Prioritize Plain Language to Boost your CAHPS Score

Have you ever made the link between language and CAHPS scores? Plain language = improved member experience = higher Star Ratings.
Claire Whelan
4 min read
plain language to boost your CAHPS score

Have you ever made the link between language and your CAHPS score? Perhaps not. So, consider the following equation:

Plain language = improved member experience = higher Star Ratings

It checks out if you think about it.

The Centers for Medicare & Medicaid Services (CMS) created Star Ratings to track health insurance providers’ performance on certain metrics, including customer experience. So, health insurers can improve their CAHPS score by focussing on the experience of their members. And, when members clearly understand policies and messaging, they have a better customer experience and remain loyal. You can read more about this here. Clear communications, therefore, lead to better Star Ratings.

Complexity dominates the health insurance industry

However, as an industry, we’re not in a good place when it comes to plain language. Members don’t currently understand communications from their health insurer. An Accenture report showed that 52% of consumers struggle to navigate the U.S. health insurance system. And when we conducted research into the health insurance industry in 2019, we found that 2/3 of health insurers produced content that was more difficult to read than Moby Dick. It’s no surprise that customers are struggling to figure out the meaning of their health insurance communications. And that translates to a poor customer experience.

Health plan example

Let’s take some text from a real health plan. The example below is from an Anthem Blue Cross Blue Shield plan, but the language is typical of most insurers’ content. It describes what happens when a long-term care resident needs a drug that’s not covered.

The “Before” text is from the original Anthem Blue Cross Blue Shield plan. We scanned it through our Language Analysis Platform and you can see the results in red below. Then we fixed the content to make it more readable; see the text in the “After” column.



If you are a resident of a long-term-care facility and, you need a drug that is not on our formulary, or if your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a 34-day emergency supply of that drug while you pursue a formulary exception.

If you live in a long-term care facility, then the rules about drugs are different. If you need a drug that’s not usually covered by your health plan, we will pay your costs for 34 days. During this time, you will need to ask us to include the drug in your plan. Please note that this only applies after you have been a member with us for over 90 days.

This paragraph has:

  • A 59-word sentence
  • 100% passive voice (“is limited”).
  • Health jargon that most of the population would struggle to understand unless they worked in healthcare (formulary; formulary exception).
  • A grade level of 8. This means that the reader would need over 24 years of education to understand it, which is PhD level.
  • A readability score of 22. This is well under the NAIC-recommended level of 40. It’s also more complex than the Harvard Law Review which scores 30

Now, we have:

  • 0% long sentence use
  • 0% passive voice
  • No health jargon.
  • A grade level of 4 and a readability score of 79.

In the “Before” scenario

Let’s say you’re the patient in question. You don’t understand what a formulary is. You don’t know what a formulary exception is, nor whether you need one. You’re confused. You call the number on the back of your health insurance card. You wait on hold for an hour. Finally, you speak to a Customer Service Representative who tries to explain how the condition applies to your situation. You’re tired – let’s not forget that you’re sick. Eventually, you find out that you need to apply for an exception. This requires filling out another form full of confusing medical jargon. You make an error, and the form gets returned to you.

How does this experience make you feel about your provider? How would you answer the following question as part of a CAHPS survey:

Was the information about your health plan’s coverage and benefits confusing?

I’d bet that you’re very likely to reply “yes”.

In the “After” scenario

Let’s look at the “After” scenario above. It’s written in plain language and clearly explains what you need to do. You need to ask your insurer to include the new drug in your plan. The relevant information is easily accessible on your insurer’s website. You make the request, and receive an answer within a few days.

Let’s answer the survey question again:

Was the information about your health plan’s coverage and benefits confusing?

You’re much more likely to rate your insurer higher, and report that their communications have been clear.

How health insurers can use language to improve customer experience

Plain language translates to better CAHPS ratings around member experience. This is highly rewarded by the CMS. The solution sounds so simple – use plain language to get better ratings. So why are insurers failing to prioritize clear communications?

In fairness to the industry, it’s challenging to maintain quality as content volumes rise. Each organization has hundreds of communications created each week, by a range of different teams. There are messages created by Claims teams. Customer Support replies written by Customer Service. Letters about referrals created by a patient’s Gatekeeper. Different teams create content independently, all with varying degrees of writing skills. The result is an incoherent and confusing customer experience.

Here at VisibleThread, we recognize that insurers need support from technology to manage this issue at scale. Using VisibleThread’s Language Analysis Platform, providers can measure the readability of their content to get a baseline. Insurers can then use the solution to allow writers to score and clarify their own content, enabling quantifiable improvements over time.

The hidden benefits of improving customer experience

Improving customer experience is clearly worthwhile for insurance providers. And not only for the Star Rating improvements. Prioritizing customer experience leads to more efficient operations and reduced operational costs.

Last year, we spoke to Jack Nelson, former Executive Vice President of Operations for CVS Caremark. He explained that if customers get clear communications, they will call less often. Remember the example of our long-term care resident? She ended up spending hours on the phone to her provider, resulting in unnecessary costs for both insurer and customer. Jack estimated that upfront clear communications could lead to a 10-30% reduction in Call Center volume. That adds up to significant cost savings.

Finally, customers who trust their provider feel less anxious. Plain language is the compassionate choice. It reduces confusion and builds confidence. And if you trust your insurer, you’re more likely to stay loyal. That’s great news for the customer, and for the insurer’s bottom line.

Complexity is damaging your Star Ratings


Book a Demo