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May 7 -- The Centers for Medicare & Medicaid Services (CMS) invites public review and comment to OMB by June 9, 2021 of its proposal to conduct the Medicare Health Outcomes Survey (HOS). Medicare Advantage Organizations (MAOs), and researchers rely on the consistent collection of Medicare beneficiary health outcomes data from the HOS to understand trends in the health outcomes of the MAO population over time and to inform continuous quality improvement.

The HOS is a longitudinal patient-reported outcome measure (PROM) that assesses self-reported beneficiary quality of life and daily functioning. As a PROM, the HOS measures the impact of services provided by MAOs, whereas process and patient experience measures only provide a snapshot of activities or experiences at a specific point in time. PROM data collected by the HOS allows CMS to continue to assess the health of the Medicare Advantage population. This older population is at increased risk of adverse health outcomes, including chronic diseases and mobility impairments that may significantly hamper quality of life. The HOS supports CMS's commitment to improve health outcomes for beneficiaries while reducing burden on providers. CMS accomplishes this by focusing on high-priority areas for quality measurement and improvement established in the agency's Meaningful Measures Framework. The HOS uses quality measures that ask beneficiaries about health outcomes related to specific mental and physical conditions.

Consistent collection of HOS PROM data for the Medicare population has allowed CMS, MAOs, and researchers to understand trends in the Medicare population’s health outcomes over time as well as beneficiary perspectives on their own health status.

Each year the HOS is administered (Baseline) to a random sample of MAO beneficiaries from participating MAOs that have a minimum of 500 enrollees. Two years later, the baseline respondents are surveyed again (Follow-up). For each member who completes the Follow-Up Survey, a two-year change score is calculated and (accounting for risk-adjustment factors) the member’s physical and mental health status is categorized as “better than expected,” “as expected,” or “worse than expected.” Summary HOS results are calculated for each MAO based on aggregated beneficiary outcomes. CMS includes multiple measures from HOS in the Medicare Star Ratings program to help consumers choose health plans.4 Star Ratings serve as the basis for a quality bonus payments (QBPs) for Medicare Advantage plans that was implemented in 2012.

CMS continues to consider how new longitudinal PROMs may be developed from the HOS. For example, CMS is considering a new longitudinal measure, Physical Functioning Activities of Daily Living (PFADL), to further assess health status. PFADL measures the change in the physical functioning of beneficiaries enrolled in MAOs over a two-year period and complements the measurement of physical health status. PFADL was introduced as a display measure for 2021 (display measures are publicly reported for informational purposes only and are not included in the Star Ratings or used for QBP calculations.) CMS is in the process of exploring additional HOS measures for plans to use as a focus of their quality improvement efforts.

Medicare HOS website: https://www.hosonline.org/
HOS submission to OMB: https://www.reginfo.gov/public/do/PRAViewICR?ref_nbr=202104-0938-016 Click on IC List for survey instruments, View Supporting Statement for technical documentation, including crosswalk of proposed changes
FR notice inviting comment: https://www.federalregister.gov/documents/2021/05/07/2021-09750/agency-information-collection-activities-submission-for-omb-review-comment-request

Point of contact: hos@hsag.com 888-880-0077

For AEA members wishing to provide comments, "A Primer on How to Respond to Calls for Comment on Federal Data Collections" is available at https://www.aeaweb.org/content/file?id=5806

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