Combining Data from
Medicare HOS and Medicare
Advantage CAHPS®
Academy Health
Annual Research Meeting
June 30, 2009
Richard D. Hector, MA, MPH, PhD
Health Services Advisory Group
Goal
To demonstrate that linking Medicare Health Outcomes
Survey (HOS) and Medicare Advantage Consumer
Assessment of Healthcare Providers and Systems (MACAHPS®) survey data produce patient-related outcomes
and perception / experience of care information that is
actionable, meaningful and relevant
® CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
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When one is not enough…
• In addition to the usual demographics, the HOS routinely
collects patient related outcomes
• In addition to the usual demographics, the MA-CAHPS
routinely collects “perception / experience of care”
• Neither instrument by itself can tell you whether positive
perceptions are associated with more desirable patient
related outcomes
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Advantages of HOS Data
• Unique identifier for linking data
• Outcomes are calculated
• Baseline and Follow up data
• Items are validated
*
*
*
*
*
*
*
Physical Component Summary (PCS) Score
Mental Component Summary (MCS) Score
Falls
General Health
Chronic Diseases
Urinary Incontinence
Osteoporosis
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Advantages of MA-CAHPS Data
• Unique identifier for linking data
• Standard core questions
• Usable comparative information
• Items are validated
* Number of personal MD visits
* Number of clinic visits
* Number of specialists seen
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Advantages of Both
• Trained interviewers
• Established sampling protocol
• Results that can be compared
• Large sample size (power)
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Trade-offs Due to Merging
• The merged data set is not representative of HOS or MACAHPS
• The merged data set is a convenience sample from
Medicare Advantage beneficiaries
• Data do not apply at the level of health plan (unless merged
on health plan identifier)
• The 95% confidence intervals would be wider than HOS or
MA-CAHPS
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HOS vs. MA-CAHPS Analytic Data Set
HOS
MA-CAHPS
Changes in health status of enrollees
Patient-centric care
Patient reported outcomes
Patient evaluated experience with health care
Mixed mode (mail/phone)
Mixed mode (mail/phone)
Random sample
Random sample
1,000 sample size per plan
300 completed surveys per plan
≥ 65 years
≥ 65 years
Fielded: April – July (current year)
Fielded: January – March (previous year)
Enrolled for six months
Baseline with two-year follow up
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Data Considerations
• Hopefully both surveys capture major life events
• Both data sets have the same “merge by” variable
– Type and size are the same for the “merge by” variable
• Expect fewer observations in resulting (merged) data set
– Persons that responded to both surveys
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Link HOS to MA-CAHPS Data
HICNUM
Clinic visits
MD visits
Specialists visits
12345
1
2
0
12346
0
1
1
12347
0
1
0
……..
….
…..
…..
MA-CAHPS
Use HIC numbers to merge data sets
HICNUM
Age
Gender
GenHlth
PCS
MCS
12345
72
Female
Fair
55
67
12346
66
Male
Good
60
61
12347
65
Female
Very good
75
80
……..
….
….
….
….
….
HOS
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Direction of Linking Data
HICNUM
Age
GenHlth
Clinic
MD visits Specialists
12345
71
Very good 1
2
0
12346
65
Excellent
0
1
1
12347
64
Excellent
0
1
0
……..
….
…..
….
…..
…..
MA-CAHPS
Use HIC numbers to merge data sets
HICNUM
Age
Gender
GenHlth
PCS
MCS
12345
72
Female
Fair
55
67
12346
66
Male
Good
60
61
12347
65
Female
Very good
75
80
……..
….
….
….
….
….
HOS
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Examples for Demonstration
• HOS distribution of obesity by race and gender
• PCS score by BMI level
• PCS score by experience of care (MA-CAHPS)
• Health services utilization (MA-CAHPS) by number of
chronic diseases by BMI level (both HOS)
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BMI by Race for Females and Males (HOS) (n= 93,066)
Females
Actual Data
Males
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Unadjusted PCS Score by Number of Chronic Diseases (HOS) (n= 76,535)
Obese beneficiaries have lower PCS scores at any number of chronic diseases
Each additional chronic disease reduces mean PCS scores by a constant amount
Actual Data
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PCS Scores (HOS) by MD Experience (MA-CAHPS) (n= 4,216)
Percentage
Actual Data
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Low vs. Moderate Utilization Clinic Visits (HOS & MA-CAHPS) (n= 4,216)
1 – 2 visits
3 – 9 visits
Similar
rates
of into
Overweight
Normal
Obese cross
cross
into
moderate
moderateutilization
utilization
(4)
(6+)
(3)
utilization
(0)
MA-CAHPS
HOS
Actual Data
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Summary
• HOS and MA-CAHPS populations can overlap
• Some beneficiaries respond to both
• Highly trained interviewers
• Standard interview methods
• Merge to take advantage of different features
• Due to sample size, these data support advanced
statistical methods
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Technical Queries
Health Services Advisory Group
For inquiries, please contact the
Medicare Health Outcomes Survey (HOS)
Information and Technical Support
Telephone Line at (888) 880-0077 or
E-mail Address (hos@azqio.sdps.org).
CMS HOS Website:
http://www.hosonline.org
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Presentation Queries
Richard D. Hector, MA, MPH, PhD
Health Services Advisory Group
Phone: (602) 665 – 6133
Email: rhector@azqio.sdps.org
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Thank you for your attention
Please ask QUESTIONS
Please share your COMMENTS
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