The Importance and Current Changes of CAHPS and HOS
As the importance of CAHPS (Consumer Assessment of Healthcare Providers and Systems) and HOS (Health Outcomes Survey) have taken center stage over the last few years, health plan focus on these surveys has significantly (and understandably) increased. These surveys not only provide insight into how members perceive their care and health outcomes, but also directly impact Star Ratings and associated reimbursements in a major way.
For the 2027 rating year, they will together account for nearly 30% of a plans total Star Rating. Even though CAHPS will have moved from a 4x weight to a 2x weight (Annual Flu Vaccine remains 1x), the two longitudinal HOS measures have returned from the display page and will move to 3x each, the two together still play a very significant role in a plan’s success even among other measure movements and weight changes. Given CMS’s strategic shift toward rewarding plans that improve and sustain member outcomes across all domains, HOS is emerging as a critical differentiator in performance measurement.
Trends in the Data: Understanding HOS Responders
With the full return of Improving or Maintaining Physical Health and Improving or Maintaining Mental Health, understanding who completes the Health Outcomes Survey—and how they differ from the general Medicare Advantage population—is critical. mPulse analyzes data sourced from our own customers, including medical claims, pharmacy claims, eligibility, and member provided demographics-along with consumer and public data, such as census data, area deprivation indices, and social vulnerability indices. Put all together, this data reveals several compelling trends that can inform both strategy and operational decision-making.
The Connection Between CAHPS and HOS
The first apparent insight from this analysis is the significant overlap between members who respond negatively to HOS measures and those who also report issues in CAHPS. Approximately 43% of members with at least one negative HOS response are also struggling with at least one CAHPS-related issue, such as problems with access, provider communication, or plan services.
When focusing specifically on members reporting physical or mental health decline, that overlap increases to 45%. This intersection suggests that HOS and CAHPS are deeply interconnected. Members who report negative health outcomes are also more likely to have negative experiences with their health plan or providers, underscoring the importance of coordinated strategies that address both clinical outcomes and overall member experience.
High Utilization and Complex Needs
The next conclusion we can draw is that HOS responders seem to be higher utilizers of care than the broader population, meaning these members tend to have more chronic conditions, greater disease burden, and more frequent interactions within the healthcare system.
On average, HOS responders are more likely to have conditions such as:
- Diabetes
- Hypertension
- Heart disease
- Depression and anxiety
These chronic conditions often require regular follow-up, medication adherence, and coordination across multiple care settings. Their prevalence among HOS responders indicates the survey responses reflect the experiences of members with more intensive and ongoing care needs.
Behavioral Health: A Defining Characteristic
One of the most consistent patterns observed among HOS responders is a higher prevalence of behavioral health diagnoses, particularly depression and anxiety. These conditions clearly influence how members perceive both their physical health and the care they receive. Members with these diagnoses are more likely to report declines in well-being or challenges in functioning, which in turn can impact survey responses.
A Sicker Responder Population Is Emerging
And an interesting trend has emerged over the last few years: members responding to the HOS survey are becoming sicker over time. While not confirmed with direct evidence, the data trends suggest that the responding population is increasingly made up of individuals with multiple chronic conditions, behavioral health comorbidities, and higher preventable ED usage.
Compared to earlier years, the percentage of respondents reporting both physical or mental decline—and presenting with complex health issues—has gone up significantly, and members who are relatively healthy or disengaged with the healthcare system may be dropping off.
If true, this emerging pattern highlights the importance of recognizing that today’s HOS responses may reflect a higher-risk, more clinically complex member segment than in previous years, further reinforcing the need for proactive and targeted engagement.
Talking CAHPS: The 2025 HOS Edition
The Need for AI in Predictions and Targeting
HOS responders represent a distinct and influential segment of the Medicare Advantage population—members deeply engaged in care, often managing multiple chronic conditions and behavioral health challenges. Their responses significantly impact Star Ratings and reflect both their health realities and care experiences. Understanding who these members are and what patterns emerge from the data is a foundational step in any effort to improve HOS performance.
But while these trends offer valuable directional insight, recognizing and acting on them at scale requires far more than charts and spreadsheets. The complexity of the patterns—ranging from behavioral health comorbidities to overlapping CAHPS and HOS issues—and the sheer number of data points that need to be factored in to make accurate predictions means that manual analysis alone is insufficient.
Pinpointing the exact cohorts of members who are most likely to respond to the HOS survey, and more importantly, those who are at risk of responding negatively, demands the use of advanced machine learning and AI-driven predictive models. These technologies can analyze vast amounts of data across multiple dimensions—clinical history, engagement behavior, social needs, and prior response patterns—to assign precise probabilities to each member and creates the difference between a general understanding and actionable targeting that drives measurable improvement.
And once you have that targeting in place, you then need the right strategy for engagement.
Strategies to Improve Your HOS Scores Through Engagement
Given the complexity of HOS responders and the survey’s focus on long-term health outcomes, improving HOS scores demands more than short-term fixes. It requires a coordinated effort that blends clinical, operational, and engagement strategies throughout the year. We break out a comprehensive HOS engagement strategy into two main parts: Just in Time outreach and Year-Round Touchpoints.
Once a health plan has predictive insights into which members are likely to struggle with HOS-related issues, a wide range of strategic opportunities open up. One of the primary approaches is “just-in-time” outreach¾a form of pre-HOS engagement. This strategy focuses on engaging members ahead of the official survey period in July, with the goal of influencing outcomes during this critical window of time before survey responses are collected. And this isn’t about making massive leaps in ratings—such as moving from a 1-star to a 5-star, which could require 25–30 percentage points—but about improving incrementally based on current performance: moving select measures a few percentage points higher to reach the next performance tier.
And it’s important to target precisely—focusing on members who not only have multiple HOS issues but are also highly likely to respond to the survey if targeted. This is where predictive modeling comes in. For example, in a sample plan with over 53,000 members, raising each key HOS measure by just one star might require influencing a very small group—around 35 members. Identifying and reaching those individuals is where predictive analytics becomes essential. This brings the number of members to focus on from 53,000 to just over 2,500 members to target pre-HOS and another 3,700 to support broader movement.
Another crucial tactic involves targeting key inflection points throughout the year—moments in a member’s health journey that correlate with negative HOS responses. These inflection points might include events like a new sleep apnea diagnosis, a preventable emergency department (ED) visit, a hospitalization, or a change in risk score. Each of these situations presents an opportunity to intervene with outreach that supports the member and potentially alters the trajectory of their health status or perception of their care. By recognizing and acting on these points in real time, plans can proactively address the factors that often lead to unfavorable HOS scores. This approach extends the influence window far beyond the survey period, allowing for year-round impact on member outcomes.
Together, just-in-time outreach and inflection point engagement form a powerful strategy for improving HOS performance. By combining timely, targeted interventions with predictive insight, plans can move beyond reactive tactics and drive meaningful impact—both during the survey window and throughout the entire year.
Readiness is Year-Round
As CMS continues to shift toward value-based care and member-centered metrics, the importance of HOS will only grow. Unlike CAHPS, which captures near-term satisfaction, HOS assesses long-term health trajectory—a more complex but equally vital component of Star Ratings.
The data reveals that HOS responders represent a particularly complex population: high utilizers with multiple chronic and behavioral health needs. Engaging this group effectively requires a sustained, personalized, and clinically integrated strategy.
Health plans that succeed in improving HOS scores are those that treat the survey not as a moment-in-time event but as an outcome of consistent, whole-person engagement and care. By aligning clinical and engagement teams, leveraging data insights, and maintaining a relentless focus on improving members’ physical and mental health, plans can not only enhance HOS performance but also drive better outcomes for their most vulnerable members.
