Health Services Research Data
Update
Dan Waldo
Information and Methods Group
Office of Research, Development, and Information
Centers for Medicare & Medicare Services
daniel.waldo@cms.hhs.gov
Topics
• Medicare Current Beneficiary
Survey
• Health Outcomes Survey
• Chronic Conditions Database
(“Section 723”)
• Research Data Distribution Center
Medicare Current Beneficiary Survey
(MCBS)
• Survey of a random sample
of Medicare enrollees
• Stratified to oversample
very old beneficiaries and
those eligible because of
disability
• Survey data aligned with
administrative data
• Annual files available from
1991 forward
• Access to Care File covers
questions on
sociodemographics,
economic status, health
status, program
knowledge, insurance, etc.
• Cost&Use File includes
event-level encounters and
sources of payment for
these encounters
• Companion MDS, OASIS,
and claims data files are
available
http://www.cms.hhs.gov/mcbs
What’s New in this Year’s MCBS Files?
• Access to Care 2004
– Generosity of drug benefit
– Rotation of health status questions
– Facility-level characteristics of
group living places
– Patient activation supplement
• Cost&Use 2003
– No new features
http://www.cms.hhs.gov/mcbs
Rx Generosity Questions for
insurance that covers Rx drugs
• Does the plan have an Rx drug
deductible? If so, what amount?
• What are the coinsurance amounts
for brand drugs? For generic drugs?
• Does the plan have “coverage limit”
for drugs? If so, what is it?
• How would you rate your Rx drug
coverage through this plan?
http://www.cms.hhs.gov/mcbs
Rotation of Health Status Questions in
2004
• The plan is to rotate questions in
every other year
• Why?
– Experience shows little year-to-year
variation in responses to many
questions
– By reducing the number of questions
we can reduce respondent burden
http://www.cms.hhs.gov/mcbs
Rotations in 2004 Access to Care File
In
Out
• Expanded diabetes
questions
– Disease management
– Testing for/treatment of
diabetic complications
– Disease knowledge
– Etc.
• Hypertension questions
• Falls questions
• Colorectal or colon
cancer screening
questions
• Osteoporosis questions
http://www.cms.hhs.gov/mcbs
Facility-Level Characteristics of
Group Living Places
• Currently …
– In 2001 we began asking question about group
living places to explore alternatives to traditional
LTC settings for people with long term care
needs
– We asked about the characteristics of the
specific place the respondent lives but not about
the characteristics of the broader campus.
• Beginning with Access 2004, if the group living place
offers support services we collect information on
the characteristics of the total facility to
determine whether the facility offers LTC services.
http://www.cms.hhs.gov/mcbs
Patient Activation Supplement
• Questions explore the extent to
which beneficiaries are ready to
direct or manage their health care
• This supplement was first included
in Access 2001 and is repeated for
Access 2004
http://www.cms.hhs.gov/mcbs
Patient Activation Questions
• Does the beneficiary feel confident
about their ability to manage their
health care?
• How important is it to the
beneficiary to be an active
participant in managing their health?
• How proactive is the beneficiary
with regard to understand and
managing their health care needs?
http://www.cms.hhs.gov/mcbs
For More Information ...
MCBS Website:
http://www.cms.hhs.gov/mcbs
Email:
MCBS@cms.hhs.gov
Medicare Health Outcomes Survey (HOS)
•
A longitudinal, self-administered
survey of Medicare Advantage
enrollees
– One thousand Medicare
beneficiaries are randomly
sampled from each plan and
surveyed every spring
– Two years later, these same
respondents are surveyed again
– Cohort I was surveyed in 1998
•
HOS currently uses the RAND
36-Item Health Survey 1.0
(RAND SF-36) (a physical and
mental health status measure),
and additional case mix/risk
adjustment variables.
•
The Medicare HOS is being used
as part of the effectiveness of
care component of HEDIS®. All
managed care plans with
Medicare + Choice contracts
must participate.
•
CMS is legislatively required by
MMA 2003 to collect, analyze,
and report data permitting the
measurement of health
outcomes and other indices of
quality.
http://www.cms.hhs.gov/surveys/hos
HOS to Date
• Independent Evaluation completed in
December 2004
– Conducted by the Delmarva Foundation and
the University of Maryland Baltimore
County
– Concluded that the HOS data are valid,
reliable, and that the HOS Program has
been effective in meeting its goals.
http://www.cms.hhs.gov/surveys/hos
HOS to Date
• Response Rates Remain Steady
2000
2001
2002
2003
2004
Baseline
71.7
68.0
66.4
66.9
67.4
Follow-Up
83.5
83.4
79.5
81.1
82.3
http://www.cms.hhs.gov/surveys/hos
Coming Up in HOS Version 2
(Effective with 2006 Surveys)
• Changes
– Veterans RAND 12 Item Health Survey (VR-12)
replaces the RAND 36-Item Health Survey 1.0
(RAND SF-36)
– Urinary continence question has been
reworked.
• Deletions
– Stroke symptom severity questions
• Additions
– Self-reported height and weight categories
– Osteoporosis testing HEDIS measure
– Falls management HEDIS measure
http://www.cms.hhs.gov/surveys/hos
For More Information…
Medicare HOS Website:
http:\\www.cms.hhs.gov/surveys/hos
Health Care Financing Review – Summer 2004
Health Outcomes Survey Theme Issue
http://www.cms.hhs.gov/review/04summer/
Email: hos@cms.hhs.gov
Section 723 Chronically Ill Medicare
Beneficiary Research and Data Initiative
• Establish a data
warehouse to study
chronically ill Medicare
beneficiaries
– Improving the quality of
care for chronically ill
Medicare beneficiaries
– Reducing the cost of care
for chronically ill
Medicare beneficiaries
• Data warehouse
integrates existing CMS
data
• Policy goals
– Study chronic illnesses in
the Medicare population
– Make current Medicare
program data more
readily available to
researchers
– Improve process time for
research data requests
• Operational goals
– Utilize data extraction
tools to organize data
– Focus on analytic
perspective vs.
operational
Project Objectives
• Establish a partnership with internal and external
customers
• Implement phased-in approach
• Create person level linkage of data
– Medicare
– Medicaid
– Assessment (MDS/OASIS)
• Construct analytical files specific to research
• Construct a data warehouse with data extraction
tools
• Provide a 5% sample of the beneficiary population
Data Warehouse Objectives
• Create person-level view of data
• Construct data extraction tools that support:
– Accessing data by chronic conditions
– Complex customized research data
requests related to chronically illness
• Develop new formats for Medicare enrollment,
claims and assessment data that support
research
• Develop useful documentation and metadata
Challenges in Person-Based
Data Linkage
• Personal identifiers can change within
each of the major CMS programs
– Need to un-duplicate identifiers within
each program
• Person identifiers vary across CMS programs
(Medicare, Medicaid, and Assessments)
– Need to link un-duplicated identifiers
across programs
Data Linkage Activity
• The Enterprise Cross Reference Table (MMX) ― IBM
– Develop the assessment link key to un-duplicate
identifiers within the assessment database
– Expand the MMX to link un-duplicated identifiers
across databases
• Validating the MMX results ― Brandeis/Jen
– Provide an objective measure of the rate of false
negatives and false positives
– Suggest approaches to improve match accuracy
Disease Classification Activity
• “Pre-defined” conditions
– Activity coordinated by ResDAC
– Consult research experts establish
algorithms for identifying conditions
from claims and other data
• “User-defined” conditions
– User provides filter specifications
Creation of Data Warehouse
• Currently being done at the Iowa
Foundation for Medical Care (IFMC)
• Data stored in the warehouse will have
the following features:
– Unique patient ID linked to all CMS
program data
– Core research file format
– Chronic disease flags
– Custom data extract capability
Data Included in the Warehouse
• 5% sample of all Medicare beneficiaries
from CY 1999 through 2004 (about 2.5
million people), linking …
–
–
–
–
–
Medicare enrollment data
Medicare claims
Medicaid claims
MDS & OASIS assessments
HPMS (managed care) data
• Increased sample of beneficiaries in CY
2005
• Beneficiary data and data collected from
relevant surveys (e.g., MCBS)
Data Warehouse Features
• Use existing IFMC data extraction tool to
accommodate custom and standard requests
• Provide SAS functionality
• Enable queries of claims and enrollment data
• Develop a customer order receipt and tracking
system to support data release requests
• Provide ResDAC technical support as a focal
point for researchers to understand CMS
Medicare and Medicaid programs
Future Activity
• Incorporate lessons learned from Phase I
• Provide ongoing improvements to the
research database
– Expand data sources
– Expand 5% sample
– Enhance data access tools
– Establish consultation and technical
support group
– Support data release requests
For Further Information
on the 723 Database...
ResDAC
E-Mail: resdac@umn.edu
1-888-9-ResDAC
Fax: 612-378-4866
URL: www.resdac.umn.edu
Frank Eppig
feppig@cms.hhs.gov
Research Data Distribution Center
(RDDC)
• The RDDC is a 27 month pilot project to
test using a contractor to distribute
Medicare claims and enrollment data to
researchers.
• The RDDC will fill Medicare data requests
from public and private researchers.
• Result should be essentially transparent to
the user
Research Data Distribution Center: Scope
of the Data
• CMS will initially furnish the RDDC with 2
years of 100% Medicare claims and
eligibility files
• Over the first 6 months of the contract,
CMS will add 5 additional years of data.
• The RDDC will also receive CMS sponsored
national surveys, including MCBS, HOS, and
CAHPS.
Research Data Distribution Center:
Scope of the Contract
• The RDDC will provide researchers
with Medicare standard analytical
files (Inpatient hospital, outpatient
hospital, SNF, HHA, DME, hospice,
and physician/supplier bill types).
• The RDDC will also be to create
custom extracts of Medicare data.
Research Data Distribution Center:
Beneficiary Privacy and Confidentiality
• Researchers must meet the existing rules,
policies, and procedures designed to protect
the confidentiality of the individual, including:
– CMS privacy board review
– Completion of a Data Use Agreement.
• After CMS reviews the request and is
satisfied that the researcher can adequately
protect the privacy and confidentiality of the
beneficiary, RDDC releases the data files.
Research Data Distribution Center:
Data User Fees
• The RDDC will charge the researcher a
data use fee based on the contractor’s
cost of producing the data added to the
Federal cost of monitoring the process.
• The data use fees will go into a special
CMS account that will help fund the
RDDC contract.
For Further Information
on the RDDC...
ResDAC
E-Mail: resdac@umn.edu
1-888-9-ResDAC
Fax: 612-378-4866
URL: www.resdac.umn.edu
Spike Duzor
sduzor@cms.hhs.gov