Implementing the HEDIS (Healthcare Effectiveness Data and Information Set) Medicare Health Outcomes Survey

The Medicare Health Outcomes Survey (HOS) is the first patient-based health outcome measure for the Medicare population. The survey assesses a Medicare Advantage Organization's (MAO) ability to maintain or improve the physical and mental health functioning of its Medicare beneficiaries over time, using the best available science in functional status and health outcomes measurement. Implemented in 1998, the survey is fielded nationally as a Healthcare Effectiveness Data and Information Set (HEDIS) measure. It is a longitudinal, self-administered survey, which utilizes the VR-12 health survey, as well as additional health status and case mix adjustment variables. Questions are also included to collect results for four HEDIS Effectiveness of Care measures. Each year, survey data are collected for a new sample (cohort) of Medicare managed care beneficiaries from each eligible MAO. Members who respond to the baseline survey are resurveyed 2 years later as a follow up. The survey is administered through a group of certified HOS vendors. The goal of the Medicare HOS is to collect valid, reliable, and clinically meaningful data that may be used to [1] monitor managed care performance in the Medicare Advantage program and reward high performance, [2] help beneficiaries make informed health care choices, [3] promote quality improvement based on competition, and [4] advance the state-of-the-science in health outcomes research. The HOS-M is a modified version of the Medicare HOS that is administered to vulnerable Medicare beneficiaries at greatest risk for poor health outcomes. Similar to the HOS, the HOS-M design is based on a randomly selected sample of individuals from each eligible Program of All-Inclusive Care for the Elderly (PACE) Organization. The HOS M is cross sectional, measuring the physical and mental health functioning of beneficiaries at a single point in time. The main purpose of the HOS-M is to assess annually the frailty of the population in these health plans in order to adjust plan payments.