Winter 2012 
  In This Issue:

Provider Directory Validation Survey Begins

Upcoming Medical Record Audits for 2012


Claims Corner

Medicare and Medicaid Benefit Changes for 2012

Emblem Behavioral Health Services Program Underway

More Information on ICD-10

Good Notices for our Medical Manual on Religio-Cultural Competence

Behind the Scenes


Introducing Patient Health Profiles

Adolescent Immunizations

Vaccines For Children

Flu: It’s Not Too Late to Vaccinate

Medication Safety and Adherence

Health and Wellness Programs

Clinical Corner

News&Notes Archive


The annual Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys are being conducted for our Medicare, Medicaid, and Commercial members, excluding Child Health Plus. Each year, EmblemHealth asks our members to rate their satisfaction with their doctors and their plan by completing the CAHPS survey. The surveys measure how well we are meeting our members' expectations and allow us to compare our performance with that of our competitors. The results are used to calculate our National Committee for Quality Assurance (NCQA) accreditation status and CMS's Stars scores, and to assist in meeting our members' satisfaction.

Physician Experience
The following CAHPS survey categories address members' experiences with their physicians when obtaining care and service.

  • Getting Care Quickly: Reviews the member's experience with getting appointments with his/her doctor or specialist in a reasonable time.
  • How Well Doctors Communicate: Evaluates how well the member's doctor explained things to him/her.
  • Shared Decision Making: Questions if the member was offered any treatment options by his/her doctor.
  • Coordination of Care: Asks if the member's doctor was informed and up to date on any care received from other doctors or health practitioners.
  • Health Promotion and Education: Determines if a member was offered specific information to prevent illness and improve health.

Plan Satisfaction
The CAHPS survey assesses members' satisfaction with their insurance plan. It also asks members to rate their health plan the most important measure for public reporting and NCQA accreditation in the following categories:

  • Getting Needed Care: Measures a member's experience with getting the necessary care, tests or treatment through the plan.
  • Claims Processing: Asks how quickly a claim was processed and if the result was correct.
  • Customer Service: Questions how the member was treated when seeking information or help from our customer service staff.
  • Plan Information on Costs: Obtains the member's feedback on premiums, deductibles, copays and other plan-related costs.

You Can Help
The quality of your interactions with our members is reflected in the survey results. You can help us improve member satisfaction by seeing patients within 15 minutes of their appointment time, explaining medical matters in easy-to-understand terms and involving the patient in treatment decisions.

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

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