CMS Chronic
Condition
Data
Warehouse
June 4, 2007
Chronic Condition Data Warehouse
Background
• Medicare Modernization Act of 2003, Section 723,
mandated a plan to “improve the quality of care and
reduce the cost of care for chronically ill Medicare
beneficiaries”
• Essential component of plan was to establish a research
database that contains fee-for-service Medicare claims
data and assessments, linked by beneficiary, across the
continuum of care
• Claims and assessment data linked to Medicare
eligibility/enrollment data
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Chronic Condition Data Warehouse
Population: 1999-2004
• Random 5% sample of Medicare beneficiaries (e.g.,
claims-based sampling methodology)
• Eligible for and enrolled in Medicare on or after January 1,
1999 through the most current period
• Health Insurance Claim (HIC) number where the eighth
and ninth digits are in the set {05, 20, 45, 70, 95}
• Qualified for 5% sample, therefore, remained part of the
ongoing CCW sample (includes ever-qualifying
beneficiaries from January 1, 1999 forward, i.e., an
enhanced or person-based 5% sample)
2
Chronic Condition Data Warehouse
Population: 2005 - Forward
• 100% Medicare beneficiaries
• Linked with historical data
• Random 5% sample flags
• Current data
3
Chronic Condition Data Warehouse
Linkage Across the Continuum of Care
• All CCW data files linked by assignment of a unique,
unidentifiable beneficiary link key for ease of analysis
across data files (unique link keys replace HIC numbers)
• Allows for cross-sectional and longitudinal research from
1999 forward
• Allows linkage across the continuum of care to construct
patient-centric views of enrollment and service utilization
• Link keys encrypted prior to delivery to the researcher, for
privacy protection
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Chronic Condition Data Warehouse
Chronic Condition Categories
Researchers may request data for 21 predefined chronic
condition categories, allowing for timely data extraction:
Acute Myocardial Infarction Chronic Obstructive Pulmonary Disease
Alzheimer's Disease, Related Congestive Heart Failure
Disorders, or Senile Dementia Diabetes
Alzheimer's Disease only Glaucoma
Atrial Fibrillation Hip/Pelvic Fracture
Cancer, Breast Ischemic Heart Disease
Cancer, Colorectal Major Depression
Cancer, Prostate Osteoporosis
Cancer, Lung Rheumatoid Arthritis/Osteoarthritis
Cancer, Endometrial Stroke/Transient
Cataract Ischemic Attack
5 Chronic Kidney Disease
Chronic Condition Data Warehouse
Key Features
• Patient-centric data files linked by unique beneficiary key, across
the continuum of care (deidentified and encrypted prior to delivery
to researcher)
• Readily available chronic condition cohorts, customized cohorts
(defined by researcher), and other categorization schemes
• Beneficiary Summary File
• Chronic Condition Summary File
• Easy to use data files designed specifically for researchers (e.g.,
limited data set, SAS® input and label statements, frequency output,
etc.)
• Services from 1999 forward
• Manageable 5% sample; 100% data for larger
subsets or samples
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Chronic Condition Data Warehouse
www.ccwdata.org
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Chronic Condition Data Warehouse
Web Site – Statistical Summaries
• Available to general public (pdf format)
• Produced by IFMC staff
• Resource for high level, summary statistics by
segmentation variables (e.g., predefined CCW chronic
conditions, utilization summary information,
demographic, and/or enrollment factors)
• Helpful for finding quick facts
• Useful with exploring sample size options
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Chronic Condition Data Warehouse
Web Site – Statistical Summaries
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Chronic Condition Data Warehouse
Statistical Summaries – Beneficiary Demographics
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Chronic Condition Data Warehouse
Statistical Summaries – Population Statistics
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Chronic Condition Data Warehouse
Statistical Summaries – Assessment data
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Chronic Condition Data Warehouse
Data Files Available Upon Request from CMS
• Enrollment/eligibility data
• Administrative claims
– Fee-for-service institutional claims for inpatient,
outpatient, skilled nursing facility, hospice, and home
health agency settings
– Fee-for-service non-institutional claims for
physician/supplier and durable medical equipment
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Chronic Condition Data Warehouse
Data Files Available Upon Request from CMS (cont.)
• Assessment data
– Minimum Data Set (MDS) - nursing facilities
– Outcome and Assessment Information Set (OASIS) -
home health agencies
– Inpatient Rehabilitation Facility Patient Assessment
Instrument (IRF-PAI)
– Swing bed data
• CCW (CMS) Denominator (100% or 5% sample)
• Beneficiary Summary File
• Chronic Condition Summary File
• Medicare Current Beneficiary Survey (MCBS)
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Chronic Condition Data Warehouse
Beneficiary Summary File
• Annual beneficiary summary file containing
demographic and enrollment data
• Includes data for beneficiaries in the requested cohort
or other specified population who were:
– Ever part of the CCW 5% sample
– Documented as being alive for some part of the
reference year
– Enrolled in Medicare Part A or B at some point
during the reference year (may also have been
enrolled in managed care)
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Chronic Condition Data Warehouse
Chronic Condition Summary File
• Summary of a beneficiary’s chronic conditions (if
any) by year
• Flag indicator for presence of a CCW condition
during that year
• Includes beneficiaries in requested cohort (or other
specified population)
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Chronic Condition Data Warehouse
Data Request Options
• Standard (e.g., based on predefined chronic condition
cohort criteria, entire 5% sample for a given year, etc.)
• Custom (e.g., researcher-defined cohort based on
demographic or clinical information such as diagnosis
or procedure codes, etc.)
• Finder file (e.g., based on known beneficiary
identifiers, etc.)
• Introductory pricing for 5% sample
17
Chronic Condition Data Warehouse
Data Delivery Options
• Data loaded to USB hard drive or DVD (no tapes!)
• Flexible for use with different operating systems (e.g.,
Windows, Linux, etc.)
• SAS read-in statements
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Chronic Condition Data Warehouse
Data Request Process
1. Researcher contacts Research Data Assistance Center
(ResDAC) and/or IFMC for assistance with data request
packet.
2. Researcher submits data request packet to CMS.
3. CMS approves data request, researcher submits payment
to CMS, and and CMS forwards approval to IFMC as
notification to fulfill request.
4. IFMC processes, encrypts, and delivers data package to
researcher.
5. Copy of data package archived.
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Chronic Condition Data Warehouse
Considerations when Requesting CCW Data
1. Consider broad criteria for predefined chronic
condition cohorts (indicating beneficiary probably
has condition of interest); may require narrowing for
analyses
2. Determine whether to restrict cohort based on
Medicare coverage criteria
3. Decide whether to include a control or comparison
group (chronic condition flags can make this simple)
4. Consider claims maturity
20
Chronic Condition Data Warehouse
CCW Chronic Condition Flags
For each chronic condition, an annual condition flag in the Chronic
Condition Summary File includes the following values:
3 = Met full coverage criteria (Part A and B, no HMO) for entire
look-back period (varies by condition) and claims diagnosis
criteria
2 = Met full coverage criteria (Part A and B, no HMO) for entire
look-back period (varies by condition) and did not meet claims
diagnosis criteria
1 = Had intermittent coverage (any partial coverage combination
of Part A or B, or HMO) for the look-back period and met
claims diagnosis criteria
0 = Had intermittent coverage (any partial coverage combination
of Part A or B, or HMO) for the look-back period and did not
meet claims diagnosis criteria
21 Note: Coverage required only up to month of death.
Chronic Condition Data Warehouse
Defining CCW Cohorts:
• Use CC Summary File flags
Example: Study diabetes health services in 2005 with
control group of non-diabetes health services
- Cohort of CC diabetes flag = 3
- Control of CC diabetes flag = 2
• Use Beneficiary Summary File variables to further define
(or supplement) cohorts using additional demographics,
partial coverage options, HMO coverage, etc.
Note: CCW does not contain managed care claims.
22
Number of Medicare Beneficiaries in 5% Sample for 2005 by Chronic Condition1
Number of Reference Period
Chronic Condition Beneficiaries2 (in years)3
Acute Myocardial Infarction 27,209 1
Alzheimer's Disease 91,626 3
Alzheimer's Disease and Related Disorders or Senile Dementia 194,726 3
Atrial Fibrillation 153,939 1
Cancer, Colorectal 15,931 1
Cancer, Endometrial 2,329 1
Cancer, Female Breast 27,250 1
Cancer, Lung 15,868 1
Cancer, Prostate 39,687 1
Cataract 550,325 1
Chronic Kidney Disease 172,604 2
Chronic Obstructive Pulmonary Disease 239,467 1
Congestive Heart Failure 349,256 2
Diabetes 461,861 2
Glaucoma 208,139 1
Hip/Pelvic Fracture 22,075 1
Ischemic Heart Disease 628,481 2
Major Depression 261,438 1
Osteoporosis 278,546 1
Rheumatoid Arthritis/Osteoarthritis 415,404 2
Stroke/Transient Ischemic Attack 113,281 1
None of the conditions 759,108
1Twenty-one chronic conditions have been predefined by CMS for timely, efficient extraction of CCW data files.
2Counts based on beneficiaries who were alive on January 1, 2005 and enrolled in Part A or Part B for at least one
month during the reference year.
23 3Reference period represents the look-back time period during which a beneficiary qualified for a condition.
Chronic Condition Data Warehouse
Types of coverage used for these analyses:
• Full 1YR (no break in coverage)
Months PtA + Months PtB – Months HMO = 24
• Partial 1YR (minimal break in coverage)
Months PtA + Months PtB – Months HMO 22
• January
PtA & PtB & no HMO in January of reference year
• July
PtA & PtB & no HMO in July of reference year
• Any
At least one month PtA or PtB
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Chronic Condition Data Warehouse
Beneficiary Demographics by Type of Coverage in 2005*
Age Full Partial January July Any
85 183,263 185,461 187,348 172,573 230,435
Race Full Partial January July Any
White 1,386,624 1,408,142 1,427,028 1,425,827 1,870,224
Black 154,508 158,329 163,980 164,216 220,950
Asian 21,192 21,715 22,198 22,779 37,313
Hispanic 31,849 33,200 35,166 35,132 53,325
N Am Native 6,907 7,023 7,143 7,300 9,209
Other 18,837 19,387 19,893 20,696 37,171
Unknow n 2,388 2,427 2,463 2,382 4,336
*Based on 5% Medicare sample.
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Chronic Condition Data Warehouse
Number of Beneficiaries with Chronic Condition(s) in 2005*
by Type of Coverage
800,000
Number of Beneficiaries
600,000
400,000
200,000
0
0** 1 2-3 4+
Number of Chronic Conditions
Full 1YR Partial 1YR July Any
* Basedon 5% Medicare sample.
**Anycoverage includes beneficiaries who may not have sufficient coverage to meet the chronic
condition diagnosis criteria.
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Chronic Condition Data Warehouse
Number of Beneficiaries with Acute Myocardial Infarction
in 2005* by Age and Type of Coverage
12,000
Number of Beneficiaries
10,000
8,000
6,000
4,000
2,000
0
85
Age (in years)
Full 1YR Partial 1YR July Any
*Based on 5% Medicare sample.
27
Chronic Condition Data Warehouse
Number of Beneficiaries with Colorectal Cancer
in 2005* by Age and Type of Coverage
7,000
Number of Beneficiaries
6,000
5,000
4,000
3,000
2,000
1,000
0
85
Age (in years)
Full 1YR Partial 1YR July Any
*Based on 5% Medicare sample.
28
Chronic Condition Data Warehouse
Number of Beneficiaries with Diabetes in 2005*
by Age and Type of Coverage
200,000
Number of Beneficiaries
150,000
100,000
50,000
0
85
Age (in years)
Full 2YR Partial 2YR Full 1YR July Any
*Based on 5% Medicare sample.
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Chronic Condition Data Warehouse
CCW Cohort Considerations:
• Effect of coverage selections varies by:
1. Demographics (e.g., age)
2. Condition
3. Look-back period
• Equal opportunity for observing diagnosis of interest in
control group as in cohort
• ResDAC/IFMC Review Board can assist with refining
selection criteria
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Chronic Condition Data Warehouse
Total Medicare Payments ($275 Billion) in 2005
by Claim Type and Number of Chronic Conditions
180
Total Medicare Payment
160
140
120
($ Billions)
100
80
60
40
20
0
0 1 2-3 4+
Number of Chronic Condition(s)
DMERC Carrier Hospice Outpatient HHA SNF Inpatient
*Includes total Medicare fee-for-service payments; extrapolated from 5% Medicare sample.
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Chronic Condition Data Warehouse
Percent of Medicare Payments* Percent of Claims*
for Beneficiaries with Diabetes in for Beneficiaries with Diabetes
2005 by Claim Type in 2005 by Claim Type
Inpatient HHA
DMERC DMERC 1% SNF 1% Outpatient
4% 9% 1%
Carrier 13%
Hospice
24% <1%
Inpatient
46%
Hospice
2%
Outpatient
12% HHA SNF
5% Carrier
7%
75%
*Includes total Medicare fee-for-service payments/claims for beneficiaries identified as having
diabetes; based on 5% Medicare sample.
32
Chronic Condition Data Warehouse
Number of Medicare Beneficiaries* with Diabetes and
Total Medicare Payment Amounts by Year
10 $113.5 $120
$102.2
Total Payment Amount
$90.3
Number of Beneficiaries
$100
8
($ Billions)
(in Millions)
$80
6
$60
4
$40
2
$20
0 $0
2003 2004 2005
Number of Beneficiaries Payment Amount
*Includes total Medicare fee-for-service payments/claims for beneficiaries identified as having
diabetes; based on extrapolation from 5% Medicare sample.
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Chronic Condition Data Warehouse
Research Potential Using CCW Data
• Supports increased need for chronic disease research as
aging population increases
• Allows longitudinal analyses of Medicare utilization,
expenditures, quality of care, and health outcomes across
continuum of care
• Provides researchers with low cost, easy-to-use data files
• Flexible data extract system allows researchers to
request only minimum data needed for studies
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Chronic Condition Data Warehouse
Potential Enhancements for CCW
• Part D enrollment and drug event data (pending federal
regulation)
• Enhanced Summary Files:
– Beneficiary Summary File
– Chronic Condition Summary File
– Condition-specific statistics in form of beneficiary-
level (deidentified) analytical file
– Care setting/timeline summary file
• SAS code for deriving denominators
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Chronic Condition Data Warehouse
Questions?
Visit these web sites for additional information!
Research Data Assistance Center
www.resdac.umn.edu
E-Mail: resdac@umn.edu
Phone: 1-888-9-ResDAC or 1-888-973-7322
Iowa Foundation for Medical Care
www.ccwdata.org
E-Mail: ccwdata@ifmc.org
Phone: 1-800-383-2856, ext. 8357
36 Visit us at AcademyHealth booth #305!