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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 is the Health Outcomes Survey (HOS)?
The Medicare Health Outcomes Survey (HOS) is an annual survey administered to Medicare Advantage enrollees to assess patient-reported outcomes and health plan performance. First fielded in 1998, the goal of the Medicare HOS program is to gather valid and reliable clinically meaningful data that have many uses, such as targeting quality improvement activities and resources; monitoring health plan performance and rewarding top performers; helping people with Medicare to make informed health plan choices; and advancing the science of functional health outcomes measurement. In 2002, an abbreviated version of the HOS, known as the Health Outcomes Survey-Modified (HOS-M), was fielded for the first time. The HOS-M is used to assess frailty in Program of All-Inclusive Care for the Elderly (PACE) organizations.
What is the annual survey administration cycle?
The 2023 HOS and HOS-M surveys were fielded from July to November 2023, as detailed in the HOS Survey Administration Memo and HOS-M Survey Administration Memo. The annual memos, which are distributed by NCQA and made available by CMS on the HOS website, provide important information about the annual survey administration requirements, including plan reporting, contracting with survey vendors, and the sampling process. The 2024 HOS-M Survey Administration Memo will be emailed to PACE organizations by late February, and the 2024 HOS Survey Administration Memo will be emailed to MAOs by late March.
An updated list of the 2024 HOS Survey Vendors and HOS-M Survey Vendors will be available on the HOS website. Other information, including materials from the most recent annual survey vendor training, can be found on the Survey Administration page. The most recent HEDIS® Volume 6: Technical Specifications for the Medicare Health Outcomes Survey manuals are available at no cost from the NCQA Store. Copies of older editions of HEDIS publications may be obtained by calling NCQA Customer Support at (888) 275-7585.
Copies of the HOS and HOS-M survey instruments are available for download from NCQA at www.ncqa.org/hedis/measures/hos. 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. 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 are HOS results reported?
Results from Round 25 of the HOS survey (Cohort 25 Baseline and Cohort 23 Follow-Up) that was fielded in 2022 were reported in 2023. The 2020-2022 Cohort 23 Performance Measurement Report and the Round 25 HEDIS HOS Effectiveness of Care Report (HEDIS HOS Report) were released in July 2023. The Performance Measurement Report and HEDIS HOS Report are released concurrently to allow MAOs to review their HEDIS process measure results and HOS Performance Measurement (PM) outcome results together. Member-level PM data are available by request with the PM reports to help MAOs target strategies to improve the health of their members and track plan-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 25 Baseline Reports were released in November 2023 to 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 the HOS total respondent population. Although member-level baseline data are not released until after the cohort is complete (i.e., after the follow up survey had been fielded), the plan-level baseline reports can help plans identify and target quality improvement efforts to address the specific needs of their membership. Plan-level results are also trended across the three most recent years to help MAOs identify areas where their membership is doing well and to identify weaknesses they can address to improve the health of all enrollees. Plans are encouraged to use their baseline reports to develop focused improvement strategies that can be applied to their entire plan membership to improve the health of all enrollees.
The 2022 HOS-M Reports were also released to participating PACE organizations in November 2023. The annual plan report is produced for each PACE organization participating in the survey. The report compares selected health status measures for Medicare enrollees from each PACE organization to the entire HOS-M sample.
Where can I find my organization’s frailty scores?
Frailty scores for PACE organizations and Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs) that participated in the HOS or HOS-M for frailty are posted on HPMS in the Risk Adjustment module under “Survey Results for Frailty Adjustment.” Results of the 2022 HOS-M for Payment Year (PY) 2023 are currently posted on HPMS.
Results of the 2023 HOS-M for PY 2024 are not yet available. The annual HOS and HOS-M data collection ends in November each year and frailty results are typically posted in the spring.
How is HOS used in the Medicare Star Ratings?
The measures used to calculate 2024 Medicare Part C Star Ratings included results from the contract-level HEDIS Effectiveness of Care measures. Preview periods for the 2024 Medicare Star Ratings were provided to health plans in August and September 2023. Consumers were able to use the Explore Your Medicare Coverage Options page to view the 2024 Medicare Star Ratings starting in October 2023. Details about the Medicare Star Ratings including technical notes and data tables are published on the CMS Part C and D Performance Data website.
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.
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Improving or Maintaining Physical Health (PCS)
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Improving or Maintaining Mental Health (MCS)
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Physical Functioning Activities of Daily Living (PFADL)
Effectiveness of Care (Process) Measures:
These HEDIS HOS measures are cross-sectional and are calculated using data 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 that will be used in the 2025 Medicare Part C Star Ratings are the three HEDIS Effectiveness of Care measures from the combined Cohort 24 Follow Up and Cohort 25 Baseline data collected in 2023. The PCS and MCS Functional Health (outcome) measures will remain on display for the 2025 Medicare Star Ratings Year and will return to the 2026 Medicare Part C Star Ratings. The PFADL outcome measure is currently in development and will remain on display. The display measures are publicly available but are not used in the Star Ratings calculations.
How will I know when the HOS and HOS-M reports are available?
The HOS reports are distributed annually. The Performance Measurement Reports are released in the summer following data collection for each completed cohort of data (two-year follow up combined with a previous baseline) and the annual HEDIS HOS Reports are released at the same time. The Baseline Reports are available in the fall of the year following data collection. The Program and survey administration timelines are posted on the HOS website on the About HOS and the Program Timeline sections of the Program page provide an estimate of when data collection will be completed each year. The “Medicare HOS Report and Data Distribution” table on the Data Dissemination section provides distribution dates from prior year.
The HOS-M Reports are distributed to PACE organizations annually, approximately one year after data collection ends for the new cross-sectional survey data. The HOS-M program timelines are posted on the HOS-Modified Overview page to provide an estimate of when HOS-M Reports will be completed and ready for distribution each year. The “Availability of Reports and Data” section provides the distribution dates from previous years.
Approved HPMS users at each MAO and PACE will receive an electronic communication from HPMS announcing the availability of HOS and HOS-M reports. If assistance is required with HPMS access, please contact CMS at hpms_access@cms.hhs.gov or visit the CMS website.
How can research be done using HOS data?
Researchers in public health and other fields are encouraged to consider the various types of Medicare HOS data files. Medicare HOS data files are available as:
- research identifiable files (RIFs),
- limited data sets (LDSs), and
- public use files (PUFs).
An approved CMS Data Use Agreement (DUA) is required to obtain LDS and 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. More information about the HOS PUF, LDS and RIF data files available can be found on the Research Data Files page.
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 every Medicare beneficiary. The Health Insurance Claim (HIC) number, based on the SSN, was the member-level identifier used for HOS data from 1998-2019. Beginning in 2020, the HIC number has been removed from all new rounds of HOS data and only the MBI is retained.
What HOS data sets are available to the MAOs?
The most recent data sets available to MAOs are the 2020-2022 Cohort 23 beneficiary-level data. These data are available for MAOs that participated in 2020 Baseline and 2022 Follow Up HOS. The files distributed are analytic data sets, which contain the survey data for a completed cohort (combined baseline and two-year follow up). Since 2020, availability of the data sets coincides with the distribution of the Performance Measurement Reports. In addition to beneficiary level data set, downloads of each new MAO report also include a summary level data file with plan-level information, including the HOS summary measures from the report 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 plan-level summary data files included with the reports.
What HOS-M data sets are available to the PACE plans?
The most recent HOS-M data sets available to PACE plans are the 2022 HOS-M beneficiary-level data. These data are available to PACE plans that participated in the 2022 HOS-M. The files distributed are the data sets from the cross-sectional HOS-M survey (a single survey without a follow up). These data sets coincide with the distribution of the HOS-M Reports. The “Availability of Reports and Data” section on the HOS-Modified Overview page contains information about the data sets that have been distributed to PACE plans.
How can I obtain data sets for my MAO or PACE organization?
An announcement of the availability of HOS or HOS-M new data is sent to the participating organizations through HPMS. Contact the HOS team at hos@hsag.com to request your data. Data sets are formatted as encrypted Comma Separated Values (CSV) files and sent via electronic secure file transfer to the organization’s designated recipient (one per company). Per CMS policy, one copy of each beneficiary-level data set is provided to each organization 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 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 internally within your organization as necessary once received.
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