Identifying Opportunities for Improvements With Health Outcome Surveys

Helping members improve their health and manage chronic conditions requires continuous interactions throughout their health journeys. Keeping a constant eye on a member’s health status allows health plans to determine which resources and interventions are needed to improve their physical and mental wellbeing. With the right data aggregation and stratification tools, plans can optimize operational efficiencies, revenue growth and plan performance strategies to deliver meaningful improvements in quality and health outcomes.

Monitoring health statuses at a member level for entire contracts is a monumental task for plans, no matter the size and resources at their disposal. To simplify the process, health plans are encouraged to routinely check in with members throughout the year with specialized survey tools. Just as Health Risk Assessments capture risk factor data and mock Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys evaluate member experiences, plans can use Health Outcome Surveys to track health statuses.

What are Health Outcomes Surveys?

The Medicare Health Outcome Survey (HOS) is an annual survey that asks Medicare Advantage members a handful of questions about their physical and mental health. Medicare Advantage plans with at least 500 members are required by the Centers for Medicare & Medicaid Services (CMS) to conduct a baseline survey to a random sample of members each year through a CMS approved survey vendor. Two years later, plans must conduct a follow-up survey with the same members to determine if their health statuses have changed.

Members are asked to answer questions related to:

• Quality of their physical health in the past 30 days
• Quality of their mental health in the past 30 days
• Number of doctor visits in the past year
• Health risks, screenings and treatments discussed at doctor visits
• Quality of the doctor visits
• Nutrition, exercise, fall risk and bladder control
• Daily activities, pain, depression, sleep quality and chronic conditions
• Their demographics, such as race, ethnicity, language, sex and disability status

The Role of Health Outcome Surveys as a Performance Metric

The HOS was developed in collaboration with the National Committee for Quality Assurance (NCQA) in 1998 as the first Medicare managed care outcomes measure in the Healthcare Effectiveness Data and Information Set (HEDIS®). This collaboration allowed CMS to standardize a member’s health status into the HEDIS® performance measurement set. Since then, CMS and the NCQA have designed three HOS-specific HEDIS® Effectiveness of Care measures that condense survey results into standardized data files.

The results of HOS are reported to CMS and enable the organization to measure health outcomes and improvements at a contract and member-level. All results are reported publicly to inform research purposes and have been folded into the Star Ratings program to incentivize Medicare Advantage plans to conduct the surveys. Currently, there are three HEDIS Effectiveness of Care measures that are included in the Medicare Part C Star Ratings and three functional health measures that are for display only.

The HOS measures are:

• HEDIS® measures:
  • Monitoring Physical Activity
  • Improving Bladder Control
  • Reducing the Risk of Falling
• Display-only functional health measures:
  • Improving or Maintaining Physical Health
  • Improving or Maintaining Mental Health
  • Physical Functioning Activities of Daily Living

However, CMS is planning on moving the three display-only measures to active status in measurement year 2024. As triple-weighted measures, they will have a powerful impact on Star Ratings.

How is the Health Outcomes Survey Conducted?

CMS contracts with the NCQA to administer the HOS, and Medicare Advantage plans are required to use approved survey vendors to conduct the survey based on their guidelines. Every year plans must perform the baseline survey on a new sample of members, also referred to as a cohort. Each cohort will receive a follow-up survey within two years. For 2023, plans will need to conduct a baseline survey on cohort 26 and a follow-up survey on cohort 24. If a contract receives less than 30 responses, then the results will not impact the related HEDIS® measures.

There are several versions of the Medicare HOS that have been used to evaluate health statuses since the survey’s inception. The latest Medicare HOS survey is version 3.0, which collects information surrounding:

• The Veterans RAND 12-Item Health Survey
• Case-mix and risk-adjustment
• Four HEDIS® Effectiveness of Care measures
• Race, ethnicity, primary language, sex and disability status
• Additional health questions, including new and revised questions

During the survey process, vendors will provide Medicare Advantage plans with regular progress reports that highlight contract-level data, including response rates. Each fall, vendors will also provide plans with a HOS Baseline Report, a HEDIS HOS Effectiveness of Care Report and a HOS Performance Measurement Report, which is focused on the follow-up survey.

Similar to the mock-CAHPS, the HOS has a blackout period. Plans cannot ask HOS questions to members eight weeks prior to and during the survey administration, but they can notify members that they might receive the survey. Outside of this blackout period, plans can conduct their own survey to track performance in each HOS measure and implement interventions to improve health statuses and quality scores.

How Do Health Outcome Surveys Impact Health and Quality Outcomes?

The HOS allows health plans to monitor changes in health status at a member level and offers the opportunity to secure easy growth in the Star Ratings program. HOS results incorporate a wealth of valuable information about members’ physical and mental health, quality of providers, health risks and ability to improve healthy behaviors. When leveraged alongside the right member engagement strategies, Medicare Advantage plans can implement meaningful interventions that address negative health outcomes and quality scores.

Implementing Mock-Health Outcomes Surveys in Pulses

Surveying members throughout the year with HOS-related questions allows plans to evaluate and address member pain points before the official survey is administered. Pulse Surveys provide Medicare Advantage plans with immediate feedback on member health statuses, provider quality and plan performance metrics without overwhelming members with a hefty questionnaire. Shorter surveys are less likely to cause member abrasion and experience higher response rates, increasing the amount of data a plan can capture.

Segmenting the HOS into pulses is a faster way of addressing issues that members are facing in their day-to-day lives. The survey covers a wide variety of scenarios that are not measured in most surveys, including isolation, loneliness, depression, anxiety and living situations. Some questions even drill down into social determinants of health and provide insight into how members deal with specific age-related issues. If a plan needs feedback on a specific HEDIS measure or health status like fall risks, incorporating HOS questions into a pulse survey would provide a faster response than the full HOS.

Pulse Surveys also present plans with more channels to collect member-reported data. The official HOS is a mail-in survey with follow-up telephone calls if a member doesn’t respond. Health plans can distribute Pulse Surveys through emails and text messages depending on a member’s preference. A digital-first survey strategy reduces member abrasion, improves response rates and reduces costs when it involves a digital-first approach.

What Results Can Tell You About Your Health Plan

The HOS contains a wealth of information about a member’s health status, interactions with providers, chronic conditions and mental health. Drilling down into this information enables health plans to construct data-driven quality improvement strategies that address health outcomes and quality scores in coordinated campaigns. While launching multiple full HOS surveys risks overwhelming members, trickling HOS questions into pulses simplifies the process, improves response rates and reduces the cost of outreach.

Plans can further streamline the HOS data aggregation process by using a centralized survey platform. Healthmine’s Pulse Survey solution offers plans a single dashboard to draft and implement HOS Pulse Surveys across multiple channels. You can leverage our solution to:

• Create your Pulse Surveys with a library of pre-selected HOS questions or design your own to identify specific contract-, provider- or member-specific issues.
• Distribute surveys through member-preferred channels, including email and text messages.
• Analyze the responses when you take advantage of four hours of consulting time with our Expert Advisory Services team.

Access the fastest tool for keeping track of member health statuses to inform engaging and impactful interventions when you partner with Healthmine.