Fall 2022 HOS Newsletter
Volume 11, Issue 2
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Welcome to the Fall 2022 edition of the Medicare Health Outcomes Survey (HOS) Newsletter. As announced in Volume 11, Issue 1, the newsletter is now published in the Spring and Fall to align more closely with the survey administration schedule and the release of survey results. This newsletter continues to provide general information and updates about the HOS Program and is shared with everyone who requests it. This issue and all previous issues are available on the HOS website.

The newsletter is intended to help you understand the HOS and use the reports and data generated by the survey to improve the health of Medicare Advantage Organization (MAO) enrollees, inform quality improvement activities, and contribute to research that benefits public health. We are always interested in hearing about additional topics that are of interest to you, and we encourage MAOs and other stakeholders to send suggestions and ideas to hos@hsag.com.
What's New
In 2022, the Centers for Medicare & Medicaid Services (CMS) continued efforts to review, revise, and refine the HOS in order to better meet the needs of people with Medicare, quality improvement efforts of MAOs, and researchers seeking to improve the health of older adults. Information gathered by the HOS is part of CMS’s authority to collect various types of quality data under section 1852(e) of the Social Security Act (the Act). CMS uses this information to monitor quality and to help beneficiaries compare and make choices about enrolling in a health plan.

Survey Administration in 2022
The 2022 HOS and HOS-Modified (HOS-M) are fielded from July to November 2022, as detailed in the annual HOS Survey Administration Memo and HOS-M Survey Administration Memo. Each year, CMS makes the memos available on the Health Plan Management System (HPMS) and the HOS website to provide important information about the annual survey administration requirement, including plan reporting, contracting with survey vendors, and the sampling process.

The list of 2022 CMS-Approved Survey Vendors and PowerPoint slides that were used during annual training for new and returning survey vendors in May 2022 are also available on the HOS website. The most recent HEDIS® Volume 6: Technical Specifications for the Medicare Health Outcomes Survey manuals are available at no cost from the NCQA Store (https://store.ncqa.org/hedis-quality-measurement/hedis-specifications-for-the-medicare-health-outcomes-survey.html). Copies of older editions of HEDIS publications may be obtained by calling NCQA Customer Support at 1-888- 275-7585.

Copies of the HOS and HOS-M survey instruments are also available for download from NCQA’s website (www.ncqa.org/hedis/measures/hos). Those interested in using the HOS and HOS-M survey instruments or questions from either instrument must submit a Survey Use Application and signed Terms of Use to NCQA (hos@ncqa.org). For more information on the permitted uses of the HOS and HOS-M survey instruments, or to download the Survey Use Application and Terms of Use, visit NCQA’s website.

Results Reporting in 2022
Results from the HOS Round 24 survey (Cohort 24 Baseline and Cohort 22 Follow-Up) that was fielded in 2021, were reported in 2022. The 2019-2021 Cohort 22 Performance Measurement Report and the Round 24 HEDIS HOS Effectiveness of Care Report (HEDIS HOS Report) were released in July 2022. The annual Performance Measurement Report and HEDIS HOS Report are released concurrently, which allows MAOs to simultaneously review their HEDIS process measure results and HOS Performance Measurement outcome results. Eligible MAOs are also able to request their member-level Performance Measurement data with their reports. These data are released together so that MAOs can target strategies to improve the health of their members and track contract level progress and improvement. Both reports include MAO, state, region, and national results; trend results over three rounds of data; and summaries of evidence-based interventions for improving health outcomes.

The Cohort 24 Baseline Reports were released in November 2022 to eligible participating MAOs. The annual Baseline Report provides plan-level cross-sectional information about the health of respondents, as well as benchmark comparisons to other plans and to the HOS total respondent population. While member-level Baseline data are not released until after the cohort is complete, the Baseline Reports can be very useful in identifying areas where plans can target quality improvement efforts that address specific needs of their membership. Plan-level results are also trended across the three most recent years to help MAOs identify areas where plan membership is doing well and to identify weaknesses the plan can address to improve the health of all enrollees. Plans are encouraged to make effective use of their Baseline Reports to devise focused health improvement strategies in identified areas that can be applied to their whole membership.

In addition to tables providing the distribution of case-mix adjusted PCS and MCS percentile scores, the annual Baseline Report now includes tables reporting the results of the Physical Functioning Activities of Daily Living (PFADL) measure.

The 2021 HOS-M Reports will also be released to participating Program of All-Inclusive Care for the Elderly (PACE) organizations in November 2022.

For Researchers
Several types of Medicare HOS data files are available for research purposes. Medicare HOS data files are available as research identifiable files (RIFs), limited data sets (LDSs), and public use files (PUFs). A signed Data Use Agreement (DUA) with CMS is required to obtain either LDS or RIF data files. De-identified HOS Public Use Files (PUFs), beginning with Cohort 1, are available without a DUA and may be downloaded directly from the HOS website. The PUFs exclude all individually identifying information and aggregate demographic categories such as race and age. The PUF data are available for download in the CSV format that does not require specific import software. The Research Data Files page has more information about the PUFs.

Of note to investigators requesting RIFs, the identification numbers assigned to people with Medicare have been changed as part of an overall effort to better ensure privacy. To this end, Social Security Numbers (SSN) are no longer used, and an alphanumeric Medicare Beneficiary Identifier (MBI) number has been issued to everyone with Medicare. The Health Insurance Claim (HIC) number, based on the SSN, was the member-level identifier used for HOS data from 1998-2019. The timeline of MBI introduction into the HOS and the transition away from HIC numbers is as follows:
  • 2017-2019 Cohort 20 Analytic data was the first cohort that contained the MBI at follow up; included baseline and follow up HIC; and only baseline SSN.
  • 2018-2020 Cohort 21 Analytic data had the MBI at follow up; baseline and follow up HIC; and baseline SSN.
  • 2019-2021 Cohort 22 Merged data had only baseline and follow up MBI. The HIC number and SSN were no longer included.

Beginning in 2020, the HIC number has been removed from all new rounds of HOS data and only the MBI is retained.
HOS Timeline
HOS 2022 Administration Cycle
This year’s fielding of the Medicare HOS and HOS-M ran from July 18, 2022 through October 31, 2022, and survey vendors were required to submit final data to CMS no later than November 12, 2022. Information about the 2022 data collection dates can be found on the Program Timeline page. Additional information about survey administration protocols, the survey instrument, and mailing materials can be found on the Survey Administration page of the HOS website.

HOS Reports
The most recent reports available are:
  • 2019-2021 HOS Cohort 22 Performance Measurement Report
  • 2021 HEDIS HOS Effectiveness of Care Report
  • 2021 HOS Cohort 24 Baseline Report
  • 2021 HOS-M Report

Registered HPMS users have access to these reports through the HPMS site. Information about how you can get access to HPMS is available on the CMS site. If you require assistance accessing reports in HPMS, please contact CMS via email at hpms_access@cms.hhs.gov.

HOS Data Sets
Current HOS data sets are now available that provide beneficiary-level HOS survey responses for each participating MAO. Eligible MAO recipients (refer to the HPMS memo for details) may request their HOS data sets. The data sets currently available to request are:
  • HOS Cohorts 1–22 and accompanying Data Users Guides (DUGs)
  • HOS-M 2007–2021 and accompanying DUGs

The DUG included with each data set provides detailed documentation about the file structure and the data set contents. 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.

The HOS website also provides downloadable sample Baseline, HOS-M, HEDIS HOS, and Performance Measurement Reports with actual aggregate national benchmark data compared to example plan data. These sample reports are found in the Sample Reports section on the Publications and Resources page.

Contact the HOS Team at hos@hsag.com to request data for your MAO or PACE organization. Encrypted data are distributed to eligible recipients via secure file transfer.
Medicare Star Ratings
The measures used to calculate 2023 Medicare Part C Star Ratings include results from the contract-level HEDIS Effectiveness of Care measures. Plan preview periods for the 2023 Medicare Star Ratings were provided in August 2022 and September 2022. The 2023 Medicare Star Ratings have been available on the Medicare Plan Finder since October 2022. Information about the Medicare Star Ratings is published on the CMS website.

Functional Health (Outcome) Measures:
These HOS measures are longitudinal. Data are obtained from the same cohort of beneficiaries who are surveyed at baseline and again two years later at follow-up.
  • Improving or Maintaining Physical Health
  • Improving or Maintaining Mental Health
  • Physical Functioning Activities of Daily Living

Effectiveness of Care (Process) Measures:
These HEDIS HOS measures are cross-sectional. Data are collected from all survey respondents (baseline and follow up) in a single survey year.
  • Monitoring Physical Activity
  • Improving Bladder Control
  • Reducing the Risk of Falling

The HOS measures used in the 2023 Medicare Star Ratings Year are the three HEDIS Effectiveness of Care measures from the combined Cohort 22 Follow Up and Cohort 24 Baseline data that were collected in 2021. The Functional Health (Outcome) measures are not currently used in the Star Ratings. Improving or Maintaining Physical and Mental Health outcome measures were moved to the display page on CMS.gov for the 2022 and 2023 Star Ratings, as announced in the August 5, 2021 HPMS memo.

The highlighted sections of the following table depict the relationship between the data collection and reporting periods. The green highlighted sections of the table indicate the 2023 Medicare Star Ratings Year. The 2023 Medicare Star Ratings data are from the 2021 HEDIS Effectiveness of Care measures. The 2023 Medicare Star Ratings display page data are from the Cohort 22 Improving or Maintaining Physical Health, Improving or Maintaining Mental Health, and Physical Function Activities of Daily Living outcome measures.

Medicare HOS Survey Administration and Part C Star Ratings Timeline
This is the timeline for HOS data collection, reports to MAOs, and year of Star Ratings report.
HOS Star Ratings - Fall 2022
Of Note
Of Note
Recent Research from the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) Data Resource
The SEER-MHOS linked data present longitudinal information on over 180,000 cancer patients and over two million Medicare beneficiaries with no history of cancer. The SEER Program collects data on cancer cases in an effort to reduce the burden of cancer among the U.S. population. This purpose is in line with the goal of the HOS to gather valid and reliable clinically meaningful data, including improving the care of MAO beneficiaries with cancer. Peer-reviewed journal articles continue to be published reporting on the results of research using the SEER-MHOS data on how outcomes can be improved for beneficiaries with cancer. These references and a listing of other SEER-MHOS research publications can be found in the Applications and Results pages on the HOS website and are also listed on the SEER-MHOS website. A listing of current projects using SEER-MHOS data under DUAs, shared with permission from the identified Principal Investigators, can also be found on the SEER-MHOS website.

Health-related quality of life among elderly breast cancer patients treated with adjuvant endocrine therapy: a U.S Medicare population-based study
Various types of adjuvant endocrine therapy (AET) are often used with elderly breast cancer patients, but there has been limited research examining the impact of the various therapies on health-related quality of life (HRQoL). A group of researchers from the Health Outcome Division, of The University of Texas at Austin College of Pharmacy, examined the association between several types of AET and the self-reported HRQoL of respondents in the SEER-MHOS linked data. The study was cross-sectional and the sample of 3,537 women with breast cancer was derived from the years between 2006 and 2017.

Using multivariate linear regression, the association between four types of AET (anastrozole, letrozole, exemestane, and tamoxifen) and PCS and MCS HRQoL scores was assessed. The researchers found no significant differences in PCS scores between the four AET agents. However, patients treated with anastrozole reported higher MCS scores compared to those treated with the other endocrine therapies. Multivariate linear regression was also used to examine the impact of PCS and MCS on one-year mortality in the SEER-MHOS. Higher one-year mortality was associated with lower PCS regardless of AET agent. Higher one-year mortality was not found for women with lower MCS who were treated with tamoxifen. In conclusion, physical HRQoL did not differ by AET agent though better mental HRQoL was found with use of anastrozole and tamoxifen.

[1] Park, C., Park, SK., Woo, A. et al. Health-related quality of life among elderly breast cancer patients treated with adjuvant endocrine therapy: a U.S Medicare population-based study. Qual Life Res (2022). https://doi.org/10.1007/s11136-021-03059-x. PMID: 35064415. Accessed on September 22, 2022.
HOS Applications
Frequently Asked Questions
The questions received by our Medicare HOS Information and Technical Support team often follow the cyclical nature of the annual HOS cycle. The questions below are among the most frequently asked at this time of year when reports become available, when data are disseminated to eligible recipients, and when Star Ratings are published. The answers below have been reviewed and updated with the most current information available to MAOs and other users of the HOS data.

What’s included in the HOS data sets available to MAOs?
The beneficiary-level data files distributed to the MAOs are the analytic data sets, which contain the survey data for a completed cohort (combined baseline and two-year follow up). Since 2020, the availability of the data sets coincides with the distribution of the Performance Measurement Reports. Downloads of each new MAO report also include a summary level data file with contract-level information, including the HOS summary measures that are used for the Medicare Part C Star Ratings. The Data Dissemination section on the HOS website contains information about the analytic data sets that have been distributed to the MAOs and the summary level data files included with the reports.

How do I obtain the HOS (or HOS-M) reports and beneficiary-level data sets?
An announcement of the availability of the new cohort data is sent to participating plans through HPMS. Contact the HOS team via email at hos@hsag.com to request your data. Data sets will be formatted as Comma Separated Values (CSV) files. The data are sent via electronic secure file transfer to the designated recipient (one per plan). Per CMS policy, one copy of beneficiary level data, per contract, per cohort, is provided to MAOs at no cost. At the time of data disbursement, the designated recipient will receive an email containing instructions and a link to the secure file manager facility. Clicking on the link will allow for creation of an account and password establishment. The data will be available to download at that time.

Can there be multiple recipients within my organization for the data?
Per CMS policy, one copy of beneficiary-level data is provided to MAOs at no cost. One copy means a single distribution of the data and therefore there can be only one designated recipient of the data. If multiple people need to review the data, please designate a single authorized recipient who can then distribute the data file as necessary once they receive it.

How can MAOs and PACE organizations obtain their HOS reports?
All HOS report distribution (HOS and HOS-M) occurs electronically to participating MAOs and PACE organizations through the CMS HPMS. For individual MAOs and PACE organizations to access their HOS reports, an HPMS User ID is required. If you do not have an HPMS User ID, you may contact your organization's CMS Quality Point of Contact to obtain access to the reports. If assistance is required regarding HPMS access, you may contact CMS via email at hpms_access@cms.hhs.gov or visit the CMS website for information on how to establish access to HPMS: https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/HPMS/UserIDProcess.html. Samples of the most recent reports are available on the HOS website under the Sample Reports section.

When may MAOs use HOS or HOS-like questions with their health plan members?
The HOS instrument is copyrighted by NCQA; if a plan wishes to use questions from the HOS, they need to obtain prior permission from the organization. Those interested in using the HOS and HOS-M survey instrument or questions from either instrument must submit a Survey Use Application and signed Terms of Use to NCQA (hos@ncqa.org). For more information on the permitted uses of the HOS and HOS-M survey instruments, as well as the Survey Use Application and Terms of Use, visit NCQA’s website at www.ncqa.org/hedis/measures/hos.
Health plans are strongly discouraged from fielding non-CMS surveys to their members eight (8) weeks prior to or during the announced HOS data collection period. This timeframe is sometimes referenced as the "blackout period." Health plans may conduct focus groups during the HOS fielding, assuming the focus groups address broader health topics, are not specific to HOS-related topics, and are conducted throughout the year.

Available Articles and Technical Reports
In addition to the reports highlighted above, 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 the articles to hos@hsag.com for CMS review and approval. All manuscripts using HOS data must be approved by CMS prior to publication. 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@hsag.com.

Questions about the HOS Program or Policy:
Contact the Centers for Medicare & Medicaid Services at hos@cms.hhs.gov.

Medicare HOS website:
We welcome your feedback!
Please email and let us know what you think!
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