Accomplishments to Date, Challenges Ahead

Most of the Aligning Forces communities did not have efforts in place to measure patient experience with ambulatory care before the launch of the AF4Q program. Since that time, the Alliances have made great strides in working with stakeholders to help them understand the value of such efforts, and many have succeeded in convincing practices to survey patients for the first time. AF4Q has helped the industry reach a “tipping point” toward the widespread use and adoption of CG-CAHPS as the national standard for this type of survey.

However, since AF4Q’s launch, the national landscape related to surveys of patient experience with ambulatory care has evolved in response to changing external requirements. While the leveraged strategy may still face some challenges because of the various versions of the survey currently in use, continued progress toward a national standard will make this approach more feasible. Many major survey vendors have begun to shift their use of the Visit Survey because of several forces on the national stage—such as the Centers for Medicare & Medicaid Services and the National Committee for Quality Assurance—that now favor a version of the survey that asks about care retrospectively over a period of six or 12 months. Over time, the leveraged strategy will continue to highlight the growing demand for alignment in survey requirements.

Looking ahead, various factors will affect the sustainability of both centralized and decentralized efforts to implement community-wide measurement and reporting of CG-CAHPS scores, including:

  • External reporting requirements for pay-for-performance, public reporting, and certification.[1]
  • Collaboration of stakeholders to leverage the economies of scale of community-wide efforts to share financing.
  • The degree of success achieved by efforts to align survey requirements in order to reduce duplication of effort and minimize the burden on survey sponsors.[2]
  • Physician and health system buy-in to (and acceptance of) the value of measuring patient experience.

The strength of ongoing consumer demand for an improved patient experience.

[1] Further information about these external requirements is in Forces Driving Implementation of the CAHPS Clinician & Group Survey, available at:

[2] An updated brief on the evolving landscape of CG-CAHPS, including practical guidance for navigating multiple reporting requirements, is currently in production with the AF4Q National Program Office.