Medicare Health Outcomes Survey

Summer 2016 HOS Newsletter
Volume 5, Issue 2

Summer
Welcome

Welcome to the latest edition (Summer 2016) of our Medicare Health Outcomes Survey (HOS) Newsletter. Over 900 individuals now receive this newsletter, designed to provide general updates about the HOS Program. This issue and previous issues are available on the HOS website. 

As always, we encourage all Medicare Advantage Organizations (MAOs) and other stakeholders to send suggestions and ideas for future editions to hos@HCQIS.org. Please let us know what information would be helpful to you. We also invite and welcome any best practices that your organization would like to share.
What's New

New Continuing HOS Website Refresh

The HOS Website refresh continues with design and navigation enhancements to the HOS website including reorganization of the pages and content. The main pages of the website are now designed to be grouped by user interests as well as by content type. In this way, MAOs, survey vendors, researchers, beneficiaries, and members of the general public will be able to find relevant information grouped by their varying interests.

New Resource for Cancer Researchers

In partnership with the National Cancer Institute, the SEER-MHOS links two large population-based sources of data that provide detailed information about elderly persons with cancer. The data come from the HOS and the Surveillance, Epidemiology, and End Results (SEER) program of cancer registries that collect clinical, demographic, and cause of death information for persons with cancer. Because the linked SEER-MHOS data resource presently available includes fourteen cohorts of HOS data, it is a rich source of longitudinal information. New algorithms have been made available to bridge the SF-36® scales with the VR-12 scales. The SEER-MHOS website includes more information and a link to request a copy of the full report supplement and SAS code for generating the adjusted scale scores.
HOS Timeline

Timelines HOS 2016 Administration Cycle

Fielding of the 2016 HOS Administration for the Medicare HOS and HOS-M recently ended. Information about the 2016 HOS Administration protocols, questionnaires, and survey vendor notifications is available in the HEDIS® 2016, Volume 6: Specifications for the Medicare Health Outcome Survey in the Methodology section on the HOS website.

HOS Reports Now Available

The most recent HOS reports available are:
  • 2015 Cohort 18 Baseline Reports
  • 2013-2015 Cohort 16 HOS Performance Measurement Reports
  • 2015 HOS-M Reports
Registered Health Plan Management System (HPMS) users should have access to these reports through the HPMS. If you require assistance about accessing reports in the HPMS, please contact CMS via email at hpms_access@cms.hhs.gov. Sample reports with hypothetical data compared to actual national benchmarks are also available on the HOS website.

HOS Data Sets Now Available

The current HOS data sets now available on request by MAOs (refer to your organization's HPMS memo for details) are:
  • Data sets and accompanying Data User's Guides (DUGs) for HOS Cohorts 1-15
  • Data sets and accompanying DUGs for 2007-2015 HOS-M
The DUG included with each data set provides detailed documentation about file construction and contents for the data set. In the DUG, you will find information on methodology and design, the survey instrument, data file characteristics, data file layout by position, annotated baseline surveys, and follow up surveys, when applicable. Contact the HOS team at hos@HCQIS.org to request data for your MAO or Program of All-Inclusive Care for the Elderly (PACE) Organization. New this year, encrypted data will be distributed via secure file transfer, rather than by mailing physical media.

Medicare Star Ratings

The Medicare Part C Star Ratings include results from five contract level HOS measures: two measures of functional health and three HEDIS Effectiveness of Care measures. The HEDIS Effectiveness of Care measure Improving Bladder Control will not be reported in the 2016 or 2017 Medicare Star Ratings due to revisions to the measure; therefore, only four HOS measures will be included for these years. The first plan preview period for the 2016 Medicare Star Ratings was in August 2016, and the second preview period occurs in September 2016; the exact dates are announced in HPMS memos. The 2016 Medicare Star Ratings are scheduled to go live on the Medicare Plan Finder in early October 2016. Information about the Medicare Star Ratings is published on the CMS website.

Functional Health (Outcome) Measures:

These measures are longitudinal. They are obtained from the same cohort of people, surveyed at baseline and two years later at follow-up. 
  • Improving or Maintaining Physical Health 
  • Improving or Maintaining Mental Health
Effectiveness of Care (Process) Measures:

These measures are cross-sectional, from a single round. They are obtained from data for the baseline cohort, combined with the data from the follow up cohort in the same survey year. 
  • Monitoring Physical Activity 
  • Reducing the Risk of Falling 
The 2017 Medicare Star Ratings will be used to set the 2018 quality bonus payments. The green highlighted sections of the table below depict the relationship between these data collection and reporting periods. The 2016 Medicare Star Ratings will be used to set the 2017 quality bonus payments as indicated in the yellow highlighted sections of the table. The 2016 Medicare Star Ratings data are from the Cohort 15 Improving or Maintaining Physical and Mental Health outcome measures and the HEDIS Effectiveness of Care measures that were collected in 2014.

Medicare HOS Survey Administration and Part C Star Ratings Timeline

HOS Timelines for Summer 2016 Issue  
Of Note

Of Note Spotlight on New HOS Research Presented at the June 2016 Academy Health Research Meeting

A recently completed study examined the properties of a potential measure of success in limiting weight gain in enrolled Medicare beneficiaries. The study, presented at the Academy Health meeting, described an estimate of the effect of loss-to-follow-up on the measure and assessed the need for case-mix adjustment. The study also assessed the construct validity and identified geographic and beneficiary characteristics associated with performance on the measure. Passing the unadjusted Limiting Gain in BMI measure translates into limiting weight gain over two years to about 6 pounds, depending on height. The single most important case-mix adjuster that predicted passing the measure was baseline weight status-- beneficiaries who were normal weight were at highest risk of weight gain whereas beneficiaries who were heaviest gained the least weight. The measure was also found to be significantly related to contemporaneous change in six physical health measures.

Spotlight on the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS)

CMS and the National Cancer Institute (NCI) have established a partnership to improve the understanding of the health-related quality of life of cancer patients and survivors enrolled in Medicare Advantage health plans. The SEER-MHOS links cancer registry data from SEER to the Medicare Health Outcomes Survey, with health-related quality of life and other patient-reported outcomes. There are over 2.1 million individuals represented in MHOS, with over 126,000 linked to SEER. 

The data have been publicly accessible since 2011, and we recently received our 53rd unique data use agreement (DUA) application. Each DUA application is reviewed by both NCI and a designated SEER Principal Investigator. A total of 24 papers have been published using data from SEER-MHOS, and they are listed on the SEER-MHOS website. One study, led by Dr. Kelly Kenzik from the University of Alabama at Birmingham, identified chronic condition clusters pre- and post-cancer diagnosis, evaluated predictors of developing clusters post-diagnosis, and explored the impact of clusters on functional impairment in older cancer survivors.[1] Cardiovascular, musculoskeletal, metabolic, and major depressive disorder risk clusters were all identified, and cluster prevalence increased from pre- to post-cancer diagnosis. Functional impairment was more prevalent in defined clusters compared to survivors with ≥2 un-clustered conditions. 

In addition, NCI made some methodologic improvements to the SEER-MHOS data resource. Given the change in the HOS to using the VR-12 in 2006, NCI supported psychometric work by Boston University (HHSN261201400530P) to develop algorithms that bridge the eight scales (general health, physical functioning, physical roles, bodily pain, vitality, social functioning, emotional roles, and mental health) of the VR-12 with the eight scales of the SF-36®. These algorithms enable analyses to pool cohorts over the SF-36 and VR-12 eras to increase statistical power. A full technical report including the algorithms is available upon request, adapted scores are now available as part of the SEER-MHOS data resource, and a manuscript outlining the effort and related issues is currently under review.[2] 

Finally, NCI has received permission from CMS to begin exploratory work examining the Part D drug benefit claims for Medicare Advantage beneficiaries present in the SEER-MHOS data linkage who elected Part D coverage. Once the next linkage is complete, NCI will be examining patterns of medication therapy associated with self-reported pain and depressive symptoms among cancer survivors. 

[1] Kenzik K, Kent EE, Martin MY, Bhatia S, Pisu M. (2016). Chronic condition clusters and functional impairment in older cancer survivors: a population-based study. Journal of Cancer Survivorship. PMID: 27229869.   http://dx.doi.org/10.1007/s11764-016-0553-4

[2] Selim A, Rogers W, Qian S, Rothendler JA, Kent EE, Kazis LE. (Under Review). A New Algorithm to Build Bridges Between two Patient-Reported Health Outcome Instruments: The MOS SF-36® and the VR-12 Health Survey.
HOS Applications

Applications Commonly Asked Questions

Some recent questions received by our Medicare HOS Information and Technical Support site include:

How will I know when the HOS (or HOS-Modified) reports are available?

The HPMS users at your MAO or PACE Organization will receive an announcement of the availability of the reports. An HPMS User ID and password are required to access the HPMS. If further assistance is required regarding HPMS access, you may contact CMS via email at hpms_access@cms.hhs.gov

How do I obtain the HOS (or HOS-Modified) data sets?

An announcement of the availability of the new data will be sent to HPMS users at your MAO or PACE Organization. Contact the HOS team via email at hos@HCQIS.org to request your data. Data sets will be formatted as Comma Separated Value (CSV) files that are accessible with MS Excel. Your organization's designated recipient will be given instructions on how to set up an account and download the data via secure file transfer. Documentation for the data file will be included.

Where can I find information regarding HOS measures in the Medicare Star Ratings?

Details regarding the HOS measures included in the Medicare Star Ratings can be found in the following documents: 
  • Medicare Part C & D Star Ratings Technical Notes 
  • Medicare Part C & D Display Measure Technical Notes  
Both documents may be downloaded from the CMS website at http://go.cms.gov/partcanddstarratings

Available Articles and Technical Reports

New HOS-related articles and technical reports are continuously added to the HOS website as they become available. We welcome the opportunity to post HOS-related, peer-reviewed articles written by MAOs. Please send published articles to hos@HCQIS.org for CMS review and approval. The following research reports were recently added:

Pandya C, Magnuson A, Dale W, Lowenstein L, Fung C and Mohile SG. (2016). Association of Falls with Health-Related Quality of Life (HRQOL) in Older Cancer Survivors: A Population Based Study. Journal of Geriatric Oncology. 2016; 7(3):201-210. Abstract available online at http://dx.doi.org/10.1016/j.jgo.2016.01.007.

Kent EE, Malinoff R, Rozjabek HM, Ambs A, Clauser SB, Topor MA, Yuan G, Burroughs J, Rodgers AB, DeMichele K. (2016). Revisiting the Surveillance Epidemiology and End Results Cancer Registry and Medicare Health Outcomes Survey (SEER-MHOS) Linked Data Resource for Patient-Reported Outcomes Research in Older Adults with Cancer. Journal of the American Geriatrics Society. 2016; 64(1):186-92. Abstract available online at http://dx.doi.org/10.1111/jgs.13888.

For a full listing of HOS-related articles in the literature and technical reports, please visit the Resources section of the HOS website. 

Medicare HOS Contacts

General Questions about
the Medicare HOS:

Contact Medicare HOS Information and Technical Support
Telephone: 1-888-880-0077
Email: hos@HCQIS.org.

Questions about the HOS Program
or Policy:

Contact the Centers for Medicare & Medicaid Services at hos@cms.hhs.gov.

Medicare HOS website:
http://www.hosonline.org
We welcome your feedback! Please email and let us know what you think!
 
To view past issues, visit http://www.hosonline.org.