About the Health Outcomes Survey
Introduction to Medicare HOS
The Centers for Medicare & Medicaid Services (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 and HOS-Modified surveys, including the selection and training of the independent survey vendors. Medicare Advantage Organizations (MAOs) and Program of All-Inclusive Care for the Elderly (PACE) organizations contract with the survey vendors to administer the surveys.
Medicare HOS Survey Administration Timeline
Each year, a random sample of Medicare beneficiaries is drawn and surveyed from each MAO that has a minimum of 500 enrollees (i.e., a survey is administered to a new baseline cohort, or group, each year). Two years later, the baseline 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 most recent HOS administration (2020 Round 23), Cohort 23 was surveyed and Cohort 21 was resurveyed using HOS 3.0. Changes in sample selection over time include the following:
Information about the HOS cohorts related to data collection and report dissemination are provided in the table below. Information about the HOS cohorts included in the Medicare Star Ratings may be found in the Star Ratings page.
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.
Medicare HOS 1.0
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, 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 first patient-reported outcomes measure in Medicare managed care and therefore remains a critical part of assessing health plan quality. The Medicare HOS 1.0 survey instrument can be downloaded from NCQA’s website (www.ncqa.org/hedis/measures/hos).
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 page. The Medicare HOS-M survey instrument can be downloaded from NCQA’s website (www.ncqa.org/hedis/measures/hos).
In the Spring of 2006 CMS implemented the Medicare HOS 2.0. The Medicare HOS 2.0 contains four major components:
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 survey instrument can be downloaded from NCQA’s website (www.ncqa.org/hedis/measures/hos). Further information about the VR-12, scoring algorithms, and documentation are available from the measure developer's website.
In the Spring of 2013, CMS implemented the Medicare HOS 2.5. The Medicare HOS 2.5 contains the following major components:
The HOS 2.5 uses the VR-12 as the core physical and mental health outcomes measures and the four HEDIS Effectiveness of Care measures are the Osteoporosis Testing in Older Women, Physical Activity in Older Adults, Management of Urinary Incontinence in Older Adults, and Fall Risk Management measures. Changes in the HOS 2.5 compared to the HOS 2.0 include the following items. As part of the Affordable Care Act, questions on race, ethnicity, sex, primary language, and disability status were updated. Depression was added to the chronic condition list. New questions also include Instrumental Activities of Daily Living (IADLs), cognitive function, memory, living arrangements, and a new rating of pain level, while questions about chest pain, shortness of breath, leg/foot problems, arthritis pain and low back pain were removed. Two questions about vision and hearing and four questions previously used for a depression screen have been replaced with new questions. The Medicare HOS 2.5 survey instrument can be downloaded from NCQA’s website (www.ncqa.org/hedis/measures/hos).
Medicare HOS 3.0
In the Spring of 2015, CMS implemented the Medicare HOS 3.0; the latest version of the HOS questionnaire. The Medicare HOS 3.0 contains the following major components:
In a formatting change from previous versions of the HOS, the new survey uses a two column layout for each page. Other modifications in the HOS 3.0 as compared with the HOS 2.5 include changes to questions about leakage of urine, osteoporosis testing in older women, sleep, and primary language spoken in the home. The Medicare HOS 3.0 survey instrument can downloaded from NCQA’s website (www.ncqa.org/hedis/measures/hos).
This page was last modified on 06/29/2021