The Medicare Health Outcomes Survey

Assessing Quality of Care of Medicare Managed Care Health Plans and Frailty Adjustment Using the Medicare Health Outcomes Survey and the Medicare Health Outcomes Survey-Modified Academy Health Annual Research Meeting June 3, 2007 Panelists: Vijit Chinburapa, PhD, CPHQ, HSAG Judy Ng, PhD, NCQA Lewis Kazis, ScD, Boston University Sean Creighton, MSc, CMS Nancy Kenly, MPA, CMS Galina Khatutsky PhD Candidate, RTI International The Medicare Health Outcomes Survey (HOS) and the Medicare Health Outcomes Survey-Modified (HOS-M): Introduction Vijit Chinburapa, PhD, CPHQ Health Services Advisory Group Medicare HOS      The Medicare HOS assesses each Medicare Advantage (MA) plan's ability to maintain or improve the physical and mental health functioning of its Medicare beneficiaries over a two-year period Gather valid and reliable health status data in Medicare managed care for quality improvement activities, public reporting, plan accountability, and improving health outcomes Launched in 1998 – currently completing 10th year of survey administration First Medicare managed care outcomes measure More than 2 million beneficiaries surveyed to date 3 HOS Version 1 (HOSv1) 1998-2005        36-item health status measure  Eight scales  Physical and Mental Component Summary Scores (PCS and MCS) Activities of daily living (ADLs) Healthy days Clinical symptoms Chronic medical conditions Depression screen Demographics 4 HOS Version 2 (HOSv2) 2006 - Present    12-item health status measure (VR-12)  PCS and MCS Two additional HEDIS® measures  Osteoporosis Testing in Older Women (OTO)  Fall Risk Management (FRM) Height and weight for BMI 5 Sampling Methodology     National survey Baseline cohort of 1,000 beneficiaries randomly sampled from each participating plan Mailed survey  Telephone follow-up of non-respondents Longitudinal: MA members surveyed at baseline, and respondents resurveyed two years later  Each cohort comprises respondents from one baseline and the associated follow-up 6 Medicare HOS Response Rates Sampling MA Time Period Reporting Units Baseline 161 - 312 Cohort 1 - 8 Follow-up Cohort 1 - 6 Sample size Response Rates 159,31161.4% - 71.6% 301,184 69,86589,332 146 - 188 77.1% - 85.8% 7 National Baseline Mean Unadjusted PCS and MCS Scores Medicare HOS Surveys:1998-2005* 60.0 52.6 52.3 52.1 51.6 51.6 51.6 51.8 51.7 50.0 40.0 30.0 20.0 10.0 0.0 41.4 40.7 40.3 42.0 42.0 42.0 41.8 41.6 1998 1999 2000 2001 2002 2003 2004 2005 PCS MCS *1998-2000 scores were normalized based on 1990 US general population 2001 –2005 scores were normalized based on 1998 US general population 8 Medicare HOS Performance Measurement Results Years MA Reporting Units 188 160 146 152 PCS Better None 9 plans 20 plans 22 plans PCS Worse None 5 plans 1 plan 1 plan MCS Better 13 plans 8 plans 15 plans None MCS Worse 15 plans 5 plans 4 plans None 1998 -2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 153 154 21 plans None None None 27 plans 18 plans 3 plans 2 plans 9 Medicare HOS-M     The HOS-M, a modified version of the HOS, was fielded for the first time in the spring of 2005 The survey is administered to vulnerable Medicare beneficiaries who are enrolled in specialized Medicare plans The goal is to assess the frailty of the population in these specialized plans in order to adjust Medicare payments The survey includes 12-item physical and mental health status questions as well as limitations and assistance with activities of daily living (ADLs) 10 Additional Information HOS Web Site • www.hosonline.org HOS Technical Support • Medicare HOS Information and Technical Support Telephone Line: 1-888-880-0077 • E-Mail: hos@azqio.sdps.org 11