1. Panelists: Vijit Chinburapa, PhD, CPHQ, HSAG Judy Ng, PhD, NCQA Lewis Kazis, ScD, Boston University Sean Creighton, MSc, CMS Nancy Kenly, MPA, CMS Galina Khatutsky PhD Candidate, RTI International Assessing Quality of Care of Medicare Managed Care Health Plans and Frailty Adjustment Using the Medicare Health Outcomes Survey and the Medicare Health Outcomes Survey-Modified Academy Health Annual Research Meeting June 3, 2007

2. Vijit Chinburapa, PhD, CPHQ Health Services Advisory Group The Medicare Health Outcomes Survey (HOS) and the Medicare Health Outcomes Survey-Modified (HOS-M): Introduction

3. 3 Medicare HOS The Medicare HOS assesses each Medicare Advantage (MA) plan's ability to maintain or improve the physical and mental health functioning of its Medicare beneficiaries over a two-year period The Medicare HOS assesses each Medicare Advantage (MA) plan's ability to maintain or improve the physical and mental health functioning of its Medicare beneficiaries over a two-year period Gather valid and reliable health status data in Medicare managed care for quality improvement activities, public reporting, plan accountability, and improving health outcomes Gather valid and reliable health status data in Medicare managed care for quality improvement activities, public reporting, plan accountability, and improving health outcomes Launched in 1998 – currently completing 10 th year of survey administration Launched in 1998 – currently completing 10 th year of survey administration First Medicare managed care outcomes measure First Medicare managed care outcomes measure More than 2 million beneficiaries surveyed to date More than 2 million beneficiaries surveyed to date

4. 4 HOS Version 1 (HOSv1) 1998-2005 36-item health status measure 36-item health status measure  Eight scales  Physical and Mental Component Summary Scores (PCS and MCS) Activities of daily living (ADLs) Activities of daily living (ADLs) Healthy days Healthy days Clinical symptoms Clinical symptoms Chronic medical conditions Chronic medical conditions Depression screen Depression screen Demographics Demographics

5. 5 HOS Version 2 (HOSv2) 2006 - Present 12-item health status measure (VR-12) 12-item health status measure (VR-12)  PCS and MCS Two additional HEDIS ® measures Two additional HEDIS ® measures  Osteoporosis Testing in Older Women (OTO)  Fall Risk Management (FRM) Height and weight for BMI

6. 6 Sampling Methodology National survey National survey Baseline cohort of 1,000 beneficiaries randomly sampled from each participating plan Baseline cohort of 1,000 beneficiaries randomly sampled from each participating plan Mailed survey Mailed survey  Telephone follow-up of non-respondents Longitudinal: MA members surveyed at baseline, and respondents resurveyed two years later Longitudinal: MA members surveyed at baseline, and respondents resurveyed two years later  Each cohort comprises respondents from one baseline and the associated follow-up

7. 7 Medicare HOS Response Rates Sampling Time Period MA Reporting Units Sample size Response Rates Baseline Cohort 1 - 8 161 - 312 159,311-301,184 61.4% - 71.6% Follow-up Cohort 1 - 6 146 - 188 69,865-89,332 77.1% - 85.8%

8. 8 National Baseline Mean Unadjusted PCS and MCS Scores Medicare HOS Surveys:1998-2005* *1998-2000 scores were normalized based on 1990 US general population 2001 –2005 scores were normalized based on 1998 US general population

9. 9 Medicare HOS Performance Measurement ResultsYears MA Reporting Units PCS Better PCS Worse MCS Better MCS Worse 1998 -2000 188NoneNone 13 plans 15 plans 1999-2001160 9 plans 5 plans 8 plans 5 plans 2000-2002146 20 plans 1 plan 15 plans 4 plans 2001-2003152 22 plans 1 plan NoneNone 2002-2004153 21 plans None 27 plans 3 plans 2003-2005154NoneNone 18 plans 2 plans

10. 10 Medicare HOS-M The HOS-M, a modified version of the HOS, was fielded for the first time in the spring of 2005 The survey is administered to vulnerable Medicare beneficiaries who are enrolled in specialized Medicare plans The goal is to assess the frailty of the population in these specialized plans in order to adjust Medicare payments The survey includes 12-item physical and mental health status questions as well as limitations and assistance with activities of daily living (ADLs)

11. 11 Additional Information HOS Web Site www.hosonline.org HOS Technical Support Medicare HOS Information and Technical Support Telephone Line: 1-888-880-0077 E-Mail: hos@azqio.sdps.org