Summer 2024 HOS Newsletter

Volume 13, Issue 1

Welcome to the Summer 2024 edition of the Medicare Health Outcomes Survey (HOS) Newsletter! This newsletter provides general information and current updates about the HOS. This issue and all previous issues are available on the HOS website.

The newsletter will help you:

• understand the HOS, how the data are gathered and how the results are calculated;
• use the reports and data generated by the survey to improve the health of Medicare Advantage Organization (MAO) enrollees;
• inform quality improvement activities by MAOs and providers; and
• learn about ways research based on the HOS 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.

Other enhancements to the HOSonline web pages are being planned for implementation soon. In addition to the information for survey participants, the resources for researchers, plans, and survey vendors are being refreshed and reorganized for easier access and viewing with less scrolling required. The Glossary and Frequently Asked Questions (FAQs) pages are now displayed with expandable headings describing the detail contained within each topic.

FAQs included in this newsletter:

• Where can I find the current HOS and HOS-Modified (HOS-M) survey vendor lists and survey administration documents?
• May MAOs use HOS or HOS-like questions with their health plan members?
• When may MAOs use HOS or HOS-like questions with their health plan members?
• I received a CMS announcement about the availability of data. Does that mean my plan has data available?
• How do I obtain the HOS (or HOS-M) reports and beneficiary-level data sets?
• What are the reporting requirements at baseline and follow up for calculating the Star Ratings Measures?

The list of CMS-Approved Survey Vendors and copies of the slides used in the required survey vendor training are available on the same page. Other materials, including links to pertinent documents for the current and past survey administration cycles are available on the Survey Administration page.

HOS and HOS-M Reports

Results from the HOS Round 26 survey (Cohort 26 Baseline and Cohort 24 Follow-Up) fielded in 2023 are reported in 2024. The 2021-2023 Cohort 24 Performance Measurement Report and the Round 26 HEDIS HOS Effectiveness of Care (HEDIS HOS) Report were released early August 2024. The annual Performance Measurement Report and HEDIS HOS Report are released concurrently so MAOs can review their HEDIS process measure results and HOS Performance Measurement outcome results simultaneously. Both reports include MAO, state, region, and national results, as well as trend results over three rounds of data; and summaries of evidence-based interventions for improving health outcomes. Eligible MAOs are also able to request their own member-level Performance Measurement data with their reports. These reports and data are released together so that MAOs can target strategies to improve the health of their members and track contract level progress and improvement.

The Cohort 25 Baseline Reports and 2022 HOS-M Reports were released in November 2023 to eligible participating MAOs and Program of All-Inclusive Care for the Elderly (PACE) organizations. The Cohort 26 Baseline Reports and 2023 HOS-M Reports will be released in Fall 2024.

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.

Registered HPMS users have access to these reports through the HPMS site. Information about obtaining access to HPMS is available on the CMS site. If you require assistance accessing reports in HPMS, please contact HPMS Access at CMS.

HOS and HOS-M Data Sets

The following HOS and HOS-M data sets now available and provide beneficiary-level survey responses for each participating MAO or PACE organization. Eligible recipients from each organization may request their organization’s data.

• HOS PM data from Cohorts 1–23 and accompanying Data Users Guides (DUGs)
• HOS-M (PACE only) data from 2007–2022 with accompanying DUGs

The DUG included with each data set provides detailed documentation including:

• information on methodology and design;
• annotated baseline and follow up survey instruments;
• data file characteristics;
• data file layout by position.

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

Contact the HOS Team via email to request data for your MAO or PACE organization. Encrypted data are distributed to eligible recipients via secure file transfer.

Where can I find the current HOS and HOS-M survey vendor lists and survey administration documents?

The current HOS and HOS-M survey vendor lists are available under the HOS Survey Vendors and HOS-M Survey Vendors sections on the Program page. Survey administration documents (including the 2024 HOS survey administration memos for MAOs and HOS-M for PACE plans, and the HOS exclusion memo) are available under the Survey Administration section. Additional information about HOS program requirements may be found in the HOS Quality Assurance Guidelines (QAG) and HOS-M QAG Addendum, both of which are available in the Methodology section of the Resources page. The most recent HEDIS® Volume 6: Specifications for the Medicare Health Outcomes Survey manuals are available at no cost from NCQA.

Copies of the HOS and HOS-M survey instruments are available for download from NCQA. Those interested in using the HOS and HOS-M survey instruments or questions from either survey must submit a Survey Use Application and signed Terms of Use to NCQA.

May MAOs use HOS or HOS-like questions with their health plan members?

The HOS instrument is copyrighted by CMS and NCQA. Anyone who wishes to use questions from the HOS, must obtain prior permission from NCQA and CMS. 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.

When may MAOs use HOS or HOS-like questions with their health plan members?

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 data administration, assuming the focus groups address broader health topics, are not specific to HOS-related topics, and are conducted throughout the year.

I received a CMS announcement about the availability of data. Does that mean my plan has data available?

CMS announcements about the availability of data are sent to all plans and therefore are not an automatic indication of data availability. A plan would have Performance Measurement data available if the plan participated in both the baseline and the follow up phases of the survey for that cohort and continues to participate in HOS when the data are distributed. For example, for plans to have Cohort 24 Performance Measurement data available, they would have had to participate in both the 2021 baseline and the 2023 follow up surveys. Plans that did not collect survey data at both of those times will not have reports and data available.

Plans that are no longer participating in the Medicare Advantage or PACE programs when the data are distributed will not be eligible to obtain their data. Although your plan may have previously participated in the HOS or HOS-M, not all plans will have data available for the particular cohort of data being released. Plans that are not eligible will be informed of the reason they cannot obtain data. Also, announcement of HOS data availability does not mean that HOS-M data are also available at that time and vice versa.

How do I obtain the HOS (or HOS-M) reports and beneficiary-level data sets?

HPMS users at each MAO or PACE organization will receive an emailed announcement of the availability of HOS or HOS-M reports. An HPMS User ID and password are required to access HPMS. If you require further assistance regarding HPMS access, please visit the CMS website or contact CMS HPMS Access via email.

For beneficiary-level data sets, an announcement of the new data availability is sent to registered HPMS users at your MAO or PACE organization. HOS data will be distributed in August and HOS-M data will be distributed in the Fall. Contact the HOS team via email to request your data once the CMS announcement memo has been published. Data sets will be formatted as Comma Separated Values (CSV) files. 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 is also included.

Per CMS policy, one copy of beneficiary level data, per contract, per cohort, is provided to MAOs at no cost. You may request your organization’s past data by contacting the HOS team as described above. However, if the data have already been delivered and downloaded, there is a replacement fee for each data set (per contract, per cohort).

What are the reporting requirements at baseline and follow up for calculating the Star Ratings Measures?

The following MAOs and other organization types with Medicare contracts in effect on or before January 1, 2023, are required to report the Baseline HOS in 2024, provided they have a minimum enrollment of 500 members in February 2024 as reflected in the March 2024 monthly enrollment file:

• All MAOs, including all coordinated care plans, Private Fee-for-Service (PFFS) contracts, and Medical Savings Account (MSA) contracts
• Section 1876 Cost contracts, even if they are closed for enrollment
• Employer/union only contracts
• Medicare Medicaid Plans (MMPs)

In addition, all organizations that reported a Cohort 25 Baseline survey in 2022 are required to administer a Cohort 25 Follow-Up survey in 2024.

Star Ratings results for the three cross-sectional HEDIS HOS Effectiveness of Care (Process) Measures are calculated using the round of HOS data collected in a single survey year. Data are combined for contracts fielding both the HOS baseline and follow up surveys. If a contract fields only the HOS baseline or HOS follow up (not both), results are calculated using the available data. In either case, results are reportable only if a denominator of 100 is achieved. Please note that the same survey is fielded to both baseline and follow up respondents.

Results for the two longitudinal Functional Health (Outcome) Measures are not calculated until follow up data are available. Assuming no consolidated contracts are involved, a newly established MAO administering their very first HOS survey would not have follow up data or outcome results for two years, until the cohort is completed.

The measures used to calculate 2025 Medicare Part C Star Ratings include results from the contract-level 2021-2023 Cohort 24 Performance Measurement and the HEDIS Effectiveness of Care measures. Information about the Medicare Star Ratings is published on the CMS website and distributed via the HPMS system.

Functional Health (Outcome) Measures:

These longitudinal HOS measures are calculated using data from a cohort of beneficiaries who respond to a baseline survey and again two years later at follow-up.

• Improving or Maintaining Physical Health (PCS)
• Improving or Maintaining Mental Health (MCS)
• Physical Functioning Activities of Daily Living (PFADL)

The HOS longitudinal outcome measures remain on display status in 2024. Display measures are publicly available for informational purposes but are not used for Star Ratings calculations.

Effectiveness of Care (Process) Measures:

The HEDIS HOS measures listed below are cross-sectional. The plan scores are calculated using data collected in a single survey round for members sampled in the combined baseline and follow up cohort. The HEDIS HOS Reports are made available concurrently with the Performance Measurement Reports.

• Monitoring Physical Activity
• Improving Bladder Control
• Reducing the Risk of Falling

This section highlights some of the more recent research publications of note. Selected other research publications using HOS data are referenced on the Resources page of the HOS website.

Recent Research from the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) Data Resource

The SEER-MHOS is a data resource designed to improve understanding of the health-related quality of life (HRQOL) of cancer patients and survivors enrolled in MAOs based on a linkage between data collected by the National Cancer Institute’s (NCI) SEER cancer registry and CMS’s HOS. Results of research using the SEER-MHOS data that show how outcomes can be improved for MAO enrollees with cancer that were published in peer-reviewed journals can be found on the HOS website's Applications and Results pages and also on the SEER-MHOS website. A list of current projects using SEER-MHOS data can also be found on the SEER-MHOS website.

Health-related quality of life among prostate cancer survivors with metastatic disease and non-metastatic disease and men without a cancer history in the USA

In this publication, SEER-MHOS researchers from the American Cancer Society identified men over the age of 65 who were enrolled in Medicare Advantage plans that had survived prostate cancer and compared their HRQOL with men without a cancer history. They observed that prostate cancer survivors were older and had higher socio-economic status than the other respondents. The researchers also found that metastatic prostate cancer survivors had lower general health, lower physical health, and lower mental health in relation to the non-cancer group. However, the researchers found that survivors with non-metastatic cancer had similar physical and mental health scores to those who did not have a cancer history. Recommendations were made to further compare metastatic and non-metastatic cancer treatments and detailed outcomes to identify ways to improve HRQOL for older men with prostate cancer.

[1] Zheng Z, Shi KS, Kamal A, Howard DH, Horný M, Richards TB, Ekwueme DU, Yabroff KR. Health-related quality of life among prostate cancer survivors with metastatic disease and non-metastatic disease and men without a cancer history in the USA. J Cancer Surviv. 2023 Dec 16:10.1007/s11764-023-01509-8. doi: 10.1007/s11764-023-01509-8. Epub ahead of print. PMID: 38102521; PMCID: PMC11180215.

Additional Articles and Technical Reports

In addition to the report highlighted above, new HOS-related articles and technical reports are added to the HOS website as they become available. A listing of additional HOS-related reference materials and technical reports can be found in the Resources section of the HOS website.

We welcome the opportunity to post HOS-related, peer-reviewed articles written by MAOs and other stakeholders. 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.