Health Services Research Data Update

1. Health Services Research Data Update Dan Waldo Information and Methods Group Office of Research, Development, and Information Centers for Medicare & Medicare Services daniel.waldo@cms.hhs.gov

2. Topics • Medicare Current Beneficiary Survey • Health Outcomes Survey • Chronic Conditions Database (“Section 723”) • Research Data Distribution Center

3. Survey of a random sample of Medicare enrollees Stratified to oversample very old beneficiaries and those eligible because of disability Survey data aligned with administrative data Annual files available from 1991 forward Access to Care File covers questions on sociodemographics, economic status, health status, program knowledge, insurance, etc. Cost&Use File includes event-level encounters and sources of payment for these encounters Companion MDS, OASIS, and claims data files are available Medicare Current Beneficiary Survey (MCBS) http://www.cms.hhs.gov/mcbs

4. What’s New in this Year’s MCBS Files? • Access to Care 2004 • Generosity of drug benefit • Rotation of health status questions • Facility-level characteristics of group living places • Patient activation supplement • Cost&Use 2003 • No new features http://www.cms.hhs.gov/mcbs

5. Rx Generosity Questions for insurance that covers Rx drugs • Does the plan have an Rx drug deductible? If so, what amount? • What are the coinsurance amounts for brand drugs? For generic drugs? • Does the plan have “coverage limit” for drugs? If so, what is it? • How would you rate your Rx drug coverage through this plan? http://www.cms.hhs.gov/mcbs

6. Rotation of Health Status Questions in 2004 • The plan is to rotate questions in every other year • Why? • Experience shows little year-to-year variation in responses to many questions • By reducing the number of questions we can reduce respondent burden http://www.cms.hhs.gov/mcbs

7. In Expanded diabetes questions Disease management Testing for/treatment of diabetic complications Disease knowledge Etc. Out Hypertension questions Falls questions Colorectal or colon cancer screening questions Osteoporosis questions Rotations in 2004 Access to Care File http://www.cms.hhs.gov/mcbs

8. Currently … In 2001 we began asking question about group living places to explore alternatives to traditional LTC settings for people with long term care needs We asked about the characteristics of the specific place the respondent lives but not about the characteristics of the broader campus. Beginning with Access 2004, if the group living place offers support services we collect information on the characteristics of the total facility to determine whether the facility offers LTC services. Facility-Level Characteristics of Group Living Places http://www.cms.hhs.gov/mcbs

9. Patient Activation Supplement • Questions explore the extent to which beneficiaries are ready to direct or manage their health care • This supplement was first included in Access 2001 and is repeated for Access 2004 http://www.cms.hhs.gov/mcbs

10. Patient Activation Questions • Does the beneficiary feel confident about their ability to manage their health care? • How important is it to the beneficiary to be an active participant in managing their health? • How proactive is the beneficiary with regard to understand and managing their health care needs? http://www.cms.hhs.gov/mcbs

11. For More Information ... MCBS Website: http://www.cms.hhs.gov/mcbs Email: MCBS@cms.hhs.gov

12. A longitudinal, self-administered survey of Medicare Advantage enrollees One thousand Medicare beneficiaries are randomly sampled from each plan and surveyed every spring Two years later, these same respondents are surveyed again Cohort I was surveyed in 1998 HOS currently uses the RAND 36-Item Health Survey 1.0 (RAND SF-36) (a physical and mental health status measure), and additional case mix/risk adjustment variables. The Medicare HOS is being used as part of the effectiveness of care component of HEDIS®. All managed care plans with Medicare + Choice contracts must participate. CMS is legislatively required by MMA 2003 to collect, analyze, and report data permitting the measurement of health outcomes and other indices of quality. Medicare Health Outcomes Survey (HOS) http://www.cms.hhs.gov/surveys/hos

13. HOS to Date • Independent Evaluation completed in December 2004 • Conducted by the Delmarva Foundation and the University of Maryland Baltimore County • Concluded that the HOS data are valid, reliable, and that the HOS Program has been effective in meeting its goals. http://www.cms.hhs.gov/surveys/hos

14. HOS to Date • Response Rates Remain Steady http://www.cms.hhs.gov/surveys/hos

15. Changes Veterans RAND 12 Item Health Survey (VR-12) replaces the RAND 36-Item Health Survey 1.0 (RAND SF-36) Urinary continence question has been reworked. Deletions Stroke symptom severity questions Additions Self-reported height and weight categories Osteoporosis testing HEDIS measure Falls management HEDIS measure Coming Up in HOS Version 2(Effective with 2006 Surveys) http://www.cms.hhs.gov/surveys/hos

16. For More Information… Medicare HOS Website: http:\\www.cms.hhs.gov/surveys/hos Health Care Financing Review – Summer 2004 Health Outcomes Survey Theme Issue http://www.cms.hhs.gov/review/04summer/ Email: hos@cms.hhs.gov

17. Establish a data warehouse to study chronically ill Medicare beneficiaries Improving the quality of care for chronically ill Medicare beneficiaries Reducing the cost of care for chronically ill Medicare beneficiaries Data warehouse integrates existing CMS data Policy goals Study chronic illnesses in the Medicare population Make current Medicare program data more readily available to researchers Improve process time for research data requests Operational goals Utilize data extraction tools to organize data Focus on analytic perspective vs. operational Section 723 Chronically Ill Medicare Beneficiary Research and Data Initiative

18. Project Objectives • Establish a partnership with internal and external customers • Implement phased-in approach • Create person level linkage of data • Medicare • Medicaid • Assessment (MDS/OASIS) • Construct analytical files specific to research • Construct a data warehouse with data extraction tools • Provide a 5% sample of the beneficiary population

19. Data Warehouse Objectives • Create person-level view of data • Construct data extraction tools that support: • Accessing data by chronic conditions • Complex customized research data requests related to chronically illness • Develop new formats for Medicare enrollment, claims and assessment data that support research • Develop useful documentation and metadata

20. Personal identifiers can change within each of the major CMS programs Need to un-duplicate identifiers within each program Person identifiers vary across CMS programs (Medicare, Medicaid, and Assessments) Need to link un-duplicated identifiers across programs Challenges in Person-BasedData Linkage

21. Data Linkage Activity • The Enterprise Cross Reference Table (MMX) ― IBM • Develop the assessment link key to un-duplicate identifiers within the assessment database • Expand the MMX to link un-duplicated identifiers across databases • Validating the MMX results ― Brandeis/Jen • Provide an objective measure of the rate of false negatives and false positives • Suggest approaches to improve match accuracy

22. “Pre-defined” conditions Activity coordinated by ResDAC Consult research experts establish algorithms for identifying conditions from claims and other data “User-defined” conditions User provides filter specifications Disease Classification Activity

23. Creation of Data Warehouse • Currently being done at the Iowa Foundation for Medical Care (IFMC) • Data stored in the warehouse will have the following features: • Unique patient ID linked to all CMS program data • Core research file format • Chronic disease flags • Custom data extract capability

24. Data Included in the Warehouse • 5% sample of all Medicare beneficiaries from CY 1999 through 2004 (about 2.5 million people), linking … • Medicare enrollment data • Medicare claims • Medicaid claims • MDS & OASIS assessments • HPMS (managed care) data • Increased sample of beneficiaries in CY 2005 • Beneficiary data and data collected from relevant surveys (e.g., MCBS)

25. Data Warehouse Features • Use existing IFMC data extraction tool to accommodate custom and standard requests • Provide SAS functionality • Enable queries of claims and enrollment data • Develop a customer order receipt and tracking system to support data release requests • Provide ResDAC technical support as a focal point for researchers to understand CMS Medicare and Medicaid programs

26. Future Activity • Incorporate lessons learned from Phase I • Provide ongoing improvements to the research database • Expand data sources • Expand 5% sample • Enhance data access tools • Establish consultation and technical support group • Support data release requests

27. For Further Informationon the 723 Database... ResDAC E-Mail: resdac@umn.edu 1-888-9-ResDAC Fax: 612-378-4866 URL: www.resdac.umn.edu Frank Eppig feppig@cms.hhs.gov

28. Research Data Distribution Center (RDDC) • The RDDC is a 27 month pilot project to test using a contractor to distribute Medicare claims and enrollment data to researchers. • The RDDC will fill Medicare data requests from public and private researchers. • Result should be essentially transparent to the user

29. Research Data Distribution Center: Scope of the Data • CMS will initially furnish the RDDC with 2 years of 100% Medicare claims and eligibility files • Over the first 6 months of the contract, CMS will add 5 additional years of data. • The RDDC will also receive CMS sponsored national surveys, including MCBS, HOS, and CAHPS.

30. Research Data Distribution Center:Scope of the Contract • The RDDC will provide researchers with Medicare standard analytical files (Inpatient hospital, outpatient hospital, SNF, HHA, DME, hospice, and physician/supplier bill types). • The RDDC will also be to create custom extracts of Medicare data.

31. Researchers must meet the existing rules, policies, and procedures designed to protect the confidentiality of the individual, including: CMS privacy board review Completion of a Data Use Agreement. After CMS reviews the request and is satisfied that the researcher can adequately protect the privacy and confidentiality of the beneficiary, RDDC releases the data files. Research Data Distribution Center: Beneficiary Privacy and Confidentiality

32. Research Data Distribution Center:Data User Fees • The RDDC will charge the researcher a data use fee based on the contractor’s cost of producing the data added to the Federal cost of monitoring the process. • The data use fees will go into a special CMS account that will help fund the RDDC contract.

33. For Further Informationon the RDDC... ResDAC E-Mail: resdac@umn.edu 1-888-9-ResDAC Fax: 612-378-4866 URL: www.resdac.umn.edu Spike Duzor sduzor@cms.hhs.gov