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Medicare Health Outcomes Survey Results

The Medicare Health Outcomes Survey (HOS) is an assessment of a health plan's ability to maintain or improve the physical and mental health functioning of its Medicare beneficiaries over a two-year period of time. It was implemented nationally in May 1998. In 1998 and 1999, baseline data were collected (Cohort I Baseline and Cohort II Baseline, respectively). Beginning in 2000, both a baseline cohort and a follow up cohort were collected. In 2004, Cohort VII Baseline and Cohort V Follow Up data were collected. For further information, please refer to the survey administration timeline.

Each year a Baseline Report and a Performance Measurement Report are produced for each Medicare + Choice Organization (M+CO) participating in the Medicare HOS. Each participating M+CO receives a plan specific baseline and/or performance measurement reports which present results for their plan, the state total, and the HOS national total. Additionally, each state's Quality Improvement Organization (QIO) receives a state specific baseline and/or performance measurement report which presents results for all plans in their state, the state total, and the HOS national total.

Plans and QIOs should note that the report distribution process of the Medicare Health Outcomes Survey (HOS) has changed. Effective Fall 2003, hard copy reports are no longer distributed. Instead, all distribution occurs electronically to participating plans through the Health Plan Management System (HPMS) and to participating QIOs through the QualityNet Exchange application. Plans require an HPMS User ID to access the HPMS. Plans should contact their CMS Quality Point of Contact to obtain access to their HOS reports. If assistance is required regarding HPMS access, please contact Neetu Jhagwani (410-786-2548) or Don Freeburger (410-786-4586) at CMS.

The following table depicts general status information, including response rates, for the baseline and follow up cohorts administered to date.

UPDATED SEPTEMBER 2004.

¹ Over the course of time, the refinement of the HOS measure has resulted in changes to the definition of a "completed survey." The information in the table provides a presentation of how a completed survey and response rate were calculated at the time of reporting for each of the baseline and follow up cohorts. Given that the definition of a completed survey has evolved over time, this table should not be utilized for response rate comparisons across the cohorts. If you are interested in comparative response rate information, please contact the Medicare HOS Information and Technical Support Line.

² For the baseline cohorts, the reporting units represent the individual plans sampled for the survey. However for the follow up cohorts, the reporting units have been adjusted to accommodate selected plan consolidations and service area reductions at the time of performance measurement reporting (which typically occurs in the year subsequent to the collection of the follow up data).

³ Invalid beneficiaries meet one of the following criteria: deceased; not enrolled in the M+CO; have an incorrect address and phone number; or have a language barrier.

⁴ In general, for Cohorts I, II, and III Baseline a completed survey is defined as a survey that has at least 80% of the questions answered. However, beginning with Cohort I Follow Up and Cohort IV Baseline, a completed survey is defined as a survey with a calculatable SF-36® PCS and/or MCS score.

⁵ Please note, invalid beneficiaries are removed from the denominator in the response rate calculations. In other words, Response Rate = [Number of Respondents/(Total Sample - Invalids)].

Medicare HOS Baseline Reports

After the administration of each baseline cohort, a cohort specific baseline report is produced. The baseline reports present SF-36® Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. The scores are case mix adjusted using demographics, chronic medical conditions, and HOS study design variables. The baseline reports also provide plan, state, and HOS national information on health status indicators and demographics (including a comparison between respondents and non-respondents). A sample baseline report (PDF, 2.1 MB) is available for download.

After baseline reports have been distributed to the participating M+COs and QIOs, beneficiary level data are disseminated electronically to all participating QIOs. The electronic dissemination occurs through the secure QIO QualityNet Exchange application. Each QIO receives a beneficiary level SAS data set comprised of data from all beneficiaries surveyed in the QIO's state. In addition to the SAS data set, each QIO is provided with a data user's guide that describes the Medicare HOS file specifications and the appropriate use of Medicare HOS data. Baseline QIO Data User's Guides are available for download.

Medicare HOS Performance Measurement Reports

After the administration of each follow up cohort, a cohort specific performance measurement report is produced. Seniors (age 65 or older) that had a calculatable PCS and/or MCS score at baseline are eligible for performance measurement. However, some of these seniors belong to plans that went out of business or discontinued offering managed care between the baseline and follow up samples. Therefore, the Performance Measurement Analytic Sample is limited to those seniors who had a calculatable PCS and/or MCS score at baseline and were still enrolled in the same participating M+CO at the time of follow up. Seniors who become deceased between baseline and follow up are classified as "dead" for purposes of performance measurement. Additionally, a certain number of seniors will voluntarily disenroll from their plans between baseline and follow up. These seniors are classified as "voluntarily disenrolled" for purposes of performance measurement. Of the seniors sampled at the time of follow up, a certain percentage will be determined to be invalid for inclusion in the sample. These invalid seniors are: not enrolled in the M+CO; have an incorrect address and phone number; or have a language barrier. Of the seniors eligible for inclusion in follow up, those that do not return a completed survey are designated as "non-respondents" and those that do return a completed survey are referred to as "respondents." The following table depicts the distribution of the Performance Measurement Analytic sample presented in all performance measurement reports to date.

UPDATED SEPTEMBER 2004.

A performance measurement report data set is created by merging a cohort's baseline and follow up data. Additionally, death information is incorporated into the performance measurement data set for those baseline respondents who died between baseline and follow up. The HOS performance measurement results are computed using a rigorous case mix/risk adjustment model. There are six main categories of actual outcomes used in the performance measurement analysis: (1) alive and PCS better; (2) alive and PCS same; (3) dead or PCS worse; (4) MCS better; (5) MCS same; and (6) MCS worse. Each beneficiary is classified into one of the three Physical Health (PCS) categories and one of the three Mental Health (MCS) categories. In calculating expected outcomes, separate case mix models are warranted for death (which requires extensive case mix control), and for PCS and MCS (which do not require much case mix control). A series of eight different death models, three different PCS models, and three different MCS models are used, since all beneficiaries do not have data for all of the independent variables that could be used to calculate an expected score. In other words, each expected outcome for a beneficiary is derived from the best fit model, which is based on those variables for which the beneficiary has data. One model is used for each beneficiary, and there are no predictions made with missing data. The beneficiary level results are then aggregated to derive the plan, state, and HOS national percent better, same, and worse than expected values. A sample performance measurement report (PDF, 2.0 MB) is available for download. The following table depicts the overall performance measurement results by cohort.

UPDATED SEPTEMBER 2004.

After performance measurement reports have been distributed to the participating QIOs, beneficiary level performance measurement data are disseminated electronically to all participating QIOs. As occurs with the baseline data, the electronic dissemination of performance measurement data to the QIOs occurs through the secure QIO QualityNet Exchange application. In addition to the data files, each QIO is provided with a data user's guide that describes the Medicare HOS file specifications and the appropriate use of Medicare HOS performance measurement data. Performance Measurement Electronic Data User's Guides are available for download. In addition to the QIO data dissemination, performance measurement data are distributed to participating M+COs. For additional information on the dissemination of performance measurement data to M+COs, please contact the Medicare HOS Information and Technical Support Line.

Medicare HOS Reports were distributed to participating M+COs and QIOs on the following dates:

BASELINE REPORTS:

• Cohort I Baseline Report: May 1, 1999
• Cohort II Baseline Report: March 1, 2000
• Cohort III Baseline Report: March 30, 2001
• Cohort IV Baseline Report: June 5, 2002*
• Cohort V Baseline Report: June 26, 2003*
• Cohort VI Baseline Report: July 27, 2004 to QIOs via QNE and September 2004* to participating plans via CMS' HPMS

PERFORMANCE MEASUREMENT REPORTS:

• Cohort I Performance Measurement Report: November 30, 2001*
• Cohort II Performance Measurement Report: September 23, 2002*
• Cohort III Performance Measurement Report: August 21, 2003 to QIOs and October 2003* to participating plans via CMS' HPMS
• Cohort IV Performance Measurement Report: August 17, 2004 to QIOs via QNE and September 2004* to participating plans via CMS' HPMS

* Available in CMS' HPMS

Medicare HOS Data were distributed to participating QIOs on the following dates:

BASELINE DATA:

• Cohort I Baseline Data: June 30, 1999
• Cohort II Baseline Data: April 15, 2000
• Cohort III Baseline Data: June 1, 2001
• Cohort IV Baseline Data: August 6, 2002
• Cohort V Baseline Data: April 22, 2004

PERFORMANCE MEASUREMENT DATA:

• Cohort I Performance Measurement Data: April 5, 2002
• Cohort II Performance Measurement Data: January 27, 2003
• Cohort III Performance Measurement Data: May 5, 2004

Participating M+COs were notified of the availability of Medicare HOS data on the following dates:

PERFORMANCE MEASUREMENT DATA:

• Cohort I Performance Measurement Data: December 13, 2002
• Cohort II Performance Measurement Data: December 13, 2002
• Cohort III Performance Measurement Data: May 12, 2004

The following sample Medicare HOS Reports are available for download:

• Sample Baseline Report (PDF, 2.1 MB)
• Sample Performance Measurement Report (PDF, 2.0 MB)

Continue on to the HOS Publications section.