Gauging member satisfaction and experience with care is definitely the trickiest aspect of measuring the Triple Aim goals.
Performance in survey - based satisfaction and outcomes measures like CAHPS and HOS can be primarily attributed to various functions in a health plan including customer service, providers, benefit design, PBM, and network management. Most importantly, people tend to remember negative experience like a rejected claim at the retail pharmacy, which colors their perception while responding to CAHPS survey questions.
Some of the CAHPS questions also require that members be sensitized about the right expectations. For example, members should be made aware that an oncologist appointment may require more than a day and they should appropriately answer "In the last 6 months, when you needed care right away, how often did you get care as soon as you thought you needed?"
Indegene collaboratively works with health plans to identify the right intervention for the right member at the right time, develop cohort-specific outreach scripts and workflows, and develop business rules using Health Risk Assessment, as well as clinical and claims data.