CMS Chronic
Condition
Data
Warehouse
June 4, 2007
Chronic Condition Data Warehouse
Background
• Medicare Modernization Act of 2003, Section 723,
mandated a plan to “improve the quality of care and
reduce the cost of care for chronically ill Medicare
beneficiaries”
• Essential component of plan was to establish a research
database that contains fee-for-service Medicare claims
data and assessments, linked by beneficiary, across the
continuum of care
• Claims and assessment data linked to Medicare
eligibility/enrollment data
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Chronic Condition Data Warehouse
Population: 1999-2004
• Random 5% sample of Medicare beneficiaries (e.g.,
claims-based sampling methodology)
• Eligible for and enrolled in Medicare on or after January 1,
1999 through the most current period
• Health Insurance Claim (HIC) number where the eighth
and ninth digits are in the set {05, 20, 45, 70, 95}
• Qualified for 5% sample, therefore, remained part of the
ongoing CCW sample (includes ever-qualifying
beneficiaries from January 1, 1999 forward, i.e., an
enhanced or person-based 5% sample)
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Chronic Condition Data Warehouse
Population: 2005 - Forward
• 100% Medicare beneficiaries
• Linked with historical data
• Random 5% sample flags
• Current data
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Chronic Condition Data Warehouse
Linkage Across the Continuum of Care
• All CCW data files linked by assignment of a unique,
unidentifiable beneficiary link key for ease of analysis
across data files (unique link keys replace HIC numbers)
• Allows for cross-sectional and longitudinal research from
1999 forward
• Allows linkage across the continuum of care to construct
patient-centric views of enrollment and service utilization
• Link keys encrypted prior to delivery to the researcher, for
privacy protection
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Chronic Condition Data Warehouse
Chronic Condition Categories
Researchers may request data for 21 predefined chronic
condition categories, allowing for timely data extraction:
Acute Myocardial Infarction
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Alzheimer's Disease, Related
Disorders, or Senile Dementia
Chronic Obstructive Pulmonary Disease
Congestive Heart Failure
Diabetes
Alzheimer's Disease only
Glaucoma
Atrial Fibrillation
Hip/Pelvic Fracture
Cancer, Breast
Ischemic Heart Disease
Cancer, Colorectal
Major Depression
Cancer, Prostate
Osteoporosis
Cancer, Lung
Rheumatoid Arthritis/Osteoarthritis
Cancer, Endometrial
Cataract
Stroke/Transient
Ischemic Attack
Chronic Kidney Disease
Chronic Condition Data Warehouse
Key Features
• Patient-centric data files linked by unique beneficiary key, across
the continuum of care (deidentified and encrypted prior to delivery
to researcher)
• Readily available chronic condition cohorts, customized cohorts
(defined by researcher), and other categorization schemes
• Beneficiary Summary File
• Chronic Condition Summary File
• Easy to use data files designed specifically for researchers (e.g.,
limited data set, SAS® input and label statements, frequency output,
etc.)
• Services from 1999 forward
• Manageable 5% sample; 100% data for larger
subsets or samples
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Chronic Condition Data Warehouse
www.ccwdata.org
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Chronic Condition Data Warehouse
Web Site – Statistical Summaries
• Available to general public (pdf format)
• Produced by IFMC staff
• Resource for high level, summary statistics by
segmentation variables (e.g., predefined CCW chronic
conditions, utilization summary information,
demographic, and/or enrollment factors)
• Helpful for finding quick facts
• Useful with exploring sample size options
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Chronic Condition Data Warehouse
Web Site – Statistical Summaries
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Chronic Condition Data Warehouse
Statistical Summaries – Beneficiary Demographics
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Chronic Condition Data Warehouse
Statistical Summaries – Population Statistics
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Chronic Condition Data Warehouse
Statistical Summaries – Assessment data
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Chronic Condition Data Warehouse
Data Files Available Upon Request from CMS
• Enrollment/eligibility data
• Administrative claims
– Fee-for-service institutional claims for inpatient,
outpatient, skilled nursing facility, hospice, and home
health agency settings
– Fee-for-service non-institutional claims for
physician/supplier and durable medical equipment
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Chronic Condition Data Warehouse
Data Files Available Upon Request from CMS (cont.)
• Assessment data
– Minimum Data Set (MDS) - nursing facilities
– Outcome and Assessment Information Set (OASIS) home health agencies
– Inpatient Rehabilitation Facility Patient Assessment
Instrument (IRF-PAI)
– Swing bed data
•
•
•
•
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CCW (CMS) Denominator (100% or 5% sample)
Beneficiary Summary File
Chronic Condition Summary File
Medicare Current Beneficiary Survey (MCBS)
Chronic Condition Data Warehouse
Beneficiary Summary File
• Annual beneficiary summary file containing
demographic and enrollment data
• Includes data for beneficiaries in the requested cohort
or other specified population who were:
– Ever part of the CCW 5% sample
– Documented as being alive for some part of the
reference year
– Enrolled in Medicare Part A or B at some point
during the reference year (may also have been
enrolled in managed care)
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Chronic Condition Data Warehouse
Chronic Condition Summary File
• Summary of a beneficiary’s chronic conditions (if
any) by year
• Flag indicator for presence of a CCW condition
during that year
• Includes beneficiaries in requested cohort (or other
specified population)
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Chronic Condition Data Warehouse
Data Request Options
• Standard (e.g., based on predefined chronic condition
cohort criteria, entire 5% sample for a given year, etc.)
• Custom (e.g., researcher-defined cohort based on
demographic or clinical information such as diagnosis
or procedure codes, etc.)
• Finder file (e.g., based on known beneficiary
identifiers, etc.)
• Introductory pricing for 5% sample
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Chronic Condition Data Warehouse
Data Delivery Options
• Data loaded to USB hard drive or DVD (no tapes!)
• Flexible for use with different operating systems (e.g.,
Windows, Linux, etc.)
• SAS read-in statements
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Chronic Condition Data Warehouse
Data Request Process
1. Researcher contacts Research Data Assistance Center
(ResDAC) and/or IFMC for assistance with data request
packet.
2. Researcher submits data request packet to CMS.
3. CMS approves data request, researcher submits payment
to CMS, and and CMS forwards approval to IFMC as
notification to fulfill request.
4. IFMC processes, encrypts, and delivers data package to
researcher.
5. Copy of data package archived.
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Chronic Condition Data Warehouse
Considerations when Requesting CCW Data
1. Consider broad criteria for predefined chronic
condition cohorts (indicating beneficiary probably
has condition of interest); may require narrowing for
analyses
2. Determine whether to restrict cohort based on
Medicare coverage criteria
3. Decide whether to include a control or comparison
group (chronic condition flags can make this simple)
4. Consider claims maturity
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Chronic Condition Data Warehouse
CCW Chronic Condition Flags
For each chronic condition, an annual condition flag in the Chronic
Condition Summary File includes the following values:
3 = Met full coverage criteria (Part A and B, no HMO) for entire
look-back period (varies by condition) and claims diagnosis
criteria
2 = Met full coverage criteria (Part A and B, no HMO) for entire
look-back period (varies by condition) and did not meet claims
diagnosis criteria
1 = Had intermittent coverage (any partial coverage combination
of Part A or B, or HMO) for the look-back period and met
claims diagnosis criteria
0 = Had intermittent coverage (any partial coverage combination
of Part A or B, or HMO) for the look-back period and did not
meet claims diagnosis criteria
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Note: Coverage required only up to month of death.
Chronic Condition Data Warehouse
Defining CCW Cohorts:
• Use CC Summary File flags
Example: Study diabetes health services in 2005 with
control group of non-diabetes health services
- Cohort of CC diabetes flag = 3
- Control of CC diabetes flag = 2
• Use Beneficiary Summary File variables to further define
(or supplement) cohorts using additional demographics,
partial coverage options, HMO coverage, etc.
Note: CCW does not contain managed care claims.
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Number of Medicare Beneficiaries in 5% Sample for 2005 by Chronic Condition1
Number of
Reference Period
Chronic Condition
Acute Myocardial Infarction
Alzheimer's Disease
Alzheimer's Disease and Related Disorders or Senile Dementia
Atrial Fibrillation
Cancer, Colorectal
Cancer, Endometrial
Cancer, Female Breast
Cancer, Lung
Cancer, Prostate
Cataract
Chronic Kidney Disease
Chronic Obstructive Pulmonary Disease
Congestive Heart Failure
Diabetes
Glaucoma
Hip/Pelvic Fracture
Ischemic Heart Disease
Major Depression
Osteoporosis
Rheumatoid Arthritis/Osteoarthritis
Stroke/Transient Ischemic Attack
None of the conditions
1Twenty-one
194,726
153,939
15,931
2,329
27,250
15,868
39,687
550,325
172,604
239,467
349,256
461,861
208,139
22,075
628,481
261,438
278,546
415,404
113,281
759,108
(in years)3
1
3
3
1
1
1
1
1
1
1
2
1
2
2
1
1
2
1
1
2
1
chronic conditions have been predefined by CMS for timely, efficient extraction of CCW data files.
based on beneficiaries who were alive on January 1, 2005 and enrolled in Part A or Part B for at least one
month during the reference year.
3Reference period represents the look-back time period during which a beneficiary qualified for a condition.
2Counts
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Beneficiaries2
27,209
91,626
Chronic Condition Data Warehouse
Types of coverage used for these analyses:
•
Full 1YR (no break in coverage)
Months PtA + Months PtB – Months HMO = 24
•
Partial 1YR (minimal break in coverage)
Months PtA + Months PtB – Months HMO  22
•
January
PtA & PtB & no HMO in January of reference year
•
July
PtA & PtB & no HMO in July of reference year
•
Any
At least one month PtA or PtB
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Chronic Condition Data Warehouse
Beneficiary Demographics by Type of Coverage in 2005*
Age
< 65
Full
January
July
Any
249,063
254,887
261,077
270,580
349,167
16,048
21,328
17,220
48,265
107,316
66-75
675,756
684,816
700,203
692,055
911,322
76-85
498,175
503,731
512,023
494,859
634,288
> 85
183,263
185,461
187,348
172,573
230,435
July
Any
65
Race
Full
Partial
January
White
1,386,624
1,408,142
1,427,028
1,425,827
1,870,224
Black
154,508
158,329
163,980
164,216
220,950
Asian
21,192
21,715
22,198
22,779
37,313
Hispanic
31,849
33,200
35,166
35,132
53,325
6,907
7,023
7,143
7,300
9,209
18,837
19,387
19,893
20,696
37,171
2,388
2,427
2,463
2,382
4,336
N Am Native
Other
Unknow n
*Based on 5% Medicare sample.
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Partial
Chronic Condition Data Warehouse
Number of Beneficiaries with Chronic Condition(s) in 2005*
by Type of Coverage
Number of Beneficiaries
800,000
600,000
400,000
200,000
0
0**
1
2-3
4+
Number of Chronic Conditions
Full 1YR
* Based
July
Any
on 5% Medicare sample.
coverage includes beneficiaries who may not have sufficient coverage to meet the chronic
condition diagnosis criteria.
**Any
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Partial 1YR
Chronic Condition Data Warehouse
Number of Beneficiaries
Number of Beneficiaries with Acute Myocardial Infarction
in 2005* by Age and Type of Coverage
12,000
10,000
8,000
6,000
4,000
2,000
0
< 65
65
66-75
Age (in years)
Full 1YR
Partial 1YR
*Based on 5% Medicare sample.
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July
Any
76-85
> 85
Chronic Condition Data Warehouse
Number of Beneficiaries
Number of Beneficiaries with Colorectal Cancer
in 2005* by Age and Type of Coverage
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
< 65
65
66-75
Age (in years)
Full 1YR
Partial 1YR
July
*Based on 5% Medicare sample.
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Any
76-85
> 85
Chronic Condition Data Warehouse
Number of Beneficiaries
Number of Beneficiaries with Diabetes in 2005*
by Age and Type of Coverage
200,000
150,000
100,000
50,000
0
< 65
65
66-75
Age (in years)
Full 2YR
Partial 2YR
Full 1YR
*Based on 5% Medicare sample.
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July
Any
76-85
> 85
Chronic Condition Data Warehouse
CCW Cohort Considerations:
•
Effect of coverage selections varies by:
1. Demographics (e.g., age)
2. Condition
3. Look-back period
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•
Equal opportunity for observing diagnosis of interest in
control group as in cohort
•
ResDAC/IFMC Review Board can assist with refining
selection criteria
Chronic Condition Data Warehouse
Total Medicare Payment
($ Billions)
Total Medicare Payments ($275 Billion) in 2005
by Claim Type and Number of Chronic Conditions
180
160
140
120
100
80
60
40
20
0
0
1
2-3
4+
Number of Chronic Condition(s)
DMERC
Carrier
Hospice
Outpatient
HHA
SNF
Inpatient
*Includes total Medicare fee-for-service payments; extrapolated from 5% Medicare sample.
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Chronic Condition Data Warehouse
Percent of Medicare Payments*
for Beneficiaries with Diabetes in
2005 by Claim Type
Carrier
24%
Percent of Claims*
for Beneficiaries with Diabetes
in 2005 by Claim Type
Inpatient
DMERC 1% SNF
1%
9%
DMERC
4%
Inpatient
46%
HHA
1% Outpatient
13%
Hospice
<1%
Hospice
2%
Outpatient
12%
HHA
5%
SNF
7%
Carrier
75%
*Includes total Medicare fee-for-service payments/claims for beneficiaries identified as having
diabetes; based on 5% Medicare sample.
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Chronic Condition Data Warehouse
Number of Medicare Beneficiaries* with Diabetes and
Total Medicare Payment Amounts by Year
$90.3
$102.2
$113.5
$120
$100
8
$80
6
$60
4
$40
2
$20
0
Total Payment Amount
($ Billions)
Number of Beneficiaries
(in Millions)
10
$0
2003
Number of Beneficiaries
2004
2005
Payment Amount
*Includes total Medicare fee-for-service payments/claims for beneficiaries identified as having
diabetes; based on extrapolation from 5% Medicare sample.
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Chronic Condition Data Warehouse
Research Potential Using CCW Data
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•
Supports increased need for chronic disease research as
aging population increases
•
Allows longitudinal analyses of Medicare utilization,
expenditures, quality of care, and health outcomes across
continuum of care
•
Provides researchers with low cost, easy-to-use data files
•
Flexible data extract system allows researchers to
request only minimum data needed for studies
Chronic Condition Data Warehouse
Potential Enhancements for CCW
•
Part D enrollment and drug event data (pending federal
regulation)
•
Enhanced Summary Files:
•
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–
Beneficiary Summary File
–
Chronic Condition Summary File
–
Condition-specific statistics in form of beneficiarylevel (deidentified) analytical file
–
Care setting/timeline summary file
SAS code for deriving denominators
Chronic Condition Data Warehouse
Questions?
Visit these web sites for additional information!
Research Data Assistance Center
www.resdac.umn.edu
E-Mail: resdac@umn.edu
Phone: 1-888-9-ResDAC or 1-888-973-7322
Iowa Foundation for Medical Care
www.ccwdata.org
E-Mail: ccwdata@ifmc.org
Phone: 1-800-383-2856, ext. 8357
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