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  • Measure Summary
  • NQMC:010554
  • Oct 2015

The Medicare Health Outcomes Survey-Modified: percentage of members whose health status was "better than expected," "the same as expected" or "worse than expected" at the end of a two-year period.

National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.
National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.
National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 6, specifications for the Medicare health outcomes survey. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.

This is the current release of the measure.

This measure updates previous versions:

  • National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.
  • National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.
  • National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 6, specifications for the Medicare health outcomes survey. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.

Primary Measure Domain

Clinical Quality Measures: Outcome

Secondary Measure Domain

Does not apply to this measure

Description

This measure provides a general indication of how well a Medicare Advantage Organization (MAO) manages the physical and mental health of its members. The survey measures physical and mental health status at the beginning and end of a two-year period, when a change score is calculated. Each member's health status is categorized as "better than expected," "the same as expected" or "worse than expected," accounting for death and risk-adjustment factors. MAO-specific results are assigned as percentages of members whose health status was better, the same or worse than expected.

The Medicare Health Outcomes Survey-Modified (HOS-M) is administered to vulnerable Medicare beneficiaries who are enrolled in Program of All-Inclusive Care for the Elderly (PACE) plans and are at greatest risk for poor health outcomes.

Rationale

The Medicare Health Outcomes Survey (HOS) measure looks at keeping Medicare members healthy, with a high health-care-related quality of life. It assesses the organization's ability over time to maintain or improve the health status of its members. The measure is designed to quantify the physical and mental health of the Medicare population at the beginning and end of a defined period. The HEDIS Medicare HOS is the primary health outcome measure for seniors enrolled in a Medicare health plan.

The main goal of Medicare Health Outcomes Survey-Modified (HOS-M) is to assess the frailty of the population in order to adjust Medicare payments.

Evidence for Rationale

National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.

National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 6, specifications for the Medicare health outcomes survey. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.

Primary Health Components

Physical health; mental health; functional status

Denominator Description

Medicare members age 55 years and older as of January 1 who completed a baseline and two-year follow-up Medicare Health Outcomes Survey-Modified (HOS-M) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Members from the denominator whose physical and mental health status was "better than expected," "the same as expected" or "worse than expected" at the end of the two-year period

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

All HEDIS measures undergo systematic assessment of face validity with review by measurement advisory panels, expert panels, a formal public comment process and approval by the National Committee for Quality Assurance's (NCQA's) Committee on Performance Measurement and Board of Directors. Where applicable, measures also are assessed for construct validity using the Pearson correlation test. All measures undergo formal reliability testing of the performance measure score using beta-binomial statistical analysis.

Evidence for Extent of Measure Testing

Rehm B. (Assistant Vice President, Performance Measurement, National Committee for Quality Assurance, Washington, DC). Personal communication. 2015 Mar 16.  1 p.

State of Use

Current routine use

Current Use

Accreditation

Decision-making by businesses about health plan purchasing

Decision-making by consumers about health plan/provider choice

External oversight/Medicare

Internal quality improvement

Public reporting

Measurement Setting

Managed Care Plans

Professionals Involved in Delivery of Health Services

Does not apply to this measure (e.g., measure is not provider specific)

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

Age 55 years and older

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Staying Healthy

IOM Domain

Effectiveness

Case Finding Period

Two-year baseline and follow-up survey administration period

Denominator Sampling Frame

Enrollees or beneficiaries

Denominator (Index) Event or Characteristic

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Medicare members age 55 years and older as of January 1 who completed a baseline and two-year follow-up Medicare Health Outcomes Survey-Modified (HOS-M). Aged and disabled members are eligible for the measure.

Note:

  • Continuous enrollment: Members must have been continuously enrolled from January 1 to February 1 with no gaps in enrollment.
  • Complete survey = Q4a-f are answered

Exclusions

  • Members with end-stage renal disease (ESRD) are excluded.
  • Members assigned one of the following disposition status codes are ineligible for the survey:
    • Deceased
    • Language barrier
    • Bad address and nonworking/unlisted phone number, or member is unknown at the dialed phone number
    • Removed from sample
    • Duplicate, beneficiary listed twice in the sample frame
    • Nonresponse:
      • Partial complete survey (the member answered one or more questions but one or more of Q4a-f are unanswered)
      • Refusal by member
      • Refusal by proxy
      • Refusal by gatekeeper
      • Respondent unavailable
      • Respondent physically or mentally incapacitated
      • Respondent institutionalized
      • Nonresponse after maximum attempts

Exclusions/Exceptions

Patient factors addressed

Numerator Inclusions/Exclusions

Inclusions
Members from the denominator whose physical and mental health status was "better than expected," "the same as expected" or "worse than expected" at the end of the two-year period

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Patient/Individual survey

Type of Health State

Functional Status

Instruments Used and/or Associated with the Measure

Veterans RAND 12-item Health Survey (VR-12)

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Frequency Distribution

Rate/Proportion

Interpretation of Score

Desired value is a score falling within a defined interval

Allowance for Patient or Population Factors

Risk adjustment devised specifically for this measure/condition

Description of Allowance for Patient or Population Factors

The Health Outcomes Survey (HOS) questionnaire contains a number of items that provide information needed for adjustment of observed outcomes to account for risk outside of Medicare Advantage Organization (MAO) control, such as chronic comorbid conditions and functional limitations. Risk adjustment is essential for meaningful and valid plan-to-plan comparison of health outcomes.

Plan-to-plan comparison of health outcomes is also adjusted for a number of respondent characteristics at baseline, including age, gender, race, education and chronic conditions. Results of the risk-adjusted outcomes are aggregated across respondents for each MAO.

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Original Title

The Medicare Health Outcomes Survey-Modified (HOS-M).

Measure Collection Name

HEDIS 2016: Health Plan Collection

Measure Set Name

Effectiveness of Care

Measure Subset Name

Measures Collected Through Medicare Health Outcomes Survey

Submitter

National Committee for Quality Assurance - Health Care Accreditation Organization

Developer

National Committee for Quality Assurance - Health Care Accreditation Organization

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

National Committee for Quality Assurance's (NCQA's) Measurement Advisory Panels (MAPs) are composed of clinical and research experts with an understanding of quality performance measurement in the particular clinical content areas.

Financial Disclosures/Other Potential Conflicts of Interest

In order to fulfill National Committee for Quality Assurance's (NCQA's) mission and vision of improving health care quality through measurement, transparency and accountability, all participants in NCQA's expert panels are required to disclose potential conflicts of interest prior to their participation. The goal of this Conflict Policy is to ensure that decisions which impact development of NCQA's products and services are made as objectively as possible, without improper bias or influence.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Oct

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates previous versions:

  • National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.
  • National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.
  • National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 6, specifications for the Medicare health outcomes survey. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.

Source(s)

National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.

National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.

National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 6, specifications for the Medicare health outcomes survey. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.

Measure Availability

Source available for purchase from the National Committee for Quality Measurement (NCQA) Web site External Web Site Policy.

For more information, contact NCQA at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Phone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org External Web Site Policy.

Companion Documents

The following is available:

  • National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 2, technical update. Washington (DC): National Committee for Quality Assurance (NCQA); 2015 Oct 1. 12 p.

For more information, contact the National Committee for Quality Assurance (NCQA) at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Phone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on November 29, 2012.

This NQMC summary was updated by ECRI Institute on August 5, 2013, April 23, 2014, May 5, 2015, and again on March 18, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

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