Development of the CAHPS Health Plan Survey

The development of the CAHPS Health Plan Survey began in 1995, when AHRQ awarded the first set of grants to Harvard, RTI, and RAND. In 1997, the Consortium released the CAHPS Health Plan Survey for public use. Since that time, the Consortium has clarified and updated the survey instrument to reflect

  • Field tests results;
  • Feedback from industry experts;
  • Reports from sponsors, vendors, and other users; and
  • Evidence from cognitive testing and focus groups.

In November 2006, the CAHPS Consortium released the 4.0 version of the Health Plan Surveys. That update was part of the "Ambulatory CAHPS (A-CAHPS) Initiative," which resulted from extensive research conducted with users in the first year of the CAHPS II contract.

In May 2012, the Consortium released the 5.0 version of the Health Plan Survey. This update applies recent improvements in survey design that resulted from testing of the Clinician & Group Survey. For information about the specific changes to the Health Plan Survey, read CAHPS Health Plan Survey: Overview of the Questionnaires (PDF, 444 KB).

Key Steps in the Process

Interviews with stakeholders. In the first year of the CAHPS II contract, the Consortium members interviewed a variety of stakeholders 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 early planning stages of the 4.0 version of this survey. Additionally, the RAND CAHPS Team conducted research with health plans around the country in 2003 to elicit their perspectives on the instrument. To learn more about this research, read Supplemental Items to Support Improvements in Health Plan Quality.

Creation of A-CAHPS Advisory Group. To support the development and implementation of the updated CAHPS Health Plan Survey and the new Clinician & Group Survey, the Consortium established a new Advisory Group comprised of key stakeholders: accrediting bodies, major provider and health plan associations, purchasers, and consumer representatives. Through the Advisory Group, these stakeholders had opportunities to learn about and 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 each draft questionnaire of the Health Plan Survey 4.0 with various stakeholders asking for their input on domains, topics within domains, item content, and response scales. This feedback has helped to ensure that the survey results for each level of the health care system reflect functions that are truly under their control.

Cognitive testing. In order to determine whether the questionnaire items were understandable and meaningful to respondents, the CAHPS Consortium and the National Committee for Quality Assurance (NCQA) submitted the draft of the Health Plan Survey 4.0 to multiple rounds of cognitive testing starting in December 2004. 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. Once the Consortium had incorporated findings from cognitive testing into the draft instrument, they moved on to the field testing stage. Working closely again with NCQA, they submitted the instrument to field tests at six geographically diverse sites in the spring of 2005, analyzed the field test data, and revised the instrument as needed.

Submission of the instrument to the CPM and AQA. In January of 2006, the Consortium submitted a draft of the CAHPS Health Plan Survey 4.0H to NCQA’s Committee for Performance Measurement (CPM) for review. NCQA then released the survey for public comment in February and March of 2006. NCQA and the Consortium adjusted the instrument one last time based on feedback from this month-long period.

Public release, endorsement, and use. AHRQ released the Health Plan Survey 4.0 in November 2006, along with guidance on how to customize and administer it. The Ambulatory Care Quality Alliance (AQA) accepted the instrument in January 2006. The National Quality Forum endorsed the 4.0 version of the Health Plan Survey in July 2007. In 2007, NCQA began accepting the 4.0H version of the adult questionnaire for health plans seeking accreditation; the 4.0 version of the child questionnaire has been required by NCQA since 2009.

Release of 5.0 version. AHRQ released the 5.0 version of the Health Plan Surveys in May 2012. The changes to the surveys grew out of findings from the testing and refinement of the Clinician & Group Surveys. 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.

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
Page last reviewed March 2018
Page originally created June 2012
Internet Citation: Development of the CAHPS Health Plan Survey. Content last reviewed March 2018. Agency for Healthcare Research and Quality, Rockville, MD.
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