Medicare Health Outcomes Survey Program Overview
Introduction to Medicare HOS
CMS is committed to monitoring the quality of care provided by Medicare Advantage
Organizations (MAOs). To better evaluate this care, CMS, in collaboration with the
National Committee for Quality Assurance (NCQA), launched the first Medicare managed
care outcomes measure in the Healthcare Effectiveness Data and Information Set (HEDIS
®)
in 1998. The measure includes the most recent advances in summarizing physical and
mental health outcomes results and appropriate risk adjustment techniques. This
measure was initially titled Health of Seniors, and was renamed the Medicare Health
Outcomes Survey during the first year of implementation. This name change was intended
to reflect the inclusion of people with Medicare who are disabled and under age
65 in the sampling methodology.
The HOS measure was developed under the guidance of a Technical Expert Panel (TEP)
comprised of individuals with specific expertise in the health care industry and
outcomes measurement. CMS has contracted with NCQA to support the standardized administration
of the HOS survey, including selecting, training, and certifying independent survey
vendors that the plans contract with to administer the survey.
Medicare HOS 2.0
In the spring of 2006 CMS finalized Medicare HOS 2.0. The Medicare HOS 2.0 contains
four major components:
- the Veterans RAND 12 Item Health Survey (VR-12)
- questions to gather information for case-mix and risk-adjustment
- four HEDIS® Effectiveness of Care measures
- additional health questions
Changes in HOS 2.0 from the original HOS measure (described below) include a reduction
in outcome items (from 36 items to 12 items), the removal of redundant or less useful
items (UI question; stroke complications), the addition of HEDIS
®
measures for osteoporosis testing and fall risk management, and height and weight
questions for calculation of Body Mass Index. The Medicare HOS 2.0 can be downloaded
from the
Survey Instrument
section.
Development of the Medicare HOS
In the mid-1990s, Medicare beneficiaries were joining health maintenance organizations
(HMOs) and other types of managed care organizations (MCOs) in increasing numbers.
It became apparent to CMS that the Agency needed performance reporting requirements
for Medicare managed care. CMS worked with NCQA to incorporate the Medicare population
into NCQA's HEDIS
® performance measurement set. HEDIS
®
was rapidly becoming a standard reporting requirement of purchasers in the commercial
insurance market.
The integration of the Medicare population into HEDIS
® was achieved
with the release of HEDIS
® 3.0. CMS, NCQA, and others felt there was
a need to develop additional measures for the Medicare population including an "outcomes"
measure for HEDIS
®. Traditionally, HEDIS
® contained
"process" measures that assessed interventions such as mammograms for older women
and retinal eye exams for people with diabetes. While evidence in the scientific
literature tied the measured processes or interventions to favorable patient outcomes,
there was a desire to develop an outcomes measure that captured performance across
multiple aspects of care.
CMS, NCQA, Health Assessment Lab (HAL), and performance measurement experts worked
together to develop a measure that would assess the physical functioning and mental
well being of Medicare beneficiaries over time. It was decided that this measure
should include additional items to allow for case mix adjustment, which is essential
for meaningful and valid plan-to-plan comparisons of health outcomes. The HOS measure
was approved for inclusion in HEDIS
® by the Committee on Performance
Measurement (CPM), the NCQA panel that oversees the development and evolution of
HEDIS
®.
HOS results continue to be an important part of CMS' quality improvement activities,
as current law authorizes QIOs to ensure that medical care paid for under the Medicare
program meets professionally recognized standards of health care. Section 722 of
the Medicare Prescription Drug, Improvement, and Modernization act of 2003 mandates
the collection, analysis, and reporting of health outcomes information. This legislation
also specifies that data collected on quality, outcomes, and beneficiary satisfaction
to facilitate consumer choice and program administration must utilize the types
of data collected prior to November 1, 2003. Collected since 1998, the Medicare
Health Outcomes Survey is the only patient-reported outcomes measure in Medicare
managed care and therefore remains a critical part of assessing health plan quality.
The Medicare Health Outcomes Survey-Modified (HOS-M)
The Medicare Health Outcomes Survey-Modified (HOS-M) is administered to vulnerable
Medicare beneficiaries at greatest risk for poor health outcomes. These beneficiaries
are enrolled in Program of All-Inclusive Care for the Elderly (PACE) programs. The
main goal of the HOS-M is to assess the frailty of the population in these health
plans in order to adjust plan payments.
The survey administration occurs annually according to the standard HOS timeline.
Additional information, including the HOS-M program timeline, dissemination of results,
and sample reports, may be found in the
HOS-Modified Overview section.
Medicare HOS Survey Administration Timeline
A random sample of Medicare beneficiaries is drawn from each MAO and surveyed every
spring (i.e., a baseline survey is administered to a new sample of members [cohort
or group] each year). Two years later, these same respondents are surveyed again
(i.e., follow up measurement).
Cohort 1 was surveyed in 1998 and was resurveyed
in 2000.
Cohort 2 was surveyed in 1999 and was resurveyed in 2001, and
so on. During the current HOS administration (2011 Round 14),
Cohort 14
is surveyed and
Cohort 12 is resurveyed using HOS 2.0. Changes in sample
selection over time include the following:
- For data collection years 1998-2006, the MAO baseline sample size was one thousand.
Effective 2007, the MAO baseline sample size is increased to twelve hundred.
- For data collection years 1998-2008, a member was required to be continuously enrolled
in their MAO for a six month period for inclusion in the baseline sample. Effective
2009, the six month enrollment requirement is waived.
- For data collection years 1998-2009, beneficiaries with End Stage Renal Disease
(ESRD) were excluded. Effective 2010, those with ESRD are no longer excluded.
Information about the HOS cohorts related to data collection, report dissemination,
and results included in the CMS MA Part C Five Star Quality and Performance Ratings
are provided in the table below. Note that the 2012 star ratings are based on data
collected in 2010 and reported in 2011 (yellow sections in the table). The 2013
star ratings are based on data collected in 2011 and reported in 2012 (green sections
in the table). Additional information about the star ratings may be found in the
Survey Results section.
|
|
|
|
|
2013
|
Cohort 16
|
Cohort 14
|
Cohort 15
|
Cohort 13
|
2009-2011 Cohort 12
|
2011 Cohort 14 Baseline &
2011 Cohort 12 Follow Up
|
|
2012
|
Cohort 15
|
Cohort 13
|
Cohort 14
|
Cohort 12
|
2008-2010 Cohort 11
|
2010 Cohort 13 Baseline &
2010 Cohort 11 Follow Up
|
|
2011
|
Cohort 14
|
Cohort 12
|
Cohort 13
|
Cohort 11
|
2007-2009 Cohort 10
|
2009 Cohort 12 Baseline &
2009 Cohort 10 Follow Up
|
|
2010
|
Cohort 13
|
Cohort 11
|
Cohort 12
|
Cohort 10
|
2006-2008 Cohort 9
|
2008 Cohort 11 Baseline &
2008 Cohort 9 Follow Up
|
|
2009
|
Cohort 12
|
Cohort 10
|
Cohort 11
|
Cohort 9
|
2005-2007 Cohort 8
|
2007 Cohort 10 Baseline &
2007 Cohort 8 Follow Up
|
|
2008
|
Cohort 11
|
Cohort 9
|
Cohort 10
|
Cohort 8
|
|
|
|
2007
|
Cohort 10
|
Cohort 8
|
Cohort 9
|
Cohort 7
|
|
|
|
2006
|
Cohort 9
|
Cohort 7
|
Cohort 8
|
Cohort 6
|
|
|
|
2005
|
Cohort 8
|
Cohort 6
|
Cohort 7
|
Cohort 5
|
|
|
|
2004
|
Cohort 7
|
Cohort 5
|
Cohort 6
|
Cohort 4
|
|
|
|
2003
|
Cohort 6
|
Cohort 4
|
Cohort 5
|
Cohort 3
|
|
|
|
2002
|
Cohort 5
|
Cohort 3
|
Cohort 4
|
Cohort 2
|
|
|
|
2001
|
Cohort 4
|
Cohort 2
|
Cohort 3
|
Cohort 1
|
|
|
|
2000
|
Cohort 3
|
Cohort 1
|
Cohort 2
|
|
|
|
|
1999
|
Cohort 2
|
|
Cohort 1
|
|
|
|
|
1998
|
Cohort 1
|
|
|
|
|
|
* Four HEDIS Effectiveness of Care Measures collected by HOS are calculated
from the combined round of baseline and follow up data by reporting year: Management
of Urinary Incontinence in Older Adults; Physical Activity in Older Adults; Fall
Risk Management; and Osteoporosis Testing in Older Women. Beginning with the 2012
Part C Star Ratings, the Osteoporosis Testing in Older Women measure has been retired.
Medicare HOS Glossary
Medicare HOS Glossary (PDF, 100 KB).
This glossary of HOS related terms, which has previously been included in the annual
HOS baseline and performance measurement reports, is available for download from
this section.