. Please encourage your patients to respond to the CAHPS survey or EES if they are selected to participate.

Who gets the surveys and how are the results used?
The surveys are mailed to a random sample of members who are 18+ years of age. The results are used as a quality improvement initiative to help identify opportunities for improving member satisfaction, and also affect Star Rating programs. We strive to achieve the highest possible Star Rating for our health plans.

*Medicaid includes, Blue Cross Community Health Plans^SM (BCCHP^SM) adult and child members (guardians of children under 18 will receive the survey for their child), and Blue Cross Community MMAI (Medicare-Medicaid Plan)^SM members

How can you help improve member experiences year-round?

Provide needed care quickly and coordinate care with specialists

• Leave openings for sick visits and urgent appointments
• Discuss how to access telehealth services and after-hours care
• Follow up with members’ specialists to ensure continuity of care
• Review treatment plan at the end of each visit and discuss why or why not to take medications and all available treatment options
• Provide patients with educational materials
• Provide reasonable timely access to health care staff, customer service, etc., when BCBSIL transfers a member and calls for assistance to the provider or medical group

Communicate clearly

• Ask members about their top health concerns
• Keep conversations clear and simple
• Follow up after urgent or emergency care

Keep members healthy

• Recommend and/or administer the flu shot during flu season
• Screen members for risk factors, including tobacco use, and recommend appropriate lifestyle changes
• Educate members on preventive services, chronic conditions and ongoing care
• Let members know whether you offer telehealth services that allow them to access care from home
• Discuss the COVID-19 vaccine
• Complete and document any health assessments
• Identify and follow up with members who haven’t visited in the past year

Learn more about the CAHPS survey on the AHRQ website .

This information is for informational purposes only and is not a substitute for the sound medical judgment of a provider. Members are encouraged to talk to their provider if they have any questions or concerns regarding their health.

HMO, HMO-POS and PPO plans provided by Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC). HMO plan provided by Illinois Blue Cross Blue Shield Insurance Company (ILBCBSIC). HCSC and ILBCBSIC are Independent Licensees of the Blue Cross and Blue Shield Association. HCSC and ILBCBSIC are Medicare Advantage organizations with a Medicare contract. Enrollment in HCSC’s and ILBCBSIC’s plans depends on contract renewal.

CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).