Medicare Health Outcomes Survey

Medicare HOS Publications

The Medicare HOS Partners and other leading health outcomes experts are involved in research utilizing Medicare HOS data. These efforts have resulted in the publication of a number of manuals, peer-reviewed articles, and technical reports. Research based on the HOS data has been published in academic peer-reviewed journals such as the Journal of Ambulatory Care Management, Journal of Clinical Epidemiology, Medical Care, International Journal of Geriatric Psychiatry, Health Services Research, Health and Quality of Life Outcomes, International Journal for Quality in Health Care, Health Care Financing Review, and Cancer. Topics such as quality of care, functional health, health utilities, obesity, depression, smoking, health disparities, and chronic illness have been investigated utilizing HOS data. For additional information on Medicare HOS research, please contact the HOS Information and Technical Support Line.

The following list of publications (manuals, peer-reviewed articles, and technical reports) has been assembled to provide additional information on the Medicare HOS and to facilitate the utilization of the HOS data files produced by the Medicare HOS Program.


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The table below allows a search of publications in this section based on keyword(s) and/or author’s last name, as well as drop down boxes for selection by category (Overview, Methodology, Results, Applications/Interventions), publication type (Peer Reviewed Article, Technical Report, Manual), and/or year of publication/technical report submission.

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  • Overview

  • The Veterans RAND 12 Item Health Survey (VR-12): What It Is and How It Is Used. 2007
    Iqbal SU, Rogers WH, Selim A, Qian S, Lee A, Ren XS, Rothendler J, Miller D and Kazis L.
    Center for Health Quality, Outcomes and Economic Research at Veterans Administration Medical Center and Center for the Assessment of Pharmaceutical Practices at Boston University School of Public Health.
  • Measuring and Improving Health Outcomes in Medicare: The Medicare HOS Program. 2004
    Haffer SC and Bowen S.
    Health Care Financing Review. Summer 2004. Volume 25(4): 1-3. Available online at CMS' Health Care Financing Review website.
  • The Medicare Health Outcomes Survey program: Overview, context, and near-term prospects. 2004
    Jones, Nathaniel, III, Jones, Stephanie L. and Miller, Nancy A
    Health and Quality of Life Outcomes. July 12, 2004. Volume 2(33): Available online at www.hqlo.com (PDF, 248 KB).
  • Counterpoint: Integrating Health Status into the Quality Equation. 2001
    Golden, William.
    International Journal for Quality in Health Care. February 2001. Volume 13(1): 5-6.
  • Counterpoint: Measuring, Monitoring and Reporting Functional Health Outcomes: Opportunities and Challenges in a Bold National Initiative. 2001
    Safran, Dana G.
    International Journal for Quality in Health Care. February 2001. Volume 13(1): 7-8.
  • The Health of Seniors Project. 1998
    Haffer, Samuel C., Cooper, James K. and Gordon, Catherine.
    Managed Care and Aging. American Society on Aging. Summer, 1998. Volume 5(2).
  • Medicare HOS Glossary (PDF, 156 KB) 2014

    The glossary of HOS related terms is updated for new definitions related to the annual HOS surveys and reports.
  • 2013 HOS-M Sample PACE Report (PDF, 755 KB) 2014

    The Medicare Health Outcomes Survey-Modified (HOS-M) is an abbreviated version of the Medicare HOS that is administered to Program of All-Inclusive Care for the Elderly (PACE) Organizations. The HOS-M report presents physical component summary scores and mental component summary scores, Activity of Daily Living (ADL) items, and selected health status measures for the frail, elderly Medicare beneficiaries from each organization compared to the entire HOS-M sample. This sample PACE report contains example PACE data only; however, all references to the HOS-M Total reflect actual data for the entire HOS-M sample.
  • 2013 HOS Sample Baseline Report (PDF, 1.2 MB) 2014

    After the administration of each baseline cohort, a cohort specific baseline report is produced. The baseline reports present physical component summary and mental component summary scores. The scores are case mix adjusted using demographics, chronic medical conditions, and HOS study design variables. The baseline reports also provide MAO, state, and HOS national information on the Centers for Disease Control and Prevention (CDC) Healthy Days Measures, the HEDIS Management of Urinary Incontinence in Older Adults (MUI) Measure, the HEDIS Physical Activity in Older Adults (PAO) Measure, the HEDIS Fall Risk Management (FRM) Measure, the HEDIS Osteoporosis Testing in Older Women (OTO) Measure, additional health status indicators, and demographics. A section that relates the HOS measures to the CMS Medicare Star Ratings is included. This sample MAO report contains example MAO-level data only; however, all references to the HOS Total reflect actual national-level data.
  • 2010-2012 HOS Sample Performance Measurement Report (PDF, 1.5 MB) 2013

    After the administration of each follow up cohort, a cohort specific performance measurement report is produced. A performance measurement report data set is created by merging a cohort's baseline and follow up data. Additionally, death information is incorporated into the performance measurement data set for those baseline respondents who died between baseline and follow up. The HOS performance measurement results are computed using a rigorous case mix/risk adjustment model. MAOs are rated on whether they performed Better than Expected, Same as Expected, or Worse than Expected on Physical and Mental Health. The performance measurement reports also provide MAO, state, and HOS national information on health status indicators and demographics. A section that relates the HOS measures to the CMS Medicare Star Ratings is included. This sample MAO report contains example MAO-level data only; however, all references to the HOS Total reflect actual national-level data.
  • The Medicare Health Outcomes Survey Evaluation Final Report (PDF, 2.3 MB) 2004

    In 2003 and 2004, CMS funded an independent evaluation of the HOS program. The evaluation encompassed three components: 1) a review of the context for the HOS program; 2) an evaluation of the HOS instrument and operational protocol; and 3) an assessment of policy issues related to turning HOS data into useful information for health plans, QIOs, CMS and health care researchers. This final report summarizes the findings of the overall evaluation. A brief overview is provided on the measurement of quality of care and, in particular, the transition from structural and process measures of care to outcomes of care. Also discussed is the role of quality of care assessment and improvement within a broader strategy of health plan performance measurement. Several national initiatives are noted. Further, factors that contributed to the development of the HOS program are reviewed, followed by a discussion of the HOS program administration and data utilization.

  • Methodology

  • National Committee for Quality Assurance (NCQA). HEDIS® 1998 - 2014, Volume 6: Specifications for the Medicare Health Outcomes Survey. Washington DC: NCQA Publication. 2014

    NCQA annually publishes the HEDIS®, Volume 6: Specifications for the Medicare Health Outcomes Survey manual. The manual contains background information about the survey, the measure description, the HEDIS® protocol, the English version of the HOS and HOS-M questionnaires, and the text for the survey letters and postcards. Copies of HEDIS® Volume 6 may be purchased by calling NCQA Customer Support at (888) 275-7585 or via NCQA's Secure Online Order Center (www.ncqa.org).
  • Stochastic Curtailment of Health Questionnaires: A Method to Reduce Respondent Burden. 2011
    Finkelman MD, He Y, Kim W and Lai AM.
    Statistical Medicine. 2011 Jul 20;30(16):1989-2004. Epub 2011 Apr 26. Abstract available online at U.S. National Library of Medicine website.
  • A Preference-Based Measure of Health: the VR-6D Derived from the Veterans RAND 12-Item Health Survey. 2011
    Selim AJ, Rogers W, Qian SX, Brazier J, and Kazis LE.
    Quality of Life Research. 2011 Oct;20(8):1337-47. Epub 2011 Feb19 Abstract available online at U.S. National Library of Medicine website and the article is available at the following link (PDF, 343 KB).
  • Three Methods Tested to Model SF-6D Health Utilities for Health States Involving Comorbidity/Co-occurring Conditions. 2010
    Hanmer J, Vanness D, Gangnon R, Palta M and Fryback DG.
    Journal of Clinical Epidemiology. 2010 Mar; 63(3): 331-341. Epub 2009 Nov 6. Article available online at U.S. National Library of Medicine website.
  • Updated U.S. Population Standard for the Veterans RAND 12-Item Health Survey (VR-12). 2009
    Selim AJ, Rogers W, Fleishman JA, Qian SX, Fincke BG, Rothendler JA and Kazis LE.
    Quality of Life Research. 2009. Feb; 18(1):43-52. Epub 2008 Dec 3. Abstract available online at U.S. National Library of Medicine website.
  • A Comparison of Two Procedures to Fit Multi-Level Data: PROC GLM versus PROC MIXED. 2005
    Hope, MaryAnne DePesquo and Shannon, Erin Dowd
    SUGI 30 Proceedings. April 2005. Available online at the SUGI 30 Proceedings web page.
  • Improving the Response Choices on the Veterans SF-36 Health Survey Role Functioning Scales: Results from the Veterans Health Study. 2004
    Kazis LE, Miller DR, Clark JA, Skinner KM, Lee A, Ren XS, Spiro A, Rogers WH and Ware JE.
    Journal of Ambulatory Care Management. 2004 Jul-Sep; 27(3): 263-80. Abstract available online at U.S. National Library of Medicine website.
  • Psychometric Evaluation of the SF-36® Health Survey in Medicare Managed Care. 2004
    Gandek, Barbara, Sinclair, Samuel J., Kosinski, Mark and Ware, John E.
    Health Care Financing Review. Summer 2004. Volume 25(4): 5-25. Available online at CMS' Health Care Financing Review website.
  • Estimation of Non-Response Bias in the Medicare FFS HOS. 2004
    McCall, Nancy, Khatutsky, Galina, Smith, Kevin and Pope, Gregory C.
    Health Care Financing Review. Summer 2004. Volume 25(4): 27-41. Available online at CMS' Health Care Financing Review website.
  • Measurement Comparisons of the Medical Outcomes Study and Veterans SF-36® Health Survey. 2004
    Kazis, Lewis E., Lee, Austin, Spiro, Avron, Rogers, William, Ren, Xinhua S., Miller, Donald R., Selim, Alfredo, Hamed, Alaa and Haffer, Samuel C.
    Health Care Financing Review. Summer 2004. Volume 25(4): 43-58. Available online at CMS' Health Care Financing Review website.
  • Using Multiple Survey Vendors to Collect Health Outcomes Information: How Accurate Are the Data? 2003
    Haffer, Samuel C.
    Health and Quality of Life Outcomes. April 16, 2003. Volume 1(6): Available online at www.hqlo.com.
  • Weight Adjustments in Estimates for the 1999 Medicare Health Outcomes Survey. 2002
    Hwang, Yi-Ting, Bierman, Arlene S., Haffer, Samuel C. and Wun, Lap Min.
    ASA Proceedings of the Joint Statistical Meetings. 2002. 1565-1570.
  • Interpreting SF-36® Summary Health Measures: A Response. 2001
    Ware, John E. and Kosinski, Mark.
    Quality of Life Research. 2001. Volume 10(5): 405-413, 415-420.
  • Medicare Health Outcomes Survey: An Alternative Case-Mix Methodology (PDF, 160 KB). 2007
    Selim AJ, Iqbal SU, Rogers W, Qian SX, Fincke BG, Rothendler J and Kazis LE.
    The Medicare HOS program uses the outcomes of change in health status after adjustment with a fairly complex multi-modeling case-mix methodology. The purpose of this study was to use a theory and evidence-based hierarchical approach to develop and test an alternative case-mix methodology that is simpler and more parsimonious.
  • HOS/CAHPS® Survey Integration Formative Study Design - Final Report (PDF, 728 KB) 2004

    This document provides a preliminary assessment to determine the feasibility of integrating the HOS and the Medicare Advantage (MA) CAHPS® surveys into one survey instrument. To conduct this assessment, HSAG gathered and reviewed information from a variety of sources, including 1) key stakeholders; 2) published and unpublished literature; and 3) analyses of data from the HOS, MA CAHPS®, and Medicare Fee-For-Service CAHPS® surveys. This report summarizes the findings. To evaluate the feasibility of integrating the HOS and MA CAHPS® surveys, seven key aspects of these two surveys were examined: Questionnaire Content; Survey Administrative Protocols; Analytic Strategies; Sampling Methods; Cost and Burden; Dissemination of the Results; and Uses of the Results. This report will help to inform future discussions regarding the advantages and disadvantages of integration.
  • Imputing Physical and Mental Summary Scores (PCS and MCS) for the Veterans SF-12 Health Survey in the Context of Missing Data (PDF, 387 KB) 2004
    Spiro A, Rogers WH, Qian S and Kazis LE.
    This report describes a new method (modified regression estimation) for estimating the Physical Component Score (PCS) and the Mental Component Score (MCS) from the Veterans 12-Item Health Survey in the context of missing data. The report provides a SAS® macro implementing this method, with instructions for use of the macro.
  • Imputing the Physical and Mental Summary Scores (PCS and MCS) for the MOS SF-36 and the Veterans SF-36 Health Survey in the presence of Missing Data (PDF, 664 KB) 2004
    Rogers WH, Qian S and Kazis L.
    This report compares five different methods for imputing missing data in responses to a 36-item health survey. The various methods are compared in terms of both variance and degree of bias.
  • Calculating HOS Performance Measurement Results (PDF, 345 KB) 2004
    Rogers WH, Gandek B and Sinclair SJ.
    This document provides a detailed outline of the steps utilized for the calculation of Cohorts 1-6 HOS Performance Measurement results. The Performance Measurement results are based on risk adjusted mortality rates, and changes in physical and mental functioning and well being, among living beneficiaries over a two-year period. SAS® code utilized for the calculation of the Cohort 3 Performance Measurement results is also included.
  • HOS/VA (Veterans Administration) Comparison Project Part 1: Measurement Equivalence of Medicare HOS SF-36 and VA Veterans SF-36 (PDF, 227 KB)
    Spiro A, Lee AF, Kazis LE, Miller DR, Ren XS and Zhang M.
    This paper provides evidence that scales from a 36-item health survey can be computed and compared between the HOS and VA. Although differences exist between the two instruments, the paper's establishment of partial metric equivalence suggests that quantitative comparisons between the two samples are appropriate.
  • HOS/VA Comparison Project Part 2: Test of Reliability and Validity at the Scale Level for the Medicare HOS SF-36 and VA Veterans SF-36 (PDF, 63 KB)
    Kazis LE, Lee AF, Spiro A, Miller DR, Rogers W, Ren XS and Zhang M.
    This paper provides evidence that the scales and component summaries from the Veterans 36-Item Health Survey are as reliable and valid as those generated utilizing the Medicare HOS version. The results strongly suggest that the Veterans 36-Item Health Survey is suitable for comparisons at the scale level with the Medicare HOS version.

  • Results

  • Multiple Chronic Medical Conditions and Health-Related Quality of Life in Older Adults, 2004–2006. 2013
    Barile JP, Thompson WW, Zack MM, Krahn GL, Horner-Johnson W, Bowen SE.
    Preventive Chronic Disease. 2013; 10:120282. Available online at http://dx.doi.org/10.5888/pcd10.120282
  • Urinary Incontinence, Functional Status, and Health-Related Quality of Life Among Medicare Beneficiaries Enrolled in the Program for All-Inclusive Care for the Elderly and Dual Eligible Demonstration Special Needs Plans. 2013
    Khatutsky G, Walsh EG, and Brown DW.
    Journal of Ambulatory Care Management. 2013. Jan;36(1):35-49. Abstract available online at U.S. National Library of Medicine website.
  • Multiple Risk Factors and the Likelihood of Patient-Physician Communication and Health Maintenance Services in Medicare Health Plans. 2013
    Ng JH, Scholle SH, Kong VW, and Pawlson LG.
    Journal of Ambulatory Care Management. 2013. Jan;36(1):50-70. Abstract available online at U.S. National Library of Medicine website.
  • Health-Related Quality of Life and Quality of Care in Specialized Medicare-Managed Care Plans. 2013
    Grace SC, Elliott MN, Giordano LA, Burroughs JN, and Malinoff RL.
    Journal of Ambulatory Care Management. 2013. Jan;36(1):72-84. Abstract available online at U.S. National Library of Medicine website.
  • Obesity Utilization and Health-Related Quality of Life in Medicare Enrollees. 2013
    Malinoff RL, Elliott MN, Giordano LA, Grace SC, and Burroughs JN.
    Journal of Ambulatory Care Management. 2013. Jan;36(1):61-71. Abstract available online at U.S. National Library of Medicine website.
  • Activities of Daily Living, Chronic Medical Conditions, and Health-Related Quality of Life in Older Adults. 2012
    Barile JP, Thompson WW, Zack MM, Krahn GL, Horner-Johnson W, and Haffer SC.
    Journal of Ambulatory Care Management. 2012. 35(4):292-303. Abstract available online at U.S. National Library of Medicine website.
  • Association of Health Plans’ Healthcare Effectiveness Data and Information Set (HEDIS)® Performance With Outcomes of Enrollees with Diabetes. 2010
    Harman JS, Scholle SH, Ng JH, Pawlson LG, Mardon RE, Haffer SC, Shih S and Bierman AS.
    Medical Care. 2010. Mar; 48(3):217-223. Abstract available online at American Public Health Association’s Official Journal of the Medical Care Section website.
  • Comparison of Health Outcomes for Male Seniors in the Veterans Health Administration and Medicare Advantage Plans. 2010
    Selim AJ, Berlowitz D, Kazis LE, Rogers W, Wright SM, Qian SX, Rothendler JA, Spiro A, Miller D, Selim BJ and Fincke, BG.
    Health Services Research. 2010. April; 45(2)376-396. Abstract available online at Health Services Research website.
  • Differences in Risk-Adjusted Mortality between Medicaid-eligible Patients Enrolled in Medicare Advantage Plans and Those Enrolled in the Veterans Health Administration. 2009
    Selim AJ, Kazis LE, Qian S, Rothendler JA, Spiro A, Rogers W, Haffer SC, Wright SM, Miller D, Selim BJ and Fincke BG.
    Journal of Ambulatory Care Management. 2009. Jul; 32(3):232-40. Abstract available online at U.S. National Library of Medicine website.
  • Urinary Incontinence and Self-Reported Health Among the U.S. Medicare Managed Care Beneficiaries. 2008
    Chang CH, Gonzalez CM, Lau DT and Sier HC.
    Journal of Aging and Health. 2008 Jun; 20(4): 405-419. Abstract available online at U.S. National Library of Medicine website.
  • Patient’s Self Report of Diseases in the Medicare Health Outcomes Survey Based on Comparisons with Linked Survey and Medical Data from the Veterans Health Administration. 2008
    Miller DR, Rogers WH, Kazis LE, Spiro A, Ren XS and Haffer SC.
    Journal of Ambulatory Care Management. 2008 Apr-Jun; 31(2): 161-177. Abstract available online at U.S. National Library of Medicine website.
  • Change in Health Status and Mortality as Indicators of Outcomes: Comparison between the Medicare Advantage Program and the Veterans Health Administration. 2007
    Selim AJ, Kazis LE, Rogers W, Qian SX, Rothendler JA, Spiro A, Ren XS, Miller DR, Selim BJ and Fincke BG.
    Quality of Life Research. 2007. Sep; 16(7):1179-91. Available online at Boston University website.
  • Predictors of Voluntary Disenrollment from Medicare Managed Care. 2007
    Ng, Judy H., Judith D. Kasper, Christopher B. Forrest, and Arlene S. Bierman.
    Medical Care. June 2007. Volume 45 (6): 513-520.
  • Depression as a Risk Factor for Nursing Home Admission Among Older Individuals. 2007
    Harris, Yael.
    Journal of the American Medical Directors Association. January 2007. Volume 8 (1): 14-20.
  • Depressed Mood and Mental Health Among Elderly Medicare Managed Care Enrollees. 2006
    Bierman, Arlene S.; Ellis, Beth Hartman; and Drachman, David.
    Health Care Financing Review. Summer 2006. Volume 27(4): 123-136. Available online at CMS' Health Care Financing Review website.
  • Management of Urinary Incontinence in Medicare Managed Care Beneficiaries: Results from the 2004 Medicare Health Outcomes Survey. 2006
    Mardon, Russell E., Halim, Shaheen, Pawlson, L. Gregory, Haffer, Samuel C.
    Archives of Internal Medicine. May 2006. 166: 1128-1133.
  • Risk-Adjusted Mortality as an Indicator of Outcomes: Comparison of the Medicare Advantage Program With the Veterans' Health Administration. 2006
    Selim, Alfredo J., Kazis, L. E.; Rogers, W.; Qian, S.; Rothendler, J. A.; Lee, A.; Ren, X. S.; Haffer, S. C.; Mardon, R.; Miller, D.; Spiro, A.; Selim, B. J.; Fincke, B. G.
    Medical Care. April 2006. Volume 44(4): 359-365.
  • Depressive Symptoms in Older People Predict Nursing Home Admission. 2006
    Harris, Yael and Cooper, J. K.
    Journal of the American Geriatrics Society. April 2006. Volume 54(4): 593–597.
  • An Examination of Self-Reported Chronic Conditions and Health Care Status in the 2001 Medicare Health Outcomes Survey. 2005
    Ko, Yu and Coons, Stephen Joel.
    Current Medical Research and Opinion. November 2005. Volume 21(11): 1801-1808.
  • Tracking Healthy Days - A Window on the Health of Older Adults. 2005
    Moriarty DG, Kobau R, Zack MM, Zahran HS.
    Preventing Chronic Disease. July 2005. Volume 2(3): 1–8.
  • Multiple Cohorts Analysis of the Medicare Health Outcomes Survey, 1998-2002. 2005
    Grace, Susan C., Shannon, Erin Dowd, Drachman, David, and Ellis, Beth Hartman.
    Health Care Financing Review. Spring 2005. Volume 26(3): 125-128. Available online at CMS' Health Care Financing Review website.
  • Health Status of Dually Eligible Beneficiaries in Managed Care Plans. 2004
    Lied, Terry R. and Haffer, Samuel C.
    Health Care Financing Review. Summer 2004. Volume 25(4): 59-74. Available online at CMS' Health Care Financing Review website.
  • Chronic Conditions: Results of the Medicare Health Outcomes Survey, 1998-2000. 2004
    Ellis, Beth Hartman, Shannon, Erin Dowd, Cox, Jacquilyn Kay, Aiken, Leona and Fowler, Brenda M.
    Health Care Financing Review. Summer 2004. Volume 25(4): 75-91. Available online at CMS' Health Care Financing Review website.
  • Coexisting Illness and Heart Disease Among Elderly Medicare Managed Care Enrollees. 2004
    Bierman, Arlene S.
    Health Care Financing Review. Summer 2004. Volume 25(4): 105-117. Available online at CMS' Health Care Financing Review website.
  • Health-Related Social Disengagement in Elderly Diabetic Patients: Association with Subsequent Disability and Survival. 2004
    Kuo, Yong-F., Peek, M. Kristen, Raji, Mukaila A., and Goodwin, James S.
    Diabetes Care. July 2004. Volume 27(7): 1630–1637
  • Utilization of the propensity score method: an exploratory comparison of proxy-completed to self-completed responses in the Medicare Health Outcomes Survey. 2003
    Ellis, Beth Hartman, Bannister, Wade M., Cox, Jacquilyn Kay, Fowler, Brenda M., Shannon, Erin Dowd, Drachman, David, Adams, Randall W. and Giordano, Laura A.
    Health and Quality of Life Outcomes. September 18, 2003. Volume 1(47): Available online at www.hqlo.com.
  • Smoking and Functional Status Among Medicare Managed Care Enrollees. 2003
    Arday, David R., Milton, Micah H., Husten, Corinne G., Haffer, Samuel C., Wheeless, Sara C., Jones, Shelton M. and Johnson, Ruby E.
    American Journal of Preventive Medicine. April 2003. Volume 24(3): 234-241.
  • Assessing Beneficiary Health Outcomes and Disease Management Initiatives in Medicare. 2003
    Haffer, Samuel C., Bowen, Sonya E., Shannon, Erin Dowd and Fowler, Brenda M.
    Disease Management and Health Outcomes. February 2003. Volume 11(2): 111-124.
  • Health-Related Quality of Life of Cancer and Noncancer Patients in Medicare Managed Care. 2003
    Baker, Frank, Haffer, Samuel C. and Denniston, Maxine.
    Cancer. February 1, 2003. Volume 97(3): 674-681.
  • Beneficiary-Reported Experience and Voluntary Disenrollment in Medicare Managed Care. 2003
    Lied, Terry R., Sheingold, Steven H., Landon, Bruce E., Shaul, James A., and Cleary, Paul D.
    Health Care Financing Review. Fall 2003. Volume 25(1): 55–66. Available online at CMS' Health Care Financing Review website.
  • The Centers for Disease Control and Prevention's Healthy Days Measures – Population Tracking of Perceived Physical and Mental Health Over Time. 2003
    Moriarty, David G., Zack, Mathew M., and Kobau, Rosemarie
    Health Quality Life Outcomes, 2003. Volume 1: 37.
  • Home- and Community-Based Alternatives to Nursing Homes: Services and Costs to Maintain Nursing Home Eligible Individuals at Home. 2003
    Schwab, T. C., Leung, K.-M., Gelb, E., Meng, Y.-Y., and Cohn, J.
    Journal of Aging and Health. 2003. Volume 15: 353–370.
  • Sadness Predicts Death in Older People. 2002
    Cooper, James K., Harris, Yael and McGready, John.
    Journal of Aging and Health. November 2002. Volume 14(4): 509-526.
  • The Prevalence of Major Depression or Dysthymia Among Aged Medicare Fee-for-Service Beneficiaries. 2002
    McCall, Nancy T., Parks, Peggy, Smith, Kevin, and Griggs, Michelle.
    International Journal of Geriatric Psychiatry. 2002. Volume 17: 557-565.
  • Functional Health Outcomes as a Measure of Health Care Quality for Medicare Beneficiaries. 2001
    Bierman, Arlene S., Lawrence, William F., Haffer, Samuel C. and Clancy, Carolyn M.
    Health Services Research. December 2001. Volume 35(6) Part II: 90-109.
  • Factors Associated with Health Status of Older Americans. 2001
    Cooper, James K. and Kohlmann, Thomas.
    Age and Ageing. November 2001. Volume 30(6): 495-501.
  • Health Disparities Among Older Women Enrolled in Medicare Managed Care. 2001
    Bierman, Arlene S., Haffer, Samuel C. and Hwang, Yi-Ting.
    Health Care Financing Review. Summer 2001. Volume 22(4): 187-198.
  • The Effect of a Fitness Program on Health Status and Health Care Consumption in Medicare MCOs. 2001
    Fody-Urias, B. M., Fillit, H., Hill, J.
    Managed Care Interface. September 2001. Volume 14(9): 58-64.
  • Elderly Women in Managed Care: Impact of Race/Ethnicity, Education, and Income on HRQOL. 2000
    Bierman, Arlene S., Haffer, Samuel C., Hwang, Yi-Ting and Mandelblatt, Jeanne.
    Quality of Life Research. October 2000. Volume 9(3). Published Abstract.
  • Assessing the HRQOL of Socioeconomically Disadvantaged Elders in Medicare Managed Care. 2000
    Haffer, Samuel C., Bierman, Arlene S., Hwang, Yi-Ting and Mandelblatt, Jeanne.
    Quality of Life Research. October 2000. Volume 9(3). Published Abstract.
  • Receipt of Advice to Quit Smoking in Medicare Managed Care - United States, 1998. 2000
    Arday, David R.
    Morbidity and Mortality Weekly Report (MMWR). September 8, 2000. Volume 49(35): 797-801.
  • How Healthy ARE our Seniors?: Baseline Results from the Medicare Health Outcomes Survey. 2000
    Stevic, Marcia O., Haffer, Samuel C., Cooper, James, Adams, Randall and Michael, James.
    Journal of Clinical Outcomes Management. August 2000. Volume 7(8): 39-42.
  • Medicare Health Outcomes Survey: Differentiating Health Status Within and Across Different Medicare Programs (PDF, 4 MB). 2012

    This report details differences in how the Program for All Inclusive Care of the Elderly (PACE) plans and Medicare Advantage Special Needs Plans (SNPs) differ from regular Medicare Advantage (Other MA) health plans on health status and basic member demographics. A comparison of physical and mental health, both within and between different Medicare programs, for at-risk subgroups of Medicare members is provided. The report also examines whether there are plans that do a better job maintaining patient health status, as measured by better-than-expected mental health, among specialized programs with patients in uniformly poorer physical health. The Medicare HOS 2010 Cohort 13 Baseline data on SNP and Other MA, and the 2010 HOS-Modified data on PACE were utilized for all analyses.
  • Prevalence of Obesity in Medicare Advantage Organizations and its Effect on Health Services Utilization and Health Related Quality of Life (PDF, 628 KB). 2011

    This report provides the results of an investigation of the prevalence of obesity in Medicare Advantage Organizations (MAOs), its associations with the health of beneficiaries and their concomitant use of health services. The analyses were conducted using Medicare data from the 2006 Cohort 9 Baseline and 2008 Cohort 9 Follow Up surveys to obtain information on the prevalence of obesity and its association with the health of beneficiaries. Information about 2006 outpatient utilization was obtained from the 2007 Medicare Advantage Consumer Assessment of Healthcare Providers and Systems (MA-CAHPS®) survey.
  • Health-Related Quality of Life and Quality of Care in Specialized Medicare Managed Care Plans (PDF, 1.1 MB. 2010

    This report provides the results of an investigation of the demographics, health status, function, Health-Related Quality of Life (HRQOL), and quality of care received by Medicare beneficiaries enrolled in specialized managed care plans and compares the results with those of Medicare Advantage (MA) beneficiaries enrolled in traditional models of care. The analyses were conducted using Medicare data from the 2008-2009 Health Outcomes Survey (HOS) Cohorts 11-12 Baseline and 2008-2009 Health Outcomes Survey-Modified (HOS-M) data.
  • Implementing the HEDIS® Medicare Health Outcomes Survey: The Impact of Health Plan Quality on Medicare Beneficiary Outcomes (PDF, 231 KB). 2007
    Ng JH, Scholle SH, Pawlson LG, Harman JS, Mardon RE and Bierman AS.
    This report assesses the relationship of plan-level performance on HEDIS® measures of clinical processes and intermediate outcomes with changes over two-years in the self-reported physical and mental health outcomes from the Medicare HOS among elderly Medicare plan enrollees with diabetes, hypertension, ischemic heart disease, and depression. This study represents one of the first attempts to directly link plan HEDIS® performance to outcome measures of enrollee health.
  • Evaluation of Disease Status based on Patient Self-Report in the Medicare Health Outcomes Survey (PDF, 87 KB) 2003
    Miller DR, Rogers WH, Spiro A and Kazis LE.
    Using data from patients who are eligible for both Medicare and VA care, this report compares patient self-reports of chronic conditions to actual chronic conditions as documented from diagnostic codes obtained from these patients' medical records. Accuracy of the patient self-reports was quantitatively assessed for a variety of chronic conditions, by calculating sensitivity (the probability that patients would report the disease given its indication in the medical records), and specificity (the probability that patients would not report the disease given its absence in the medical records).
  • MCS Outlier Evaluation Report (PDF, 1.44 MB) 2003

    This project was a collaborative effort among CMS, HSAG, and NCQA. The evaluation involved surveying all 28 outlier plans from the Cohort 1 Performance Measurement Results, as well as 20 randomly selected "average" plans.
  • Multiple Cohorts Analysis: Longitudinal Analysis of SF-36® Summary Scores in the Medicare Health Outcomes Survey - Final Report (PDF, 250 KB) 2002

    This technical report examines changes in the PCS and MCS scores for beneficiaries of the Medicare Advantage Organizations (formerly referred to as Medicare + Choice Organizations) who completed a Medicare Health Outcomes Survey at yearly intervals from 1998 through 2002. This study incorporates data from those MA beneficiaries that participated in the HOS on more than one occasion. Trends in physical component summary and mental component summary scores were examined for beneficiaries who completed the survey two years, three years, four years, and five years in a row. The examination of these trends provides information on whether or not declines in health status accelerate over time or remain constant. This information is valuable in determining the optimal number of years to wait before conducting the follow up survey.
  • Report on the Health Status of the Medicare Disabled (PDF, 209 KB) 2000

    For Cohort 1 Baseline, 279,135 Medicare beneficiaries were sampled. 167,248 seniors (age 65 or older) responded to the survey. Additionally, 10,513 (out of a total of 18,864) disabled beneficiaries responded to the survey. This report performs a comparison between these two groups.
  • Report on the Health Status of the Medicare Dual Eligible (PDF, 238 KB) 2000

    For Cohort 1 Baseline, 171,510 Medicare beneficiaries responded to the survey. Additionally, 6,247 beneficiaries enrolled in both Medicare and Medicaid completed a survey. This report performs a comparison between these two groups.
  • Comparison of the Health Status of Medicare Fee-For-Service and Managed Care Enrollees Using the HOS (PDF, 963 KB) 2000
    Pope GC, Griggs M and McCall NT.
    This report compares Medicare Fee-for-Service and Medicare Managed Care enrollees on a variety of health measures, including physical health status, mental health status, reports of chronic conditions, and activities of daily living (ADLs). The report also assesses the extent to which differences in health status are due to differences in the demographic composition of the two populations.

  • Applications/Interventions

  • The Impact of Pain on Physical and Mental Quality of Life in Adults 65 and Older. 2013
    Hawkins K, Musich S, Bottone FG, Ozminkowski RJ, Cheng Y, Rush S, Carcione J, Migliori RJ and Yeh CS.
    Journal of Gerontological Nursing. 2013;39(6):32-44. Abstract available on line at U.S. National Library of Medicine website.
  • Urinary Incontinence and Health-Related Quality of Life Among Older Americans With and Without Cancer: A Cross-Sectional Study. 2013
    White AJ, Reeve BB, Chen RC, Stover AM, and Irwin DE.
    BioMed Central, Cancer. 2013;13:377. Article available online at BioMed Central website.
  • The Relationship between Body Mass Index and Quality of Life in Community-Living Older Adults Living in the United States. 2013
    Bottone FG, Hawkins K, Musich S, Cheng Y, Ozminkowski RJ, Migliori RJ, and Yeh CS.
    Journal of Nutrition, Health & Aging. 2013;17(6):495-501. Abstract available on line at U.S. National Library of Medicine website.
  • Associations of Cancer and Other Chronic Medical Conditions With SF-6D Preference-Based Scores in Medicare Beneficiaries. 2013
    Hays RD, Reeve BB, Smith AW, and Clauser SB.
    Journal of Quality of Life Research. 2013, Aug. Abstract available online at U.S. National Library of Medicine website.
  • Evaluating Outcomes of Care and Targeting Quality Improvement Using Medicare Health Outcomes Survey Data. 2012
    Bowen SE.
    Journal of Ambulatory Care Management. 2012. 35(4):260-262. Abstract available online at Journal of Ambulatory Care Management website.
  • Monitoring Outcomes for the Medicare Advantage Program: Methods and Application of the VR-12 for Evaluation of Plans. 2012
    Kazis LE, Selim AJ, Rogers W, Qian SX, and Brazier J.
    Journal of Ambulatory Care Management. 2012. 35(4):263-276. Abstract available online at U.S. National Library of Medicine website.
  • Identifying Older Adults at High Risk of Mortality Using the Medicare Health Outcomes Survey. 2012
    Ng JH, Elliott MN, Scholle SH, Ahmed K, Collins RL, and Bierman AS.
    Journal of Ambulatory Care Management. 2012. 35(4):277-291. Abstract available online at Journal of Ambulatory Care Management website.
  • Fitness Memberships and Favorable Selection in Medicare Advantage Plans. 2012
    Cooper AL and Trivedi AN.
    The New England Journal of Medicine. 2012;366:150-7. Abstract available online at U.S. National Library of Medicine website.
  • The Prevalence of Hearing Impairment and its Burden on the Quality of Life among Adults with Medicare Supplement Insurance. 2011
    Hawkins K, Bottone FG, Ozminkowski RJ, Musich S, Bai M, Migliori RJ, and Yeh CS.
    Quality of Life Research. 2011 Epub ahead of print, 2011 Oct 7. Abstract available online at U.S. National Library of Medicine website.
  • The Prevalence of Urinary Incontinence and its Burden on the Quality of Life among Older Adults with Medicare Supplement Insurance. 2011
    Hawkins K, Pernarelli J, Ozminkowski RJ, Bai M, Gaston SJ, Hommer C, Migliori RJ, and Yeh CS.
    Quality of Life Research. 2011 Jun;20(5):723-32. Epub 2010 Dec 8. Abstract available online at U.S. National Library of Medicine website.
  • The Burden of Falling on the Quality of Life among Adults with Medicare Supplement Insurance. 2011
    Hawkins K, Musich S, Ozminkowski RJ, Bai M, Migliori RJ, and Yeh CS.
    Journal of Gerontological Nursing. 2011 Aug;37(8):36-47. Epub 2011 Apr 13. Abstract available online at U. S. National Library of Medicine website and the article may be accessed directly from the SLACK Journals website.
  • Impact of Cancer on Health-Related Quality of Life of Older Americans. 2009
    Reeve BB, Potosky AL, Smith AS, Han PK, Hays RD, Davis WW, Arora NK, Haffer SC, Clauser SB.
    Journal of the National Cancer Institute.2009 June 16;101(12):860-8. Epub 2009 June 9 available online at U.S. National Library of Medicine website.
  • SEER-MHOS: A New Federal Collaboration on Cancer Outcomes Research. 2008
    Clauser SB and Haffer SC.
    Health Care Financing Review. Summer 2008. Volume 29(4): 1-4. Available online at CMS’ Health Care Financing Review website.
  • Overview of the SEER-Medicare Health Outcomes Survey Linked Dataset. 2008
    Ambs A, Warren JL, Bellizzi KM, Topor M, Haffer SC and Clauser SB.
    Health Care Financing Review. Summer 2008. Volume 29(4): 5-22. Available online at CMS’ Health Care Financing Review website.
  • Disparities in HRQOL of Cancer Survivors and Non-Cancer Managed Care Enrollees. 2008
    Clauser SB, Arora NK, Bellizzi KM, Haffer SC, Topor M and Hays RD.
    Health Care Financing Review. Summer 2008. Volume 29(4): 23-40. Available online at CMS’ Health Care Financing Review website.
  • Cancer, Comorbidities, and Health-Related Quality of Life of Older Adults. 2008
    Smith AW, Reeve BB, Bellizzi KM, Harlan LC, Klabunde CN, Amsellem M, Bierman AS and Hays RD.
    Health Care Financing Review. Summer 2008. Volume 29(4): 41-56. Available online at CMS’ Health Care Financing Review website.
  • Cigarette Smoking and Health-Related Quality of Life in Medicare Beneficiaries. 2008
    Hays RD, Smith AW, Reeve BB, Spritzer KL, Marcus SE and Clauser SB.
    Health Care Financing Review. Summer 2008. Volume 29(4): 57-68. Available online at CMS’ Health Care Financing Review website.
  • Reducing Bias in Cancer Research: Application of Propensity Score Matching. 2008
    Reeve BB, Smith AW, Arora NK and Hays RD.
    Health Care Financing Review. Summer 2008. Volume 29(4): 69-80. Available online at CMS’ Health Care Financing Review website.
  • Functional Impairment Levels in PACE Enrollees. 2008
    Walsh EG, Khatustsky G and Johnson L.
    Health Care Financing Review. Summer 2008. Volume 29(4): 81-88. Available online at CMS’ Health Care Financing Review website.
  • Use of Risk-Adjusted Change in Health Status to Assess the Performance of Integrated Service Networks in the Veterans Health Administration. 2006
    Selim AJ, Berlowitz D, Fincke G, Rogers W, Qian S, Lee A, Cong Z, Selim BJ, Ren XS, Rosen AK, Kazis LE.
    International Journal for Quality in Health Care. 2006 Feb;18(1)43-50. Available online at International Journal for Quality in Health Care website.
  • Evaluating the Performance of Medicare Fee-For-Service Providers Using the Health Outcomes Survey: A Comparison of Two Methods. 2005
    Trisolini, Michael G., Smith, Kevin W., McCall, Nancy T., Pope, G.C., Klosterman, M.
    Medical Care. July 2005. Volume 43(7): 699-704.
  • Comparing the Health Status of VA and Non-VA Ambulatory Patients: The Veterans’ Health and Medical Outcomes Studies. 2004
    Rogers WH, Kazis LE, Miller DR, Skinner KM, Clark JA, Spiro A and Fincke RG.
    Journal of Ambulatory Management. 2004 Jul-Sep; 27(3): 249-62. Abstract available online at U.S National Library of Medicine website.
  • Sad, Blue, or Depressed Days, Health Behaviors and Health-Related Quality of Life, Behavioral Risk Factor Surveillance System, 1995-2000. 2004
    Kobau R, Safran MA, Zack MM, Moriarty DG and Chapman D.
    Health and Quality of Life Outcomes. 2004 Jul 30; Volume 2(40). Available online at www.hqlo.com.
  • Use of HOS Data in Florida. 2004
    McDonald, Kathie, Ma, Jifeng and Dulabone, Elaine.
    Health Care Financing Review. Summer 2004. Volume 25(4): 93-104. Available online at CMS' Health Care Financing Review website.
  • The Health Status of Elderly Veteran Enrollees in the Veterans Health Administration. 2004
    Selim, Alfredo J., Berlowitz, Dan R., Fincke, Graeme, Cong, Zhongxiao, Rogers, William, Haffer, Samuel C., Ren, Xinhua S., Lee, Austin, Qian, Shirley X., Miller, Donald R., Spiro, Avron, Selim, Bernardo J. and Kazis, Lewis E.
    Journal of the American Geriatrics Society. August 2004. Volume 52(8): 1271-1276.
  • Measuring Quality of Care and Performance from Population Health Care Perspective. 2003
    Derose, S. F. and Petitti, D. B.
    Annual Review of Public Health. 2003. Volume 24: 363–384.
  • Health Disparities Among Older Women: Identifying Opportunities to Improve Quality of Care and Functional Health Outcomes. 2001
    Bierman, Arlene S. and Clancy, Carolyn M.
    Journal of the American Medical Women's Association. Fall 2001. Volume 56(4): 155-160.
  • Analysis of Key Drivers of Improving or Maintaining Medicare Health Outcomes Survey (HOS) Scores. 2013

    This study used data from the HOS 2009 Cohort 12 Baseline and 2011 Cohort 12 Follow Up to describe how two-year mortality and two-year changes in the Veterans RAND 12-Item Health Survey (VR-12) items relate to key Medicare HOS measures used in the Medicare Star Ratings. The HOS measures relate to maintaining and improving health and are derived from changes in the physical component summary (PCS) and mental component summary (MCS) scores. The results from this study clarify the properties of several Centers for Medicare & Medicaid Services’ (CMS) quality measures used for the Medicare Star Ratings.
  • Identifying Elderly HOS Beneficiaries at Risk for Mortality Using the Updated 2009 VES-HOS Risk Scoring. 2013

    The focus of this research was to extend and improve a previously validated Vulnerable Elders Survey-Medicare Health Outcomes Survey (VES-HOS) predictive model for identifying older adults at high risk of mortality using the HOS 2.0. In particular, an assessment was made of whether the approach is robust to the substitution of survey items. The previously validated VES-HOS model (and the approach it is based on, the original VES-13 instrument) was extended by incorporating an imputation approach that allows for the retention of a substantial proportion of the sample previously excluded because they were missing one or more items used by the algorithm. In addition, the algorithm’s performance by gender was verified; three, rather than two, risk groups were distinguished based on the risk score; and the members of vulnerable groups were characterized.
  • Opportunities for Improving Medicare HOS Results through Practices in Quality Preventive Health Care for the Elderly (PDF, 1.0 MB). 2012

    This guide is a resource to help Medicare Advantage Organizations (MAOs) develop and apply strategies that address the Medicare Health Outcomes Survey (HOS) items used in the CMS Medicare Part C Star Ratings. The guide includes an overview of HOS, national performance results on HOS items included in the Medicare Star Ratings, best practices in promoting quality preventive health care for the elderly, and HOS resources available to MAOs. Section 1 discusses the prevalence of conditions measured by the HOS items and provides a summary of national HOS results to highlight opportunities for improvement and intervention strategies. Section 2 provides examples of interventions that some MAOs have used to promote patient-physician communication, screening services or maintenance of functional status among their members.
  • Functional Status in Older Adults: Intervention Strategies for Impacting Patient Outcomes (PDF, 1.2 MB). 2011

    This literature review is a synthesis of selected articles of functional status outcomes in older adults and is designed to supplement the guide for MAOs entitled, “Opportunities for Improving Medicare HOS Results through Practices in Quality Preventive Health Care for the Elderly.” The included outcomes target short form assessments of health that span the physical to psychological from well established questionnaires. In addition, outcome measures include activities of daily living that capture functional limitations in Medicare Advantage recipients. The articles were selected from the vantage point of interventions that could impact on the functional status outcomes in elderly populations. The HOS includes the Veterans RAND 12 Item Health Survey (VR-12) as the core measure for the physical (PCS) and mental (MCS) summary scores. It also includes HEDIS® Effectiveness of Care Measures for Management of Urinary Incontinence in Older Adults, Physical Activity in Older Adults, Fall Risk Management and Osteoporosis Testing in Older Women.
  • Medicare Part D Data Linked with the Health Outcomes Survey: Association between Quality of Care using Prescription Drugs and Mortality as Outcomes among those Enrolled in the Medicare Advantage Program (PDF, 715 KB). 2010

    This report examines the relationship between use of medications based upon nationally recognized clinical practice guidelines and health outcomes using mortality among Medicare Advantage (MA) patients enrolled in the Medicare Part D program. The analysis utilized the linked data from the Medicare Health Outcomes Survey (HOS) 2006-2008 Cohort 9 and the 2006-2007 Medicare Part D prescription benefit files to calculate the medication based performance indicators for five high volume chronic conditions: diabetes, coronary artery disease (CAD), congestive heart failure (CHF), chronic obstructive lung disease (COPD)/asthma, and depression. The investigators examined the variations of the performance indicators across plans and examined the associations of performance indicators and mortality at the patient and the plan levels.
  • Implementing the HEDIS® Medicare Health Outcomes Survey: Linking Medicare Health Outcomes Survey Data and Part D Drug Data (PDF, 296 KB). 2010

    This report discusses the linking of the Medicare Health Outcomes Survey (HOS) 2006-2008 Cohort 9 and the 2006–2007 Medicare Part D Drug Event (PDE) data, which allowed examination of associations between drug benefits and use, as well as patient-specific health and functional status. Two separate analyses were conducted. The initial analysis focused on assembling the linked HOS and Part D data master file and evaluating key demographic differences between HOS respondents who had a Part D benefit claim and those who did not. The second part of the analysis examined Part D prescription drug use among MA members in the HOS sample.
  • Implementing the HEDIS® Medicare Health Outcomes Survey: Applying Missing Data Imputation Methods to HOS Household Income Data (PDF, 359 KB) 2009

    The 2009 HOS Cohort 9 Baseline data was used to investigate several missing data imputation methods for self-reported income, which consistently experiences a high rate of missing data in the HOS. This report provides a brief summary of selected statistical methods that use existing information from the HOS data set, applies them to the data for missing income values, and compares results across the various methods. This work is an extension of previous NCQA research that used an external data source for the imputation.
  • Implementing the HEDIS® Medicare Health Outcomes Survey: Imputation Analysis for HOS Income Data (PDF, 155 KB) 2008

    Data from the Medicare Health Outcomes Survey (HOS) offer important longitudinal information about insights into the self-assessed health status of the older population in the United States. CMS has surveyed this population annually over several years and repeatedly found that income information is missing in Baseline and Follow-up surveys for about 10-20 percent of respondents. To address this issue and to generate complete information across HOS data sets, CMS is collaborating with NCQA to explore and help define a valid income imputation method using HOS 2000 Cohort 3 Baseline and HOS 2006 Cohort 9 Baseline data that could be applied to other HOS cohorts.
  • Report on the Health Status of Managed Care Smokers and Nonsmokers: Cohort III Baseline and Follow Up (PDF, 313 KB). 2007

    This research examines differences in physical and mental health status for beneficiaries who were smokers and nonsmokers in Cohort III(2001-2003) of the Medicare Health Outcomes Survey (HOS).
  • Disparities in Medicare Beneficiary Outcomes: Socio-Demographic Vulnerability and Prevalent Problems in Older Populations (PDF, 242 KB). 2007
    Ng JH, Scholle SH, Wong L, Kong V, Iruka N and Mierzejewski R.
    This report assesses the extent to which receipt of recommended preventive services varies by vulnerability status. Studies indicate that vulnerable Medicare Managed Care subgroups, such as racial/ethnic minorities or low socioeconomic populations, continue to disproportionately experience quality of care problems. Strategies to reduce disparities have generally emphasized the importance of improving preventive services.
  • Report on a Longitudinal Assessment of Change in Health Status and the Prediction of Health Utilization, Health Expenditures, and Experiences with Care for Beneficiaries in Medicare Managed Care (PDF, 298 KB). 2006

    This report explores longitudinal change in beneficiary physical and mental health, bodily pain, and impaired Activities of Daily Living (ADLs) in 2002, and relates these health measures to health care usage and expenditures in 2003. Additionally, the report examines whether changes in health status from 2000-2002 relate to patient experience with care ratings in 2002. In sum, longitudinal changes in health status were found to significantly relate to future health care costs and utilizations.
  • The Evaluation of a Mental Component Summary Score Threshold for Depression Risk in the Medicare Population (PDF, 367 KB) 2006

    This report examines different thresholds of mental component summary (MCS) scores for identifying beneficiaries diagnosed with depression, and those at risk for depression. The results indicated a low prevalence of depression (7%) based on the diagnoses recorded on claims data among Medicare FFS beneficiaries. Beneficiaries with depression diagnoses had lower MCS scores than those without depression diagnoses. The results indicated that a score of 48 represents reasonable predictive accuracy and would imply screening for 20% of elderly beneficiaries.
  • The Relationship between Health Status, Utilization, and Expenditures: Comparison between Medicare Managed Care and Fee-For-Service Beneficiaries (PDF, 554 KB). 2006

    This report examines possible differences in the relationship between health status, health expenditures, utilization of services, and experiences with care between Medicare FFS and managed care (Medicare Advantage [MA]) beneficiaries. As expected, higher expenditures are associated with lower PCS and MCS scores, with small but statistically significant differences between managed care and FFS. Significant differences were found between the self-reported frequency of FFS and managed care beneficiaries' visits to doctors' offices or clinics at lower levels of physical and mental health. Finally, managed care beneficiaries have a significantly higher probability of providing low satisfaction ratings when compared to FFS beneficiaries.
  • National and State Comparisons of Health Status for Medicare Managed Care and Fee-For-Service Beneficiaries (PDF, 406 KB) 2006

    Analysis was conducted to compare the longitudinal change of physical and mental health status of the 2002-2004 Medicare HOS to a simulated longitudinal change in the 2002 and 2004 CAHPS Fee-For-Service. At a national level, the results indicated that there is not a significant difference between Medicare Fee-For-Service and Managed Care beneficiaries in relation to the amount of physical and mental health status change for the years examined.
  • Report on the Health Status of Disadvantaged Medicare Beneficiaries (PDF, 690 KB). 2005

    This report examines the predictors of disparities in health outcomes for Medicare beneficiaries in Cohorts 2 and 3 of the Medicare Health Outcomes Survey (HOS).
  • Report on Enrollment Duration: Cohort I Baseline (PDF, 135 KB). 2005

    This paper presents potential differences in health status between Medicare Health Outcomes Survey (HOS) Cohort I Baseline (1998) beneficiaries with fewer than six months tenure in their health plans and those with more than six months tenure.
  • Report on Mental Health Status of Managed Care Beneficiaries: Cohort I Baseline and Follow Up (PDF, 339 KB). 2005

    This research examines the differences between beneficiaries at high risk for depression and those at low risk for depression sampled in the Medicare Health Outcomes Survey (HOS).
  • Using Claims Data to Identify Medicare+Choice Enrollees At Risk for a Decline in Functional Health Status (PDF, 200 KB). 2005
    Welch WP.
    This report presents results from a study sponsored by the Agency for Healthcare Research and Quality to identify Medicare managed care enrollees at risk for a decline in health status. Using HOS data and Medicare managed care administrative data, the analysis characterized utilization of health care and developed risk models for identifying enrollees appropriate for early medical intervention.
  • Report on the Comparison of Seniors in Program of All-Inclusive Care for the Elderly (PACE) and Medicare Advantage Plans: Cohorts II, III, IV and V Baseline (PDF, 278 KB). 2005

    This report compares the health status of beneficiaries enrolled in Program of All-Inclusive Care for the Elderly (PACE) plans with the health status of beneficiaries enrolled in Medicare managed care plans who participated in Cohorts II, III, IV and V Baseline (1999 to 2002) of the Medicare Health Outcomes Survey (HOS).
  • Medicare HOS National Pilot Project on Depression Final Report (PDF, 438 KB) 2002

    From 1999 to 2002, 16 M+COs and six QIOs participated in a pilot project to develop a strategy for using the HOS results to identify and treat beneficiaries with a high risk for depression. Claims and HOS data were used to develop a statistical profile of these high-risk beneficiaries. Each M+CO then provided their primary care providers with a list of the high-risk beneficiaries in their caseloads, as well as screening instruments, clinical guidelines, and treatment protocols for depression management. The participating plans were compared to non-participating plans to measure the impact on both process measures and HOS scores. A copy of the Pilot Project User's Guide is also available.
  • Medicare HOS National Pilot Project on Depression User's Guide (PDF, 444 KB) 2002

    This project represents a pioneering attempt to use HOS data to help identify and manage depression in a primary care setting. Six QIOs and 16 health plans participated in this quality improvement pilot project.
  • The SF-36® Health Survey: A Summary of Responsiveness to Clinical Interventions (PDF, 103 KB) 2000

    This paper provides evidence that the SF-36® scales and summary measures are sensitive measures that can demonstrate changes in health due to various treatments, including pharmacological, surgical, and educational interventions.
  • Evaluating the Two-Year Follow Up Health Status of Medicare Fee-For-Service Beneficiaries Using the Health Outcomes Survey (PDF, 2.7 MB) 2000
    Trisolini MG, McCall NT, Pope GC, Klosterman M, and Smith K.
    This report presents an analysis of follow up results for the HOS, which was administered to a sample of Medicare Fee-for-Service beneficiaries in 1998 and 2000. The primary goal of this analysis is to assess the feasibility of using longitudinal estimates of self-reported health status for cohorts of Medicare beneficiaries to evaluate the care provided to Fee-for-Service beneficiaries by physician group practices or by Fee-for-Service providers in small geographic areas.
  • Medicare HOS Information Synthesis (PDF, 3.4 MB) 1999

    This 1999 document reviews a number of interventions that have an effect on the overall well-being and functional status of seniors. The intent of the review is to provide direction in developing new interventions that are relevant to the specific needs of Medicare beneficiaries.


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Health Services Advisory Group Centers for Medicare and Medicaid Services