CR_OMB Explanations for Inclusion of Survey Qs 100520

Part C and D Complaints Resolution Performance Measure
Explanations for Inclusion of Survey Questions
Q1. According to our records, the complaint you filed was recently closed by the plan.
Was the complaint settled?
One of the primary interests of CMS is the beneficiary’s perspective on the complaint resolution
process. As would be expected, one of the main questions is the perspective of the beneficiary on
the resolution of the complaint. This question elicits the beneficiary’s overall agreement and
satisfaction with the resolution.
Limitations to this question include the possibility that asking beneficiaries about the resolution
of their complaint or whether the complaint was settled will elicit a negative response if the
resolution was not in their favor. Also, a beneficiary may not be aware of Medicare Part C and/or
Part D regulations and issues that are outside the scope of the plans. As such, beneficiaries could
respond negatively to this question despite the fact that their plans have complied with CMS
regulations in resolving the complaints. Despite these potential limitations, the responses to this
question remain an important piece of information in understanding the perspective of the
beneficiary on the complaint resolution process. To prevent bias in the development of the
performance measures, this question will not be the sole factor in producing a performance
measure.
Q2. Thinking about the aspects of the complaints process, regardless of whether you agree
or disagree with the final outcome, please indicate how satisfied you are with the
following:
This question elicits information about the complaint process from the beneficiary’s perspective.
CMS is interested in these areas since they are part of the Complaint Tracking Module
guidelines. Among the main areas of interest are: (a) “Time your plan took to contact you,”
which can include, among other aspects, the final communication from the plan informing the
beneficiary about the complaint resolution; and (b) “Amount of time spent handling your
complaint,” which reflects the burden of the complaint process on the beneficiary. Each answer
choice has its own satisfaction Likert scale (4-point rating scale). As a result, we will be able to
provide deeper analysis of the factors that can affect beneficiary satisfaction with the complaint
resolution process.
These responses will be analyzed, together with the overall satisfaction rating, to determine
which aspects of the complaint resolution process have the most influence on a beneficiary’s
satisfaction with the final outcome (and quite possibly the resolution). CMS could provide
revised recommendations based on these findings.

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Explanations for Inclusion of Survey Questions

Part C and D Complaints Resolution Performance Measure
Explanations for Inclusion of Survey Questions
Q3. During the complaint process, did you experience any of the following?
While a plan may meet CMS’s recommended time window for resolving a complaint, the
resolution time may still be too long to prevent an unexpected or unwanted event for the
beneficiary. Thus, this question asks whether the beneficiary experienced any adverse
outcome(s) during the complaint resolution process. This question will inform CMS and the
plans about areas they should focus on to prevent these kinds of adverse events in the future.
Q4. What was the final outcome or decision regarding your complaint?
This open-ended question allows beneficiaries to recount their experience with the complaint
resolution process, the contacts and communications that took place, and the final outcome or
decision that was made by the plan with regard to their complaint.
The final outcome is the series of decisions and or actions regarding the complaint. These
decisions and/or actions indicate whether a complaint has been settled (closed). An emphasis on
“final outcome or decision” rather than “resolution” puts the focus on the series of actions the
plan took, regardless of whether the beneficiary believes his/her complaint was resolved.
Q5. How satisfied are you with the final outcome of your complaint?
The responses to this question will represent beneficiaries’ level of satisfaction with the final
outcome of their complaints. This question further emphasizes the final outcome rather than the
resolution (and the potential limitations outlined in Question 1 above). Information gathered
from this question will be used together with more detailed questions about satisfaction in the
development of the performance measures.
Q6. Whether you agree or disagree with the final outcome, how would you rate your
overall satisfaction with the way your complaint was handled by the plan?
This question will provide an assessment of how satisfied beneficiaries are overall with the
process to resolve their complaints. As the overall satisfaction rating, it is placed after questions
about the complaint process. By first asking questions about process, the survey is structured to
remind beneficiaries of their full complaint experience so that they may provide a balanced
assessment of their experience. This ordering was selected to avoid starting with the satisfaction
question and eliciting a gut reaction from beneficiaries.

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Explanations for Inclusion of Survey Questions

Part C and D Complaints Resolution Performance Measure
Explanations for Inclusion of Survey Questions
Q7. Based on your recent experience, how satisfied are you with [Plan name]?
Without mentioning the complaint process, this question provides an overall assessment of the
beneficiary’s experience with the plan, including health care, customer service, and other issues.
When compared to other satisfaction questions in the survey, responses will highlight how much
the plan’s handling of the complaint affects the beneficiary’s overall opinion of the plan’s
service.
Q8. Based on your recent experience, how likely are you to stay with this plan?
The responses will indicate to what extent a beneficiary’s experience with the services provided
by the plan and with the complaint resolution process affects his/her opinion of the plan. A
complaint resolution process that is so unsatisfactory that the beneficiary is willing to switch
plans indicates that changes need to be made in the process.
Q9. Are you…? [The Beneficiary or Someone else]
Identifying the respondent is necessary to assess cases in which beneficiaries use representatives
to file or follow up on complaints. It is possible that if representatives complete the survey, their
experiences and satisfaction may be different from those of beneficiaries who complete the
survey themselves. This question allows for an analysis of satisfaction while controlling for
survey respondents. Additionally, including this question will allow for an estimation of the
number of beneficiaries who use a proxy or representative when making a complaint
Q10. Do you have any suggestions or comments about how your plan could handle
complaints better?
While this open-ended survey question may not be used directly in any of the performance
measures, given the variety of potential responses, it is still a critical question that can elicit
additional information to answer the following questions: (a) How can the complaint process be
improved, and can CMS facilitate it with additional guidance? (b) How can plans improve their
handling of complaints? (c) What types of complaints cause more problems or fewer problems?
and (d) Are beneficiaries dissatisfied with something the plan was unable to control, or do they
have reasonable issues with the process?

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Explanations for Inclusion of Survey Questions