EXL's CAHPS Analytics Framework for Medicare Stars

CAHPS Analytics Solution Implementation

Improving CAHPS (Consumer Assessment of Healthcare Providers and Systems) scores is essential for maintaining high Star Ratings and enhancing member experience. Traditional methods often rely on static demographic data and retrospective survey results, which limit the ability to act proactively. EXL’s CAHPS solution leverages behavioral modeling, sentiment analysis, and real-time analytics to identify dissatisfaction signals early and enable targeted, timely interventions.

EXL delivers a comprehensive behavioral analytics framework that empowers health plans to reduce member churn, improve CAHPS performance, and optimize outreach strategies.

How It Works

The engagement begins with a detailed assessment of the data ecosystem, survey performance trends, and outreach workflows. EXL accelerates implementation using pre-built behavioral features, risk scoring models, and dashboard templates. Scope, timelines, and effort estimates are defined upfront, with a milestone-based delivery model to ensure transparency and minimize risk. The solution is deployed within a secure, scalable Microsoft Azure cloud environment and integrated with Microsoft Power BI for advanced analytics and an interactive dashboard, offering full control and customization flexibility.

Proxy Survey Integration

• Proxy survey questions are systematically mapped to CAHPS measures, enabling measure-specific modeling and targeted interventions across domains like access, coordination, and service quality. • Questions are categorized by type (single choice, multiple choice, text) to support both structured analytics and sentiment modeling, allowing early detection of dissatisfaction signals. • The mapped survey framework supports a dynamic feedback loop that informs timely adjustments in staff behavior, outreach strategies, and service delivery driving measurable improvements in CAHPS outcomes.

Member Profiling and Utilization Insights

• Member data is aggregated across demographics, prescription behavior, program enrollment, diagnosis patterns, and utilization history to uncover care gaps and engagement trends. • Individual member profiles include claims, visits, readmissions, and call activity, enabling personalized risk assessment and outreach planning. • Service utilization and call center metrics are analyzed to identify friction points and align interventions with CAHPS domains.

Risk Segmentation

• EXL builds measure-specific segmentation models using predictors like age, claim patterns, call center interactions, lab results, geographic clusters, etc. • These predictors are statistically validated and mapped to survey response behavior to isolate member cohorts contributing to unfavorable CAHPS outcomes. • Segments are designed to represent a significant share of the unfavorable population for each measure, enabling targeted outreach to high-impact groups.

Cohort Based Outreach Enablement

• Segmented cohorts are prioritized for outreach based on measure-level risk indicators and engagement signals. • Rule-based triggers initiate timely interventions, ensuring outreach is aligned with member needs and CAHPS improvement.

Dashboarding and Impact Tracking

• Power BI Command Center: Dashboards provide drill-down views by member risk level, outreach mix, and intervention impact. • Member-Level Insights: Individual member profiles include risk scores, utilization patterns, and engagement history. • Impact Monitoring: Post-intervention tracking includes CAHPS score changes, ROI metrics, and sentiment trends.

CAHPS Improvement KPIs and Modules

• Behavioral Drivers & CAHPS Performance: Identify key factors behind low CAHPS scores (e.g., call center friction, utilization gaps) and track improvement measures and Star Ratings. • Risk Cohort Conversion: Monitor reduction in high-risk segments identified by predictive models and measure outreach success through conversion rates and sentiment change. • Operational Impact & Efficiency: Quantify ROI by linking interventions to lower call volume, better adherence, and optimized resource use validated through post-intervention tracking.

Why Choose EXL’s CAHPS Analytics Solution?

EXL’s solution is built on a data framework that leverages behavioral signals to identify dissatisfaction early. By integrating real-time data, and predictive modeling, health plans can move beyond reactive survey analysis and implement proactive strategies that improve member experience and CAHPS outcomes. Our deep healthcare expertise and Azure-native architecture ensure scalable, secure, and impactful deployments.