HEDISHEDIS® ® MedicareMedicareHealth Outcomes Health Outcomes

SurveySurvey(HOS)(HOS)

Sonya Bowen, MSWSonya Bowen, MSWHOS Program AdministratorHOS Program Administratorsonya.bowen@cms.hhs.govsonya.bowen@cms.hhs.gov

What is the Medicare What is the Medicare HOS?HOS? HEDIS Effectiveness of Care measure HEDIS Effectiveness of Care measure

implemented by CMS in 1998implemented by CMS in 1998 Annual survey of 1,200 randomly Annual survey of 1,200 randomly

selected (non-ESRD) Medicare selected (non-ESRD) Medicare beneficiaries from EACH eligible MAO beneficiaries from EACH eligible MAO at contract levelat contract level

Collects longitudinal health status data Collects longitudinal health status data (remeasurement at 2 years)(remeasurement at 2 years)

Self-administered mail survey with Self-administered mail survey with telephone follow-uptelephone follow-up

Who must report HOS?Who must report HOS?

Required MA Contracts: Required MA Contracts: local and local and regional coordinated care plans (all regional coordinated care plans (all types), SHMO, 1876 cost (w/ open types), SHMO, 1876 cost (w/ open enrollment)enrollment)

Voluntary MA Contracts:Voluntary MA Contracts: PFFS PFFS Contract Effective Date:Contract Effective Date: On or before On or before

Jan. 1 of year preceding measurement Jan. 1 of year preceding measurement yearyear

Minimum Enrollment Threshold:Minimum Enrollment Threshold: 500 500

Note: Employer/Union, MSA, 1833 Cost, and Note: Employer/Union, MSA, 1833 Cost, and Demonstration contracts excludedDemonstration contracts excluded

Special Needs PlansSpecial Needs Plans

Prior to 2008, MA contracts with Prior to 2008, MA contracts with exclusive SNP enrollment exempt from exclusive SNP enrollment exempt from HOS (with exception of LTC demo plans HOS (with exception of LTC demo plans in HOS-M)in HOS-M)

New in 2008New in 2008– Otherwise eligible MA contracts comprised of Otherwise eligible MA contracts comprised of

one or more SNP PBP must participate in HOS one or more SNP PBP must participate in HOS – Sampled and collected at contract level, Sampled and collected at contract level,

inclusive of all SNP and/or non-SNP benefit inclusive of all SNP and/or non-SNP benefit package(s)package(s)

Goal of HOS ProgramGoal of HOS Program

Collect valid and reliable data Collect valid and reliable data that may be used to promote:that may be used to promote:

Managed Care Performance Managed Care Performance AssessmentAssessment

Quality Improvement Quality Improvement Beneficiary ChoiceBeneficiary Choice Outcomes ResearchOutcomes Research

HOS-Modified (HOS-M)HOS-Modified (HOS-M)

Shorter, modified version of HOS Shorter, modified version of HOS instrumentinstrument

Allows CMS to adjust payment for Allows CMS to adjust payment for PACE and former long term care PACE and former long term care demo plans demo plans (latter plan-type will (latter plan-type will phase into HOS in 2010)phase into HOS in 2010)

Survey ContentSurvey Content

Physical HealthPhysical HealthStatusStatus

Mental HealthMental HealthStatusStatus

Chronic MedicalChronic MedicalConditionsConditions

ClinicalClinicalSymptomsSymptoms

Activities ofActivities ofDaily LivingDaily Living

DepressionDepressionIndicatorIndicator

SmokingSmokingStatusStatus

HEDIS HEDIS Measures:Measures:UI/Falls/Phys UI/Falls/Phys

Act/OsteoAct/OsteoHealthyHealthy

DaysDays

DemographicsDemographicsHeight & Height & WeightWeight

Included HEDIS Included HEDIS MeasuresMeasures Management of Urinary Management of Urinary

Incontinence in Older AdultsIncontinence in Older Adults Physical Activity in Older AdultsPhysical Activity in Older Adults Fall Risk ManagementFall Risk Management Osteoporosis Testing in Older Osteoporosis Testing in Older

WomenWomen

HOS Outcome MeasureHOS Outcome Measure % whose physical and mental health % whose physical and mental health

improved over two years;improved over two years; % whose physical and mental health % whose physical and mental health

remained the same over two years; and,remained the same over two years; and, % whose physical and mental health % whose physical and mental health

declined over two years.declined over two years.

* All numbers are case-mix and risk * All numbers are case-mix and risk adjusted for valid comparison between adjusted for valid comparison between health plans.health plans.

How does CMS use How does CMS use HOS results?HOS results? Monitor health plan performanceMonitor health plan performance Reward top performing plans with Reward top performing plans with

regulatory reliefregulatory relief Construct a frailty adjustor for Construct a frailty adjustor for

payment purposes (HOS-M)payment purposes (HOS-M) Inform agency programs and Inform agency programs and

priorities (e.g., health care priorities (e.g., health care disparities, disease management, disparities, disease management, disabled)disabled)

How do MAOs and How do MAOs and QIOs use HOS results?QIOs use HOS results? Identify opportunities to improve careIdentify opportunities to improve care Target quality improvement activities Target quality improvement activities

and resources using HOS toolsand resources using HOS tools– Beneficiary level data and data user Beneficiary level data and data user

guidesguides– Summary level Baseline Profile & 2-Year Summary level Baseline Profile & 2-Year

Performance Measurement (PM) reportsPerformance Measurement (PM) reports– HOS technical supportHOS technical support– Best practice & applied research resultsBest practice & applied research results

Annual Survey Annual Survey AdministrationAdministration

Notify eligible MAOsNotify eligible MAOs Nov-DecNov-Dec

Finalize survey specificationsFinalize survey specifications Dec-JanDec-Jan

MAOs contract with HOS MAOs contract with HOS vendorsvendors

JanuaryJanuary

Train & certify HOS vendorsTrain & certify HOS vendors FebruaryFebruary

Baseline & Follow-Up Baseline & Follow-Up samplingsampling

MarchMarch

Field Baseline surveyField Baseline survey April-JuneApril-June

Field Follow Up surveyField Follow Up survey May-JulyMay-July

Survey data submissionsSurvey data submissions Aug-SeptAug-Sept

Test, clean, & score dataTest, clean, & score data Sept-DecSept-Dec

HOS Data ReportingHOS Data Reporting

Baseline Data AnalysisBaseline Data Analysis JanuaryJanuary

PM Data AnalysisPM Data Analysis Feb-Feb-MarchMarch

Baseline Report ProductionBaseline Report Production Feb-MayFeb-May

PM Report ProductionPM Report Production Apr-JuneApr-June

Baseline Report ReleaseBaseline Report Release MayMay

Baseline Data Release (QIOs Baseline Data Release (QIOs only)only)

JuneJune

PM Report ReleasePM Report Release JulyJuly

PM Data Release (MAOs & PM Data Release (MAOs & QIOs)QIOs)

AugustAugust

HOS ResourcesHOS Resources

Email: Email: hos@cms.hhs.govhos@cms.hhs.gov Web: Web: www.hosonline.orgwww.hosonline.org Technical support for end-users Technical support for end-users

Email: Email: hos@azqio.sdps.orghos@azqio.sdps.org

Toll Free: (888) 880-0077Toll Free: (888) 880-0077