Insights into problems obtaining care believed necessary as measured by the Medicaid Consumer Assessment of Health Plans Survey (CAHPS).

Background: The Consumer Assessment of Health Plans Survey (CAHPS) is widely used to evaluate health plans; however there are few reports of Medicaid health plan efforts to improve performance as measured by CAHPS.

Objective: Data from CAHPS were analyzed to help plan administrators determine how they might address member reports of problems obtaining care they or their doctor believed necessary.

Study Design: Secondary analysis of cross-sectional survey data obtained from adults and children enrolled in 3 Medicaid health plans.

Methods: Cross-tabulations of CAHPS responses and follow-up questions asking enrollees to describe the problems they had obtaining care believed necessary.

Results: Problems obtaining care believed necessary were among the most frequently reported problems (13%-17% of adults, 9% of children). Problems obtaining a satisfactory personal doctor; receiving help when calling a physician's office; securing routine, urgent, and specialist care appointments as soon as desired; receiving referrals to specialists; obtaining behavioral health services and prescription medications; and problems with doctor communication were related to problems obtaining care believed necessary. Enrollees' descriptions of the problems corroborated observed relationships between CAHPS responses, and revealed dissatisfaction with doctors' care and lack of coverage for various services as additional contributors.

Conclusions: Analyses of relationships between enrollee-reported problems obtaining care believed necessary and their responses to other CAHPS items and follow-up questions identified a number of plausible causes of this problem. Given the multifaceted nature of problems with obtaining care believed necessary, a plan of action that might substantially improve this predicament was not apparent. Additional information about how health plan operations influence CAHPS results and the effect of health plan interventions on CAHPS measurements are needed to facilitate use of these data for quality improvement.