October Kicks Off CMS CAHPS Survey Lookback Period: Timing Strategies for Maximizing 2026 Star Ratings

October marks the beginning of the CMS CAHPS member experience survey look-back period. Nine Star Ratings measures come directly from this survey, making up about 23% of the weighted Star Ratings measure composition for Star Year 2026. While down from Star Year 2025's 33%, CAHPS continues to be a significant part of CMS's Stars methodology. When combined with HOS (the other major MA survey), these measures will account for 30% in Star Year 2026 and 34% in Star Year 2027.

Why combine CAHPS and HOS? Both surveys focus heavily on members' conversations with, and experiences within, the health plan's provider network. They include key gateway questions, such as whether members have seen their care provider in the last 6 months for CAHPS and in the last 12 months for HOS. To succeed here, plans should consider leveraging claims data to identify target populations for these measures—particularly members with primary and specialist visit claims from October 2024 through the CAHPS survey fielding, which begins in March 2025. Combining claims data with experiential insights can help shape targeted strategies to improve outcomes across both surveys.

The other half of CAHPS questions revolve around members’ experiences when contacting or accessing services through the health plan. With the CAHPS customer service gateway question asking whether members have contacted the plan in the past 6 months, now is the time to increase focus on members reaching out to the plan—starting next month through the survey fielding period. Note: the survey is sent only to members with at least 6 months of continuous enrollment at the time of fielding. While strong onboarding is essential, consider a 'welcome back' campaign for returning members, emphasizing their experience as measured through CAHPS.

Most of us are familiar with the need to mine experiential data—such as call center interactions, grievances, and disenrollments—to stay on top of member experience and drive improvement strategies. Let’s explore a few non-traditional data sources that also offer rich insights into member experiences:

1. Call Center Monitoring Performance Study: This study, separate from the FLL/TTY study that impacts Star measures, monitors the timeliness of Part C and Part D beneficiary customer service responses and pharmacy technical help desk performance. Detailed results, including hold times and disconnect rates for individual contracts, are provided quarterly through HPMS. - How to use this information: Utilize this data to identify bottlenecks and make real-time improvements to service delivery, as delays and disconnects can significantly impact member satisfaction.
2. Medicare Advantage and Prescription Drug Plan Disenrollment Reasons Survey: This survey digs deeper into why members voluntarily leave their health and drug plans, offering insights beyond standard disenrollment rates. General public results can be found here in the Star Ratings Data Table and Display Measures downloads, with more detailed data in HPMS.
3. Health Risk Assessments (HRAs): Although primarily used for clinical efforts, SNP care management, and risk adjustment, HRAs also contain valuable information about member preferences, barriers, and healthcare experiences. By analyzing this data, you can uncover challenges that influence care delivery and member satisfaction, allowing you to tailor strategies to address specific population subsets.

Post-survey analysis from your contracted survey administration vendors often reveals unique insights, analytics, and demographic trends that should inform your targeted CAHPS improvement strategies. I always recommend holding off on finalizing Q4/Q1 strategies until this data is in hand, as it provides crucial input for experiential, clinical, and quality initiatives.

For further discussion or assistance with your CAHPS strategy, feel free to reach out to me at [email protected].