Iowa Foundation for Medical Care
Chronic Condition Data Warehouse
CMS 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
June 4, 2007
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Chronic Condition Data Warehouse
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)
Population: 2005 - Forward
• 100% Medicare beneficiaries
• Linked with historical data
• Random 5% sample flags
• Current data
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Chronic Condition Data Warehouse
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
Chronic Condition Categories
Researchers may request data for 21 predefined chronic
condition categories, allowing for timely data extraction:
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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
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Iowa Foundation for Medical Care
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
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
Web Site – Statistical Summaries
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Chronic Condition Data Warehouse
Chronic Condition Data Warehouse
Statistical Summaries – Beneficiary Demographics
Statistical Summaries – Population Statistics
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Iowa Foundation for Medical Care
Chronic Condition Data Warehouse
Chronic Condition Data Warehouse
Statistical Summaries – Assessment data
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
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
• CCW (CMS) Denominator (100% or 5% sample)
• Beneficiary Summary File
• Chronic Condition Summary File
• Medicare Current Beneficiary Survey (MCBS)
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 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)
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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Iowa Foundation for Medical Care
Chronic Condition Data Warehouse
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
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.
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Number of Medicare Beneficiaries in 5% Sample for 2005 by Chronic Condition
Number of
Reference Period
Chronic Condition Data Warehouse
Chronic Condition
Acute Myocardial Infarction
Alzheimer's Disease
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.
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
Note: CCW does not contain managed care claims.
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Beneficiaries
27,209
91,626
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)
1
3
3
3
1
1
1
1
1
1
1
2
1
2
2
1
1
2
1
1
2
1
1Twenty-one chronic conditions have been predefined by CMS for timely, efficient extraction of CCW data files.
2
Counts 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.
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Iowa Foundation for Medical Care
Chronic Condition Data Warehouse
Chronic Condition Data Warehouse
Beneficiary Demographics by Type of Coverage in 2005*
Types of coverage used for these analyses:
•
Age
Full 1YR (no break in coverage)
•
•
Full
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
Months PtA + Months PtB – Months HMO = 24
65
Partial 1YR (minimal break in coverage)
Months PtA + Months PtB – Months HMO ≥ 22
Partial
January
January
Race
PtA & PtB & no HMO in January of reference year
•
•
Full
Partial
January
White
1,386,624
1,408,142
1,427,028
1,425,827
1,870,224
July
Black
154,508
158,329
163,980
164,216
220,950
PtA & PtB & no HMO in July of reference year
Asian
21,192
21,715
22,198
22,779
37,313
Hispanic
31,849
33,200
35,166
35,132
53,325
Any
N Am Native
At least one month PtA or PtB
Other
Unknow n
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Chronic Condition Data Warehouse
9,209
37,171
2,382
4,336
12,000
Number of Beneficiaries
Number of Beneficiaries
7,300
20,696
2,463
Number of Beneficiaries with Acute Myocardial Infarction
in 2005* by Age and Type of Coverage
600,000
400,000
200,000
0
2-3
7,143
19,893
2,427
Chronic Condition Data Warehouse
800,000
1
7,023
19,387
2,388
*Based on 5% Medicare sample.
Number of Beneficiaries with Chronic Condition(s) in 2005*
by Type of Coverage
0**
6,907
18,837
10,000
8,000
6,000
4,000
2,000
0
4+
< 65
Number of Chronic Conditions
65
66-75
76-85
> 85
Age (in years)
Full 1YR
Partial 1YR
Any
July
Full 1YR
* Based
on 5% Medicare sample.
coverage includes beneficiaries who may not have sufficient coverage to meet the chronic
condition diagnosis criteria.
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Partial 1YR
Chronic Condition Data Warehouse
Number of Beneficiaries with Diabetes in 2005*
by Age and Type of Coverage
7,000
Number of Beneficiaries
Number of Beneficiaries
Number of Beneficiaries with Colorectal Cancer
in 2005* by Age and Type of Coverage
6,000
5,000
4,000
3,000
2,000
1,000
0
200,000
150,000
100,000
50,000
0
< 65
65
66-75
76-85
Any
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Chronic Condition Data Warehouse
< 65
July
*Based on 5% Medicare sample.
**Any
65
66-75
> 85
76-85
> 85
Age (in years)
Age (in years)
Full 1YR
Partial 1YR
July
Full 2YR
Any
*Based on 5% Medicare sample.
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Partial 2YR
Full 1YR
July
Any
*Based on 5% Medicare sample.
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Iowa Foundation for Medical Care
Chronic Condition Data Warehouse
Chronic Condition Data Warehouse
CCW Cohort Considerations:
•
Total Medicare Payments ($275 Billion) in 2005
by Claim Type and Number of Chronic Conditions
Effect of coverage selections varies by:
1. Demographics (e.g., age)
3. Look-back period
•
Equal opportunity for observing diagnosis of interest in
control group as in cohort
•
ResDAC/IFMC Review Board can assist with refining
selection criteria
180
160
140
120
100
80
60
40
20
0
Total Medicare Payment
($ Billions)
2. Condition
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
DMERC
9%
DMERC
4%
Inpatient
1% SNF
1%
Number of Medicare Beneficiaries* with Diabetes and
Total Medicare Payment Amounts by Year
HHA
1% Outpatient
13%
Inpatient
46%
10
Hospice
<1%
Hospice
2%
Outpatient
12%
HHA
5%
SNF
7%
$90.3
Carrier
75%
$113.5
$100
$80
$60
4
$40
2
$20
0
$0
Number of Beneficiaries
*Includes total Medicare fee-for-service payments/claims for beneficiaries identified as having
diabetes; based on 5% Medicare sample.
$120
6
2003
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$102.2
8
Total Payment Amount
($ Billions)
Carrier
24%
Percent of Claims*
for Beneficiaries with Diabetes
in 2005 by Claim Type
Number of Beneficiaries
(in Millions)
Percent of Medicare Payments*
for Beneficiaries with Diabetes in
2005 by Claim Type
Chronic Condition Data Warehouse
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
Chronic Condition Data Warehouse
Research Potential Using CCW Data
Potential Enhancements for CCW
•
Supports increased need for chronic disease research as
aging population increases
•
Part D enrollment and drug event data (pending federal
regulation)
•
Allows longitudinal analyses of Medicare utilization,
expenditures, quality of care, and health outcomes across
continuum of care
•
Enhanced Summary Files:
•
Provides researchers with low cost, easy-to-use data files
•
Flexible data extract system allows researchers to
request only minimum data needed for studies
•
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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
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Iowa Foundation for Medical Care
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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