Are you Prepared for the Fielding of the Annual Health Outcomes Survey (HOS) this Month and the Significant Changes on the Horizon?

Are you Prepared for the Fielding of the Annual Health Outcomes Survey (HOS) this Month and the Significant Changes on the Horizon?

What is the HOS?

For those not familiar, the HOS is an annual survey administered from July through November, to a random sample of Medicare Advantage members. The same members are surveyed again two years later to assess changes in physical and mental health status. The CMS Star Ratings include 5 HOS measures: 2 measures of functional health (Improving Mental Health & Improving Physical Health), currently on the display page, ?and 3 HEDIS Effectiveness of Care measures (Monitoring Physical Activity, Improving Bladder Control & Reducing the Risk of Falling).

How Does the HOS Impact Health Plan Star Ratings?

This year, HOS measures comprise 3% of Star’s scoring and next year establishes the baseline for the reintroduction of the triple weighted functional health measures, a 2-year cohort measuring how well health plans work in collaboration with provider groups to improve the physical and mental health of their members. The reintroduction of these patient reported outcomes measures (PROMS) will increase HOS to 11% of the Ratings.

Last week, CMS reiterated their intent to add additional PROMS to HOS & Stars, specifically Physical Functioning Activities of Daily Living (PFADL). This PROM is derived from the combination of two physical functioning questions (limitations in moderate activities or climbing stairs) and six activities of daily living (ADL) questions (difficulty with bathing, dressing, eating, walking, getting in and out of chairs, or using the toilet). In addition to educating providers, ?Health Plans should ensure that current, and future, HOS topics are incorporated into the Health Risk Assessment and addressed in the member’s Plan of Care.

What HOS Changes Does CMS Have on the Horizon?

Last week CMS released a memo, along with a series of attachments, notifying plan’s of significant HOS ?changes on the horizon, including adding a web-based survey modality (allowing survey completion via computer, smart phone or tablet), revising the wording of several HOS questions used in Stars, and potential removal of 20 questions. Many of the questions removed will be replaced with new questions that address health-related social needs items and generalized anxiety disorder in addition to new PROMs (like PFADL) that CMS intends to pass through rule-making for possible addition to Stars. ?

CMS intends to field test the 2 versions (current & revised) of the HOS so they can measure the effects of new content and a web-based mode on response patterns and measure scores. ?CMS will use the remaining unused sample frame from the annual HOS administration to draw samples for this, one-time, field test.

Although the wording changes (these can be found in attachment C, that accompanied the CMS memo) and the addition of a web-based modality are likely improvements, the return of the 2 measures of functional health to Stars and CMS’ intention to incorporate additional PROMS is concerning. This is especially true for plans with high LIS, dual, and SNP enrollment for whom many believe the current case-mix adjustements, predictive models, and analysis of results fall short.

CMS is allowing 60 days (until August 25, 2023) for public comment on these proposals.