MEDICARE HEALTH OUTCOMES SURVEY (HOS) AN OVERVIEW FOR PROVIDERS
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1 MEDICARE HEALTH OUTCOMES SURVEY (HOS) AN OVERVIEW FOR PROVIDERS
2 WHAT IS MEDICARE HEALTH OUTCOMES SURVEY (HOS)? HOS is: A patient-reported, confidential survey designed to collect valid and reliable clinical data on members' physical and mental health status over time. Used by the Centers for Medicare & Medicaid Services (CMS) to monitor the performance of Medicare Advantage (MA) organizations and maintain or improve the physical and mental health of Medicare patients. Administered to a random sampling of Medicare members and conducted from April to June. The same group of members is resurveyed after two years to assess changes in their physical and mental health. Directly tied to the MA plan s reimbursement and services provided to members. 2
3 YOU PLAY AN IMPORTANT ROLE! Interaction with members has a direct impact on the HEDIS Effectiveness of Care measures and Functional Measures assessed on the HOS. Reducing the Risk of Falling + Monitoring Physical Activity + Improving Bladder Control = Effectiveness of Care. Improving or Maintaining Physical Health + Improving or Maintaining Mental Health = Functional Measures. Awareness of these measures can help guide discussions with members during office visits. High ratings drive patients to your practice and increase patient loyalty. 3
4 SAMPLE MEDICARE HOS QUESTIONS There are approximately 68 survey questions. Physical Status Emotional/ Mental Health Status Star and HEDIS Measures Chronic Conditions Activities of Daily Living Clinical Symptoms Chronic Medical Conditions 4
5 HOS MEASURES The five Medicare Star measures collected through HOS are: 1.Reducing the risk of falling (FRM) 2.Improving or maintaining mental health (MCS) 3.Improving bladder control (MUI)* 4.Monitoring physical activity (PAO) 5.Improving or maintaining physical health (PCS) * Currently a Star Display Measure 5
6 STAR MEASURE: REDUCING THE RISK OF FALLING (FRM) The percentage of members with a problem walking or balancing who discussed it with their doctor and received treatment during the past year. According to the Centers for Disease Control and Prevention (CDC), one out of three older adults 65 or older falls each year, but less than half talk to their health care providers about it. 1 In the past 12 months, have you fallen or had problems with balance or walking? We can help: Refer eligible Medicare members to our Steps-4-Safety PATH program for fall prevention ( ). 6
7 STAR MEASURE: IMPROVING OR MAINTAINING MENTAL HEALTH (MCS) The percent of members whose mental health was the same or better than expected after two years. According to the Centers for Disease Control and Prevention (CDC), providers may mistake an older adult's symptoms of depression as a natural reaction to illness or the aging process and older adults are often misdiagnosed and undertreated. 1 Be sure to discuss mental health with members and look for signs of depression. Do you feel down or hopeless? Are you having trouble sleeping? We can help: Refer eligible Medicare members to Emblem Behavioral Management Program administered by Beacon Health Options ( ). 7
8 STAR MEASURE: IMPROVING BLADDER CONTROL (MUI) The percentage of members with a urine leakage problem who discussed the problem with their doctor and received treatment within six months. Urinary incontinence can be a sensitive topic to discuss with members. However, it s important for improving their quality of life and identifying signs of a larger health concern. MUI is a Star Display Measure for 2016 and 2017 Star Ratings. During the past six months, how much does urine leakage change your daily activities or interfere with your sleep? 8
9 STAR MEASURE: MONITORING PHYSICAL ACTIVITY (PAO) The percent of members who discussed exercise with their doctor and were advised to start, increase or maintain their physical activity during the year. Physical activity can prevent health problems. Be sure to discuss appropriate exercise with members! Our doctor recommended that we start an exercise program to improve our health. We did and feel great! 9
10 STAR MEASURE: IMPROVING OR MAINTAINING PHYSICAL HEALTH (PCS) The percent of members whose physical health was the same or better than expected after two years. Regular physical activity is important for overall good health. Ask members about everyday activities such as walking, climbing stairs, the ability to work, pain and performing activities of daily living. The discussion can help uncover any difficulty the member may be experiencing. Do you have difficulty climbing stairs? 10
11 LET S WORK TOGETHER: HELPFUL EMBLEMHEALTH RESOURCES To help you improve health outcomes and member satisfaction, we have resources to assist you in addressing HOS health topics. 11
12 DISEASE MANAGEMENT RESOURCES Positive Actions Toward Health (PATH) programs are voluntary and available to all eligible members who qualify based on diagnosis. These programs can assist with the overall care management and are designed to complement the care our providers provide. Please refer your members. The following PATH programs are available to eligible members: Diabetes Care PATH program: Better Breathing PATH programs for asthma and chronic obstructive pulmonary disease (COPD):
13 DISEASE MANAGEMENT RESOURCES (CONTINUED) Tobacco-Free PATH smoking cessation program: Steps-4-Safety PATH program for fall prevention: Heart Care PATH programs for heart failure and coronary artery disease (CAD): Kidney Care PATH programs for chronic and end-stage renal disease (ESRD): Beacon Health Options for mental health referrals:
14 CASE MANAGEMENT RESOURCES ComplexCare Solutions (CCS) is delegated to provide complex case management services. Its in-home clinical model includes licensed NPs, RNs, SW, Pharmacists, MDs, PAs and PT/OT who coordinate care with the member s PCP and caregiver. The services provided include: adult day health care, medication reconciliation/monitoring, health assessments and others. Call or visit complexcaresolutions.com/ index.html. 14
15 PHARMACY RESOURCES There are 12 EmblemHealth pharmacies on site at our AdvantageCare Physician (ACP) locations. Call Medication Therapy Management (MTM) program is available to EmblemHealth Medicare members. A pharmacist will telephonically review medications of members: Home Delivery Pharmacy Program: Express Scripts, Inc. (ESI) is delegated for home delivery services. Prescriptions may be ordered online, by mail or phone. Call or visit emblemhealth.com/homerxprogram. 15
16 PROVIDER PORTAL RESOURCES Manage your patients care as well as get clinical and care coordination information at emblemhealth.com/providers. emblemhealth.com/en/providers/provider-resources.aspx. 16
17 HOS SURVEY RESOURCES To learn more about the Medicare Health Outcome Survey, visit hosonline.org. 17
18 THANK YOU! Thank you for providing continued quality care for our members. For more information, you may contact Liana Jonas, Clinical Quality Improvement Specialist, 18
19 QUESTIONS & COMMENTS
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