WellCare Health Plans — WellCare of Kentucky — Provider Summit 2026
18 slides from WellCare Health Plans's conference presentation, Apr 3, 2026
Slide 1: CAHPS & HOS Surveys (Member Experience)
CAHPS & HOS Surveys (Member Experience) Confidential and Proprietary Information 1
Slide 2: WellCare of Kentucky, Wellcare, and Ambetter affiliated products
WellCare of Kentucky, Wellcare, and Ambetter are affiliated products serving Medicaid, Medicare, and Health Insurance Marketplace members, respectively. The information presented here is representative of our network of products. If you have any questions, please contact Provider Relations. Confiden
Slide 3: What is CAHPS?
What is CAHPS? The Centers for Medicare & Medicaid Services (CMS) develop, implement and administer several different patient experience surveys. These surveys ask patients (or in some cases their families) about their experiences with, and ratings of, their health care providers and plans, includin
Slide 4: Why CAHPS is Important
Why CAHPS is Important Stars is a ratings system created by CMS (the Centers for Medicare and Medicaid Services) to help beneficiaries compare relative Medicare plan performance. They are publicly reported. Confidential and Proprietary Information 4 Confidential and Proprietary Information
Slide 5: Why CAHPS is important
Why CAHPS is important To calculate the Star Score for WellCare each of the 6 chapters below and the percentage of the score they account for are calculated together. Measures within each of these domains hold different weights. As providers, you are most likely very familiar with HEDIS and Pharmacy
Slide 6: Why CAHPS should be important to you?
Why CAHPS should be important to you? The CAHPS survey measures member experience. The results reflect patient loyalty, quality of care and financial viability. 1. Better CAHPS scores helps WellCare 2. CAHPS is more than scores. Communication skills, achieve higher star ratings and in turn access, b
Slide 7: How Do You Impact CAHPS?
How Do You Impact CAHPS? As a provider, you are the most critical component of patient experience. We want to ensure that you know exactly how your patients are evaluating your care. It is beneficial to familiarize yourself with the topics included in the survey and how the smallest change might mak
Slide 8: CAHPS: Getting Needed Care
CAHPS: Getting Needed Care The Getting Needed Care measure assesses the ease with which patients received their care, tests, or treatment. It also assesses how often patients were able to get specialist appointments scheduled when needed. • Help coordinate specialty appointments for urgent cases • M
Slide 9: CAHPS: Getting Appointments and Care Quickly
CAHPS: Getting Appointments and Care Quickly The Getting Appointments and Care Quickly measure assesses how often patients got the care they needed as soon as they needed it, and how often appointment wait times exceeded 15 minutes. • Schedule patients for appointments based on complexity of conditi
Slide 10: CAHPS: Care Coordination
CAHPS: Care Coordination The Care Coordination measure assesses providers’ assistance with managing the healthcare system, including access to medical records, timely follow-up on test results, and education on prescription medications. • Ensure there are open appointments for patients recently disc
Slide 11: CAHPS: How Well Doctors Communicate
CAHPS: How Well Doctors Communicate The How Well Doctors Communicate measure assesses patients’ perception of the quality of communication with their doctor. Consider using the teach-back method to ensure patients understand their health information. • The teach-back method is a communication confir
Slide 12: CAHPS: Rating of Health Care Quality
CAHPS: Rating of Health Care Quality The CAHPS survey asks patients to rate the overall quality of their healthcare on a 0-10 scale Incorporate the following into your daily practice: • Encourage patients to make their routine appointments for checkups or follow-up visits as soon as they can – weeks
Slide 13: CAHPS: Flu Vaccine
CAHPS: Flu Vaccine CAHPS measures flu vaccine awareness Getting a flu shot will often protect patients from getting a serious case of the flu. Vaccination may not always prevent infection, but it can make symptoms less severe and reduce the risk of patient hospitalization. • Find out if the patient
Slide 14: HOS - Medicare Health Outcomes Survey
HOS - Medicare Health Outcomes Survey The HOS survey is one way CMS monitors the quality-of-care Medicare Advantage Organizations (like WellCare) provide to its Medicare members. The HOS Survey assesses these organizations' ability to maintain or improve the physical and mental health of its Medicar
Slide 15: HOS Example Questions
HOS Example Questions HOS Measure HOS Survey Question “During the past four weeks, have you accomplished less than you Improving or Maintaining Physical Health would like or been limited in your work or other regular daily activities as a result of your physical health?” “During the past four weeks,
Slide 16: Remember… Every Patient is Unique
Remember… Every Patient is Unique You may answer the same patient questions 10x/day, which equates to 2,500 times a year, so it’s easy to feel overburdened and get impatient from these repetitive questions. - BUT just because we answered Patient A doesn’t mean Patient B knows! At visits, patients ma
Slide 17: Interactive Q&A
Interactive Q&A Confidential and Proprietary Information Confidential and Proprietary Information 17
Slide 18: Thank you for attending. Any questions?
Thank youfor attending. Any questions? ©2026 WellCare 6418672_KY6PCADCARMKTPRSE State Approved 03242026 Confidential and Proprietary Information