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April 9 -- The Centers for Medicare and Medicaid Services (CMS) Office of Minority Health (OMH) invites public comments by June 8, 2021 on the Medicare Beneficiary Experiences with Care Survey (MBECS) for 2021-2024.
 
Data gathered through the MBECS system will allow CMS OMH to understand and measure differences in the experiences of minority Medicare beneficiaries compared with those of the general Medicare population. This data will inform CMS OMH policies, priorities, and future initiatives, as the agency strives to reduce health disparities. This study is being conducted by CMS OMH through its contractor, NORC at the University of Chicago.  
 
The MBECS system is designed to conduct population specific surveys that will be administered to the group of interest, fielded one time. This means that over the three-year period, two individual surveys will be administered. This will allow CMS OMH to respond quickly to the data needs of stakeholders with interests in these underrepresented groups. Data collected through the MBECS system will be used to better understand—and thus serve the needs of—Medicare beneficiaries in minority populations. The core questionnaire will collect information on communication with medical professionals, coordination of health care, experiences getting needed health care, experiences with personal doctors and specialists, and key demographics. Data will be compared to benchmarks from the FFS CAHPS, MA CAHPS, and NAM CAHPS surveys. The population-specific questionnaire module described and submitted via a specific collection request will collect information about issues most relevant for that particular group of interest.

The goal of this umbrella data collection effort is to gather data via separate surveys on a variety of minority Medicare beneficiaries' experiences. Topics and questions of interest may ask about beneficiaries' communication with medical professionals, coordination of health care, experiences getting needed health care, and experiences with personal doctors and specialists. CMS OMH will compare survey data to benchmarks from the general population of Medicare beneficiaries while controlling for population characteristics, as appropriate.

Survey respondents will have the opportunity to respond to an MBECS survey via a self-administered web-based survey (also called computer-assisted web interview or CAWI). CAWI technology minimizes respondent burden by (1) Automatically providing text fills within questions and handling skip patterns based on responses to each question; (2) allowing respondents to complete the survey at a convenient time; (3) allowing respondents to stop and re-enter the survey if needed; and (4) capturing data in real-time, thereby eliminating the need for manual data entry.
  
The umbrella MBECS system will use an expanded Consumer Assessment of Healthcare Providers and Systems (CAHPS®) methodology as a standardized data collection vehicle for Medicare beneficiaries in minority populations. First, CMS OMH will develop a survey, which includes a “core” set of existing CAHPS questionnaire items. The outreach method, modes of administration, and data collection protocols will be identical across survey populations. When a specific population of interest is identified, CMS OMH will then submit an individual collections request to OMB, including a revised research and sampling plan with changes relating to the specific population of interest. These individual submissions will include the core CAHPS questionnaire plus a brief population-specific module. The brief module will include population-specific questions pulled from Federal surveys relevant to the minority population, for example: the National Health Interview Survey (NHIS), the Medicare Current Beneficiary Survey (MCBS), or the Current Population Survey (CPS). CMS OMH will also provide updated respondent materials with wording adjusted for that particular population. Each survey submitted as an individual collections request will focus on one minority group; different minority groups of interest will not be surveyed at the same time or be administered the same population-specific module.

Key to the success of collecting data from minority groups is a sampling plan that ensures adequate representation of the target population in the final analytic sample. CMS OMH proposes building the MBECS data collection system by capitalizing on three main sources. These include: existing beneficiary characteristic flags within the CMS Virtual Research Data Center (also known as the Chronic Conditions Warehouse, or CCW), International Classification of Diseases – Tenth Addition (ICD-10) codes from CMS’ Medicare-Fee-For-Service (FFS) “final action” claims from institutional and non-institutional providers, and algorithms that leverage these data sources to identify beneficiaries who are likely in the population of interest. The a priori identification of beneficiaries likely to be in the population of interest will enable CMS OMH to target individual data collection efforts to the intended population and thus ensure adequate representation in the sample. The alternative approach–screening a general population of beneficiaries in order to identify minority population—would duplicate some existing data collection efforts and is cost prohibitive.

The goal of this umbrella data collection effort is to gather data via separate surveys on a variety of minority Medicare beneficiaries’ experiences. Topics and questions of interest may ask about beneficiaries’ communication with medical professionals, coordination of health care, experiences getting needed health care, and experiences with personal doctors and specialists. CMS OMH will compare survey data to benchmarks from the general population of Medicare beneficiaries while controlling for population characteristics, as appropriate.

To achieve the goals of the MBECS system, CMS OMH will identify Medicare beneficiaries in priority minority populations of interest through review of administrative data and conduct data collection via a sequential multi-mode (web, mail, and telephone) survey that includes the module specific to one group of interest. CMS OMH will conduct up to three separate MBECS surveys over the course of this 3-year clearance. The groups considered to be priority minority populations for CMS OMH are Medicare populations that experience disproportionately high burdens of disease, worse quality of care, and barriers to accessing care. For CMS, these populations include but are not limited to, persons with intellectual or developmental disabilities, persons with mental illness, or persons with substance abuse disorders. Thus, candidates for survey through the MBECS umbrella system include beneficiaries who are: diagnosed with severe mental illness and/or intellectual or developmental disability; diagnosed with substance use disorder. Subpopulations of interest within these two key groups include Hispanic, Non-Hispanic Black or African American, and Non-Hispanic Other, including White beneficiaries. Additional demographic comparisons (e.g., rural vs. urban, age group comparison, race/ethnicity comparisons) can be made to benchmark estimates for the population of interest, where possible.  

For each of the MBECS data collection efforts, the universe of respondents will be identified either 1) using existing flags in the CMS Virtual Research Data Center (also known as the Chronic Conditions Warehouse, or CCW) or International Classification of Diseases-tenth edition (ICD-10) codes from CMS’s Medicare Fee-For-Service (FFS) “final action” claims from institutional and non-institutional providers, or 2) using algorithms that use these data sources to identify beneficiaries who are likely in the population of interest.
 
CMS Office of Minority Health: https://www.cms.gov/About-CMS/Agency-Information/OMH
Draft 2021-24 MBECS Supporting Statement: https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10701
FR notice inviting public comments (item #2):  https://www.federalregister.gov/documents/2021/04/09/2021-07342/agency-information-collection-activities-proposed-collection-comment-request
 
Point of contact: Luis Pons Perez 410-786-8557 omh@cms.hhs.gov

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