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New Data Reveal Experiences Through the Eyes of Medicaid Clients

Think about the last time you visited the doctor. If you had to choose a number between zero and 10 to rate your doctor, what would you say? Now think about your overall experience with the health care system. Would you rate it differently?

We asked these questions of adults enrolled in Medicaid’s Accountable Care Collaborative (ACC), and we found some promising results with room for improvement. Patients rated their personal doctors favorably – 8.2 on average. They give a favorable rating of all health care they’ve received as well – an average score of 7.5 – though it’s lower than the rating of their doctor.

The survey – called the ACC Consumer Assessment of Health Care Providers and Systems (ACC CAHPS) – was a joint effort between the Colorado Health Institute and the Colorado Department of Health Care Policy and Financing (HCPF). For the first time, we have client experience data for each of the ACC’s seven geographic regions and for the state. A new chart pack provides an overview of the survey and 10 key findings.

The cross section of CAHPS data presented in the report paints a mixed picture of Medicaid clients’ experiences. Most respondents said they were able to get care as soon as they needed, gave their personal doctor high marks and said that their doctor communicated effectively.

Even so, the data suggest room for improvement. They rated their care lower than the national average. Only about a third said a health care provider had discussed neighborhood resources available to manage their health, and just half said their doctor had asked about their mental and emotional health.

The survey also reveals that ACC clients tend to score their care lower than traditional fee-for-service (FFS) Medicaid clients on a number of measures, including care coordination, access and satisfaction with their personal doctor. In many cases, the differences are only a few percentage points, though the pattern remains. What could be accounting for the lower ratings, given that these are the very things that ACC strives to provide or improve?

One hypothesis is that respondents to the ACC survey may be relatively new to Medicaid or to their provider. Another is that there are important differences in the health status of the ACC and FFS clients. On average, early clients in the ACC tended to be sicker and have more complex health needs than their FFS counterparts, which may influence how they responded to the survey.

The bottom line is that many of the findings suggest areas ripe for improvement and intervention, including communication about health resources, asking about mental and emotional health and encouraging communication between providers.

The ACC represents Colorado’s big investment in transforming how care is delivered. The need for baseline data – by which to evaluate the program’s success over time – is vital. The ACC CAHPS dataset provides insight into the most important component of the Medicaid program: the Coloradans it is meant to help.