Development of the CAHPS Health Plan Survey

AHRQ launched the development of the CAHPS Health Plan Survey in 1995 and released the first version for public use in 1997. Since that time, the CAHPS team has clarified and updated the survey instrument several times to reflect changes in healthcare delivery, survey field tests results, feedback from industry experts, reports from sponsors, vendors, and other users, and evidence from cognitive testing and focus groups.

Key Steps in the Survey Development Process

The development of the original CAHPS Health Plan Survey was well documented in a 1999 issue of Medical Care:

Crofton C, Lubalin JS, Darby C. Consumer Assessment Of Health Plans Study (CAHPSTM): Foreword. Med Care. 1999 Mar, 37(3 Suppl): MS1-MS9.

This page briefly summarizes the survey development work conducted since that time.

Interviews with stakeholders. Over the years, the CAHPS research team has interviewed a variety of stakeholders, including health plans, healthcare purchasers, and consumer organizations, about their experiences with the Health Plan Survey to learn what worked well, what needed improvement, and what they wanted to see in future surveys for the ambulatory care setting. Feedback from these interviews was pivotal in the initial development of this survey and the planning stages of each new version, including the most recent 5.0 and 5.1 versions.

Advisory Group. To support the development and implementation of the CAHPS Health Plan Survey, the CAHPS team has also convened Advisory Groups comprised of key stakeholders: accrediting bodies, major provider and health plan associations, purchasers, and consumer representatives. Through the Advisory Groups, these stakeholders had opportunities to participate in the development process and provide input into the products.

Ongoing outreach to sponsors, users, and consumer organizations. The CAHPS Consortium took advantage of various opportunities to inform interested parties about the updates to the Health Plan Survey and elicit comments and questions to advance its development. These outreach vehicles included meetings, Webcasts, newsletter articles, and requests for public comment through the Federal Register. As part of this effort, the Consortium shared draft questionnaires with various stakeholders asking for their input on domains, topics within domains, item content, and response scales.

Cognitive testing. In order to determine whether the questionnaire items were understandable and meaningful to respondents, the CAHPS team has conducted multiple rounds of cognitive testing of the Health Plan Survey with consumers. This testing helped survey developers choose the most accurate and accessible language in English and Spanish for each question included in the survey.

Field testing. Over the years, the CAHPS team has conducted multiple field tests of the Health Plan Survey in geographically diverse sites, analyzed the field test data, and revised the instrument as needed based on the findings.

Public release of 4.0 version. AHRQ released the Health Plan Survey 4.0 in November 2006, along with guidance on how to customize and administer it. The National Quality Forum endorsed the 4.0 version of the Health Plan Survey in July 2007.

Release of 5.0 version. AHRQ released the 5.0 version of the Health Plan Survey in May 2012. The National Quality Forum renewed endorsement of the 5.0 version of the CAHPS Health Plan Survey in January 2015 through its Person and Family Centered Care Measures maintenance process.

Release of 5.1 version. In October 2020, AHRQ released the 5.1 version of the Health Plan Survey to address the rapid changes to healthcare delivery as a consequence of the COVID-19 pandemic. The CAHPS team made minor edits to the survey to ensure that respondents report about all synchronous healthcare they received (i.e., in person, by phone or by video). The edits were tested with consumers during the summer of 2020.

Review these articles to learn more about the development of the CAHPS Health Plan Survey.

Contributors to the Health Plan Survey's Development

Organizations contributing to the development of the CAHPS Health Plan Survey include the following:

• American Institutes for Research (AIR)
• Harvard Medical School/Yale School of Public Health
• RAND
• Research Triangle Institute (RTI)
• Westat
• Centers for Medicare & Medicaid Services (CMS)
• National Committee for Quality Assurance (NCQA)
• Foundation for Accountability (FACCT)
• Child and Adolescent Health Measurement Initiative (CAHMI)
• National Institute for Disability and Rehabilitation Research (NIDRR), U.S. Department of Education
• Centers for Disease Control and Prevention (CDC)
• George Mason University Center for the Study of Chronic Illness and Disability