Survey Results

The Medicare Health Outcomes Survey (HOS) is an assessment of a Medicare Advantage Organization's ability to maintain or improve the physical and mental health functioning of its Medicare beneficiaries over a two-year period of time, using the best available science in functional status and health outcomes measurement. The survey is used as a way of measuring how the care provided by MAOs is affecting the functional status of their enrollees. CMS includes the HOS in their performance assessment program, e.g., HOS results are included in the CMS Five Star Quality and Performance Rating System for MAOs.

The first cohort of baseline data was collected in 1998. Beginning in 2000, both a baseline cohort and a follow up cohort were collected. During the most recent survey administration (2011 Round 14), Cohort 14 Baseline and Cohort 12 Follow Up data were collected. The most recently available results are from the 2010 Cohort 13 Baseline and the 2008-2010 Cohort 11 Performance Measurement, which combines data from the 2008 Cohort 11 Baseline and 2010 Cohort 11 Follow Up surveys. For further information, please refer to the survey administration timeline. The following table depicts general status information, including response rates, for the baseline and follow up cohorts administered to date.



UPDATED August 2011

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 MAOs sampled for the survey. However for the follow up cohorts, the reporting units have been adjusted to accommodate selected MAO 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 For the baseline cohorts, the ineligible beneficiaries meet one of the following criteria: deceased; not enrolled in the MAO; have an incorrect address and phone number; or have a language barrier. For the follow up cohorts, the ineligible beneficiaries meet one of the following criteria: not enrolled in the MAO; have an incorrect address and phone number; or have a language barrier.

⁴ In general, for Cohorts 1, 2, and 3 Baseline a completed survey is defined as a survey that has at least 80% of the questions answered. However, beginning with Cohort 1 Follow Up and Cohort 4 Baseline, a completed survey is defined as a survey that can be used to calculate physical or mental health summary scores.

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

Performance Measurement Analytic Sample

After the administration of each follow up cohort, cohort specific performance measurement results are calculated. Seniors (age 65 or older) that had a calculatable physical component summary score or mental component summary score at baseline are eligible for performance measurement. However, some of these seniors belong to MAOs 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 calculatable physical or mental health summary scores at baseline and were still enrolled in the same participating MAO 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 MAOs 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 ineligible for inclusion in the sample. These ineligible seniors are: not enrolled in the MAO; 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 for the completed cohorts to date.


UPDATED August 2011

Calculating Performance Measurement Results

A performance measurement 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 health outcomes used in the performance measurement analysis:

1. alive and physical health better;
2. alive and physical health the same;
3. dead or physical health worse;
4. mental health better;
5. mental health the same; and
6. mental health worse.

Each beneficiary is classified into one of the three physical health categories and one of the three mental health categories. In calculating expected outcomes, separate case mix models are warranted for death and for physical component summary scores and mental component summary scores. A series of six different death models (formerly eight models), three different physical health models, and three different mental health 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.

Beneficiary level results are aggregated to derive the MAO, state, and HOS national percent better, same, and worse than expected values. Outliers are those MAOs that performed significantly better (i.e., better than expected) or significantly worse (i.e., worse than expected) when compared to the national average. The national average is based on all plans that participated in performance measurement. MAOs can be outliers on a measure of physical health (which is based on death and the physical component summary score), or on a measure of mental health (which is based on the mental component summary score).

Analyses of the two-year performance measurement data have demonstrated that at the national level there is significant variation among MAOs with respect to both physical and mental health outcomes. Research has identified differences in outcomes among specific groups of beneficiaries and potential opportunities to improve care. The following table depicts the overall performance measurement results by cohort.


UPDATED August 2011

A summary of the most recently available performance measurement results may be found in a sample performance measurement report (PDF, 1.1 MB). Included in the sample report is an overview of the methodology and design followed for sampling, data collection, and the cleaning, scoring, and analysis of the HOS data files.

CMS Part C Five Star Quality and Performance Rating System

Results of the HOS survey are included as part of the Medicare Advantage (MA) Part C Five Star Ratings System that was developed by CMS. As part of the Affordable Care Act, CMS is rating the relative quality of service of MAOs and rewarding high performing plans. The star rating system helps Medicare beneficiaries compare MA plans, helps educate consumers on quality, and makes quality data more transparent and comparable between plans. Up to 53 quality measures are included in the ratings, including success in providing preventive services, managing chronic illness, access to care, Healthcare Effectiveness Data and Information Set (HEDIS®), the MA & Part D Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey, and responsiveness. Five HOS measures are included in the Part C Star Ratings System:

• Improving or Maintaining Physical Health
• Improving or Maintaining Mental Health
• Monitoring physical activity
• Improving bladder control
• Reducing the risk of falling

The 2012 MA Part C Star Ratings will be used by CMS as the basis for quality bonus payments in the MA program in the 2013 quality bonus payment year. The HOS 2008-2010 Cohort 11 Merged Baseline and Follow Up dataset is used to derive the two functional health status measures and the combined HOS 2010 Cohort 11 Follow Up and 2010 Cohort 13 Baseline dataset is used to derive the three 2010 HEDIS Effectiveness of Care measures that are incorporated into the 2012 Star Ratings used for the 2013 quality bonus payments. Beginning with the 2012 Part C Star Ratings, the Osteoporosis Testing in Older women measure has been retired. Information about the specific HOS cohorts used in the annual Part C Star Ratings is available in the Medicare HOS Survey Administration Timeline table on the Program Overview section.

Information about best practices in promoting quality preventive health care for the elderly and developing intervention strategies to impact patient outcomes are available in the 2011 MAO resource guide and 2011 technical report on the functional status of older adults that are available in the Real World Uses section. For more information about the Part C Star Ratings go to the CMS website at www.cms.gov/PrescriptionDrugCovGenIn/06_PerformanceData.asp. For any questions related to Part C MA Star Ratings, you may send an e-mail inquiry directly to PartCRatings@cms.hhs.gov. Part D MA Star Rating questions may be sent to PartDRatings@cms.hhs.gov.