Assessing Quality of Care of Medicare Managed Care
Health Plans and Frailty Adjustment Using the Medicare
Health Outcomes Survey and the Medicare Health
Outcomes Survey-Modified
Academy Health Annual Research Meeting
June 3, 2007
Panelists:
Vijit Chinburapa, PhD, CPHQ, HSAG
Judy Ng, PhD, NCQA
Lewis Kazis, ScD, Boston University
Sean Creighton, MSc, CMS
Nancy Kenly, MPA, CMS
Galina Khatutsky PhD Candidate, RTI International
The Medicare Health Outcomes Survey
(HOS) and the Medicare Health Outcomes
Survey-Modified (HOS-M): Introduction
Vijit Chinburapa, PhD, CPHQ
Health Services Advisory Group
Medicare HOS
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The Medicare HOS assesses each Medicare
Advantage (MA) plan's ability to maintain or improve
the physical and mental health functioning of its
Medicare beneficiaries over a two-year period
Gather valid and reliable health status data in
Medicare managed care for quality improvement
activities, public reporting, plan accountability, and
improving health outcomes
Launched in 1998 – currently completing 10th year of
survey administration
First Medicare managed care outcomes measure
More than 2 million beneficiaries surveyed to date
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HOS Version 1 (HOSv1)
1998-2005
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36-item health status measure
 Eight scales
 Physical and Mental
Component Summary Scores
(PCS and MCS)
Activities of daily living (ADLs)
Healthy days
Clinical symptoms
Chronic medical conditions
Depression screen
Demographics
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HOS Version 2 (HOSv2)
2006 - Present
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12-item health status measure
(VR-12)
 PCS and MCS
Two additional HEDIS®
measures
 Osteoporosis Testing in Older
Women (OTO)
 Fall Risk Management (FRM)
Height and weight for BMI
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Sampling Methodology
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National survey
Baseline cohort of 1,000 beneficiaries randomly sampled
from each participating plan
Mailed survey
 Telephone follow-up of non-respondents
Longitudinal: MA members surveyed at baseline, and
respondents resurveyed two years later
 Each cohort comprises respondents from one baseline
and the associated follow-up
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Medicare HOS Response Rates
Sampling
MA
Time Period Reporting
Units
Baseline
161 - 312
Cohort 1 - 8
159,31161.4% - 71.6%
301,184
Follow-up
Cohort 1 - 6
69,86589,332
146 - 188
Sample
size
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Response
Rates
77.1% - 85.8%
National Baseline Mean Unadjusted PCS and MCS Scores
Medicare HOS Surveys:1998-2005*
60.0
52.6 52.3 52.1 51.6 51.6 51.6 51.8 51.7
50.0
41.4 40.7 40.3 42.0 42.0 42.0 41.8 41.6
1998
1999
2000
2001
2002
2003
2004
2005
40.0
30.0
20.0
10.0
0.0
PCS
MCS
*1998-2000 scores were normalized based on 1990 US general population
2001 –2005 scores were normalized based on 1998 US general population
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Medicare HOS Performance
Measurement Results
Years
MA
Reporting
Units
PCS
Better
PCS
Worse
MCS
Better
MCS
Worse
1998 -2000
188
None
None
13 plans
15 plans
1999-2001
160
9 plans
5 plans
8 plans
5 plans
2000-2002
146
20 plans
1 plan
15 plans
4 plans
2001-2003
152
22 plans
1 plan
None
None
2002-2004
153
21 plans
None
27 plans
3 plans
2003-2005
154
None
None
18 plans
2 plans
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Medicare HOS-M
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The HOS-M, a modified version of the HOS, was fielded
for the first time in the spring of 2005
The survey is administered to vulnerable Medicare
beneficiaries who are enrolled in specialized Medicare
plans
The goal is to assess the frailty of the population in these
specialized plans in order to adjust Medicare payments
The survey includes 12-item physical and mental health
status questions as well as limitations and assistance
with activities of daily living (ADLs)
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Additional Information
HOS Web Site
• www.hosonline.org
HOS Technical Support
• Medicare HOS Information and Technical
Support Telephone Line: 1-888-880-0077
• E-Mail: hos@azqio.sdps.org
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