The Medicare Health Outcomes Survey (HOS) is an assessment of a Medicare Advantage Organization's ability to maintain or improve the physical and mental health functioning of its Medicare beneficiaries over a two-year period of time, using the best available science in functional status and health outcomes measurement. The survey is used as a way to measure how the care provided by MAOs affects the functional status of their enrollees. CMS includes the HOS in their performance assessment program, e.g., HOS results are included in the CMS Medicare Star Ratings. For more information, go to the HOS and the Star Ratings page.
The first cohort of baseline data was collected in 1998. Beginning in 2000, both a baseline cohort and a two-year follow up cohort were collected. During the most recent survey administration (2016 Round 19), Cohort 19 Baseline and Cohort 17 Follow Up data were collected. The most recently available results are from the 2015 Cohort 18 Baseline and the 2013-2015 Cohort 16 Performance Measurement, which combines data from the 2013 Cohort 16 Baseline and 2015 Cohort 16 Follow Up surveys. For further information, please refer to the survey administration timeline. For general status information, including response rates, for the baseline and follow up cohorts administered and reported to date, view or download the table below:
After the administration of each follow up cohort, cohort specific performance measurement results are calculated. Seniors (age 65 or older) who had a physical component summary score or mental component summary score that could be calculated at baseline are eligible for performance measurement. However, some of these seniors belong to MAOs that went out of business or discontinued offering managed care between the baseline and follow up samples. Therefore, the Performance Measurement Analytic Sample is limited to those seniors who had physical or mental health summary scores that could be calculated at baseline and were still enrolled in the same participating MAO at the time of follow up. Additionally, a certain number of seniors will voluntarily disenroll from their MAOs between baseline and follow up. These seniors are classified as "voluntarily disenrolled" for purposes of performance measurement. Seniors who become deceased between baseline and follow up are classified as "dead" for purposes of performance measurement.
Of the seniors sampled at the time of follow up, a certain percentage will be determined to be ineligible for inclusion in the sample. These ineligible seniors are: not enrolled in the MAO; have an incorrect address and phone number; or have a language barrier. Of the seniors eligible for inclusion in follow up, those that do not return a completed survey are designated as "non-respondents" and those that do return a completed survey are referred to as "respondents." For a table that depicts the distribution of the Performance Measurement Analytic Sample for the completed cohorts to date, view or download the table below:
A performance measurement 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.
There are six main categories of actual health outcomes used in the performance measurement analysis:
Each beneficiary is classified into one of the three physical health categories and one of the three mental health categories. In calculating expected outcomes, separate case mix models are warranted for death and for physical component summary scores and mental component summary scores. A series of six different death models (formerly eight models), three different physical health models, and three different mental health models are used, since all beneficiaries do not have data for all of the independent variables that could be used to calculate an expected score. In other words, each expected outcome for a beneficiary is derived from the best fit model, which is based on those variables for which the beneficiary has data. One model is used for each beneficiary, and there are no predictions made with missing data.
Beneficiary level results are aggregated to derive the MAO, state, and HOS national percent better, same, and worse than expected values. Outliers are those MAOs that performed significantly better (i.e., better than expected) or significantly worse (i.e., worse than expected) when compared to the national average. The national average is based on all plans that participated in performance measurement. MAOs can be outliers on a measure of physical health (which is based on death and the physical component summary score), or on a measure of mental health (which is based on the mental component summary score).
Analyses of the two-year performance measurement data have demonstrated that at the national level there is significant variation among MAOs with respect to both physical and mental health outcomes. Research has identified differences in outcomes among specific groups of beneficiaries and potential opportunities to improve care. For a table that depicts the overall performance measurement results by cohort, view or download the table below:
A summary of the most recent performance measurement results are available in a sample performance measurement report (PDF, 1.0 MB). Included in the sample report is an overview of the methodology and design followed for sampling, data collection, scoring, and analysis. The MAO Performance Measurement Contract List specifies the participating MAOs from the recently completed cohort.
This page was last modified on 02/15/2017