Linking HOS with Part D Data
KAZI AHMED Ph.D.
Assistant Vice President
President, Analysis
Anal sis
Robert Saunders, Ph.D.
Rachel Collins, MPH
June 28, 2010
NCQA: A BRIEF INTRODUCTION
• Private, independent non-profit health
care quality
lit oversight
i ht organization
i ti
founded in 1990
• Committed to measurement,
transparency and accountability
• Unite diverse groups around common
goal: improving health care quality
2
NCQA MILESTONES
• 70% of insured Americans are in an NCQA
Accredited health plan
• 109 million Americans are in an NCQA
Accredited
i
health plan
• 41% of all health plans in the United States
are NCQA Accredited
HEDIS® is a registered trademark of NCQA.
NCQA
3
NCQA MILESTONES, CONT’D
• 38 states and the Federal government rely
on NCQA Accreditation and HEDIS
• Over 12,000 physicians recognized through
NCQA’s Recognition Programs
– NCQA’s Recognition Programs form the basis of
quality improvement programs nationwide
4
What is HEDIS®?
• Healthcare Effectiveness Data and Information Set (HEDIS)
comprises of 76 process, outcomes and structure
measures grouped into 8 domain areas (effectiveness of care,
care
access/availability of care, satisfaction with the experience of care, use
of services, cost of care, health plan descriptive information, health plan
stability, and informed health care choices)
• Member level data collected for some measures
–
Consumer Assessment of Healthcare Providers & Systems
(CAHPS®) survey and Health Outcomes Survey (HOS)
• Plan level data collected for all other measures
– Administration (claims) or medical records data sources
• For most reporting all data are aggregated at plan level.
The format of the file is one record per plan per measure.
• HEDIS measures are used by Commercial, Medicare, and
Medicaid plans alike
5
Medicare Health Outcomes Survey
(HOS)
•HOS collects longitudinal, functional status
survey data for Medicare beneficiaries
enrolled in Medicare Advantage plans.
–A
Assess a Medicare
M di
Advantage
Ad
t
Organization’s
O
i ti ’
(MAO) ability to maintain or improve the
physical and mental health of its Medicare
members over time.
• Project began in 1997 as the Health of Seniors Survey
• Administered to a random sample of members from each
Medicare Managed Care Organization (MAO)
• Cohort surveyed and then re-surveyed
re surveyed 2 years later
6
HOS Reporting Requirements
• Contracts in effect for at least 1 year with
a minimum
i i
enrollment
ll
t off 500 members
b
• Types of Plans:
– All Coordinated Care Plans: Medicare
Advantage Organizations (MAOs) including
local and regional Preferred Provider
Organizations (PPOs)
(PPOs), and
– Continuing cost contracts that held §1876 risk
and cost contracts
– Private Fee-for-Service Plans and Medical
Savings Accounts (voluntarily)
7
HOS Components
• Total number of questions in the HOS 2.0 Survey = 64
• Veterans RAND 12 Item Health Survey (VR-12)
(VR 12) as core
(adapted from Veterans RAND 36-item (VR-36) Health
Survey)
• Additional items:
– Information for case
case-mix
mix adjustment
– Information required by the 1997 Balanced Budget
Act
– Select HEDIS Effectiveness of Care measures
• Management of Urinary Incontinence in Older Adults (MUI),
Physical Activity in Older Adults (PAO), Fall Risk Management
(FRM), and Osteoporosis Testing in Older Women (OTO)
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Health Outcomes Survey (HOS)
• Two summary scores:
– VR 12 items form 8 scales (physical functioning (pf)
(pf), rolephysical (rp), bodily pain (bp), general health (gh), vitality (vt),
social functioning (sf), role-emotional (re), mental health (mh))
• 8 scales summarized into 2 measures
– Physical component summary score (PCS)
– Mental
M t l componentt summary score (MCS)
• Normed for U.S. population using normative values so that 50
represents the national average for summary scores and +/- 10
represents 1 standard
d d deviation
d i i
above
b
or below
b l
the
h mean
• 2-year change scores:
– Beneficiaries’ physical and mental health status are categorized
as better, the same or worse than expected.
• Case mix adjusted
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Why Link Part D Events with HOS
• Unique opportunity to directly examine
– drug benefits and usage
– Association between drug utilization and patient specific
physical and mental health outcomes
• Some research questions:
q
– What % of the HOS beneficiaries used Part D?
– How do beneficiaries with or without PDE compare along
demographic
g p
characteristics,, health outcomes,, plans,
p
, and
geographical location?
– What is the average number of prescription drugs used? What is
the average number of refills?
– What is the average patient pay amount and how do they vary
across demographic groups, health outcomes, plans, and
regions?
– What
Wh t classes
l
off d
drugs are mostt commonly
l used
d and
d how
h
do
d
they vary across demographics, health outcomes, plans, and
regions/states?
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PART D DATA (13 variables)
ID
Dates
Drug Dispensed
Cost
Dosage
Part D Event id
RX service date (date
prescription filled)
Quantity dispensed
(number of units
units-grams,
grams,
milliliters, etc. dispensed
in the current drug)
patient pay amount
(non-reimbursable
(non
reimbursable $
beneficiary paid),
dosage form code
(tablet, capsule, or
liquid)
beneficiary identifier
days supply (number of
y supply
pp y of
day’s
medication)
gross drug cost
(
(composite
p
of ingredient
g
cost paid, dispensing fee
paid, and total amount
attributed to sales tax)
dosage form code
description
p
((extended
text of dosage form
code)
product service id (NDC
p
drug)
g)
of dispensed
brand name (name that
appears
pp
on p
package)
g )
generic name (drug
ingredient name
adopted by
USAN/chemical name
when USAN not
available
drug strength
(description of drug
potency in units of
grams, milligrams, %,
other)
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Description of PDE File
• Part D Drug File of Prescription Drug Events
– CMS used the HOS Sample Frame to identify
all PDEs generated by members using all
related identification numbers
– One record-per-PDE-per-person
p
p p
(i.e., multiple prescriptions for multiple drugs)
– ≈ 11m records generated by members in the
sample frame
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Description of HOS File
• HOS Survey Database (People)
–
–
–
–
One record-per-person
188k members in the sample
p frame
118k members completed ≥ 50% of survey
≈ 60% response rate (for purposes of this
analysis)
13
Linking the Files
• 2006-2008 Medicare Cohort 9 HOS data (baseline and follow-up)
linked with 2006-2007 Medicare Part D Prescription
p
Drug
g Event ((PDE))
data
• Link records based on unique beneficiary ID (Health Insurance
Claims (HIC) number and Social Security Number (SSN))
• Person-matching: Sample Frame
– ≈ 168k people generated the 11m PDEs (≈ 20k did not have any
PDEs)
– Person-level match rate of 89%
• Person-matching:
Person matching: HOS Baseline Respondents
– ≈ 118k people had a usable baseline survey
– ≈ 100k people with baseline and PDE
– Person-level match rate of 85%
• Initial Inference: about 85% of HOS respondents use Part D for
prescription
i ti
drugs
d
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Linking Results
•
•
•
•
•
•
HOS n=118,279 (respondents with complete or partially complete baseline survey)
Match rate=85.3% (n=100,873) linked to Part D Event data set
–
Possible reasons for non
non-matching
matching PDEs
• Respondent was enrolled in Part D but did not use the benefit in 2006 and 2007
• The respondent was in a MA-only plan (not a MA-PD) and thus not enrolled in Part D
10,309,177 drug event records representing 3421 unique 9-digit NDC codes
Frequency of prescription drugs dispensed
–
–
–
Mean number of unique 9-digit drugs for each MA enrollees= 4.3 (Min=1 and Max=132)
Mean number of times a MA enrollee has a prescription for each of the 9-digit drug
numbers= 14.8 (Min=1 and Max =177)
Mean number of refills=5.78 (Min=1 and Max=131)
–
Demographics
Characteristics of non-matched versus matched
•
•
•
•
•
Women more likely to be enrolled in Part D than men (87%vs 82%)
Less than or equal to 65 most likely to use Part D than those over 65 (92% vs 84-86%)
Asian and Hispanic population utilization rate (92 vs 95%)
African American and American Indian population utilization rate (88% each)
White population utilization rate (85%)
Geographical characteristics
• Utilization rate among respondents in Mid-Atlantic
Mid Atlantic and East North Central (81 and 75% respectively)
• Utilization rate among respondents in the South Atlantic, North East and US Territories (94, 91 and 95%
respectively)
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Part D DPE Data Limitation
• Approximately 11% of HOS beneficiaries
did nott h
have matching
t hi
PDEs
PDE
• May have used other drug sources
• Non-whites higher usage rate-why?
• Do whites have alternatives to Part D
– Potential source of bias in estimates
• No Standardized Drug Classification
information available
• We used
d VA drug
d
classification
l
ifi ti
–only
l 60% off our
drugs matched VA classification
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Thank You!
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