New Data Products:
Chronic Condition Warehouse (CCW) &
Medicare Current Beneficiary Survey (MCBS)
Andy Shatto, Director, Division of Data Development and Services Group Office of Information Products and Data Analytics
CCW – What’s New?
New Research Enclave Environment
* Opening Fall 2013!!!
New Interactive Dashboards
Beneficiary Summary Dashboard –
CCW Data Enclave Benefits
ACCESS
COST
SECURITY
•Increases data security > no shipping of external media •Satisfies all privacy and security requirements •Secure File Transfer System (SFTS) transfers data files efficiently and securely • Convenient, quicker, and efficient access to CCW data •Perform analyses and data manipulation •Technical/Analytic support from CCW staff •Statistical data output reviewDATA & ANALYSIS
•Increases data access > VPN and Virtual Desktop •Utilize personal laptops •Controlled virtual access can mean greater flexibility in data policy •Increases efficiency of data delivery •Reduces infrastructure costs for data usersData Enclave Process Flow
DUA Approval by CMS Enclave Security Testing User Requests Output Review User Analysis Secure File Transfer System (SFTS) •File Transfer Request System (FTRS) •Request Data output review Extract/Transfer of Data Set to Enclave CCW Output Review Process •Statistical Review •HIPAA Compliance •Web/VM access •User performs analysis •Output results •File Upload •File Download of Approved Output File(s)Data Currently Available in the CCW Data Enclave
File Name Years
Master Beneficiary Summary File 1999-2012 Medicare claims:
Inpatient Outpatient
Skilled Nursing Facility Home Health Agency Hospice
Carrier
Durable Medical Equipment
1999-2012
MedPAR 1999-2011
Part D Event Data 2006-2011 Medicare-Medicaid Linked File 2006-2008 Medicaid:
IP, LTC, Other, PS, Rx, Medicaid Summary ‘New’
1999-2009 Long Term Care Minimum Data Set 1999-2012 Inpatient Rehab Facility 2002-2012 Swing Bed Assessments 2002-2012
Data Enclave User Requirements
Standard/Basic DE User – Using SAS environment including:
Working knowledge/experience with:
SAS programming language
SAS Enterprise Guide (EG)
Review of information on CCW
Website www.ccwdata.org/
SAS EG User Guides and
CCW 101 Video
My CCW > File Transfers page – Data
Enclave resources
CCW workbench Tool
CCW Workbench
Sign out of Workbench Create Finder File Upload Finder File
Create Extract
Access Privacy Policy and Accessibility Statements on ccwdata.org website
Access User Guide Access CCW Help Desk
To protect the confidentiality of Medicare and Medicaid
beneficiaries, CCW performs data output review prior to
release from the Data Enclave
Avoids disclosure or perceived
disclosure of protected data
PHI
PII
Small cell sizes
CCW Statistician Performs
Data Output Review
Dashboard will present statistical views of information on the
enrollment, utilization and spending for Medicare
beneficiaries
Report tabs will consist of:
Demographics by HRR
Demographics by State
Cost & Utilization
Part D Measures by State
Availability: 1999-2011
CCW Data Websites
WWW.RESDAC.ORG
WWW.CCWDATA.ORG
Research Request Assistance CCW Data/Dashboards
The MCBS is a continuous, multipurpose, in-person survey of
a representative national sample of the Medicare population.
Goals of the MCBS are to:
Provide important information on Medicare beneficiaries
that is not available in CMS administrative data;
Determine expenditures and sources of payment for all
services used by Medicare beneficiaries, including
copayments, deductibles, and non-covered services;
Ascertain all types of health insurance coverage and
relate coverage to sources of payment; and
Track changes over time, such as changes in health
status, spending down to Medicaid eligibility.
Demographics
Health status and
functioning
Cost of care
Preventive services
Access to, satisfaction
with, and usual source of
care
Health insurance
Household or facility
characteristics
Survey weights
Community/ Institutional
timeline
Event specific
information:
Inpatient/Outpatient
Provider
Drug
LTC
SNF
Dental
MCBS Contents
Access to Care:
Point in time
Always enrolled
No survey-reported cost
and utilization included
No imputation
n =15,500
MCBS Data Files
Cost and Use
:
Entire calendar year
Ever enrolled
Include costs and
utilization and
event-level info.
Imputation
“Ever enrolled” Weights for Access to Care 2012 File
Will allow researchers to use Access to Care data to produce estimates
that not only represent the continuously enrolled, but also those that had limited enrollment during the year (e.g., new enrollees, deceased, etc.).
Accountable Care Organizations
MCBS will oversample for ACO members in 2013 and hopes to identify
ACO members as part of our annual files (starting in Fall 2014 with the release of our Access to Care 2013 file).
Data Briefs and MCBS User Training
Please visit our website and review data briefs released with each
MCBS research file.
Coming soon!! Downloadable presentations & training slides on key
components of the survey (e.g., MCBS research files, MCBS survey weights, etc.).
Care coordination
Patient activation
Electronic health record use by
provider of care
Satisfaction, access to care,
and usual source of care
Knowledge and use of
preventive services
New and/or Health Reform-related Content/Questions
Mobility and Use of
Transportation Services
Premiums
Out of pocket spending
Enhanced race/ethnicity
reporting
Self-reported health
outcomes (e.g., ADLs,
health status, etc.)
MCBS Research Files
Available in .SAS or .TXT formats
Data broken out into segments (or RICs) by content area (e.g. Admin.,
Health Status, etc.)
Files available for the following years: Access to Care (1991-2011);
Cost and Use (1992-2009) – 2010 Just Released!
MCBS Data Tables
Includes weighted population statistics on Medicare population and
subpopulations using MCBS research file.
Useful for program statistics, benchmarking, program monitoring, etc.
Questions about and how to obtain MCBS data?
ResDAC – For general questions and to purchase research files
contact CMS’ Research Data Assistance Center (ResDAC),
www.resdac.org.
MCBS Website – MCBS data tables, codebooks, questionnaires, and
other information can be viewed and downloaded at the MCBS website (www.cms.hhs.gov/mcbs).
CMS Interactive Dashboards
Chronic Conditions Dashboard
●
Presents 2011 state, Hospital Referral Region, and national comparison
data on the prevalence of chronic conditions, as well as Medicare costs
and utilization measures for beneficiaries with multiple chronic conditions.
Released in December 2012.
●
Available at
http://www.ccwdata.org/web/guest/interactive-data/chronic-conditions-dashboard
Geographic Variation Dashboard
●
Presents information on state-level variation in standardized per-capita
costs for the Medicare fee-for-service population. Released in June 2013.
●
Available at
http://www.cms.gov/Research-Statistics-Data-and-
Systems/Statistics-Trends-and-Reports/Dashboard/CMS-Dashboard-Geographic-Variation-Dashboard.html
Overview
Chronic Conditions Dashboard - Prevalence
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Provides information on the
prevalence of Medicare
beneficiaries, and sub-populations, with 15 specific conditions. This set of conditions corresponds with the conditions suggested by the HHS Strategic Framework on Multiple Chronic Conditions.
Allows state and
state-to-national comparisons of condition rates.
Displays information on
Spending by Chronic Condition Count
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How does spending compare between Maryland and the nation for females aged 65 – 74?
How do the percent of
beneficiaries and percent of spending compare for this group in Maryland?
Beneficiaries with 6 or more conditions in Maryland have per capita standardized costs of $38K,
compared with $31K nationally.In Maryland, 9% of female beneficiaries aged 65 – 74 have 6 or more conditions, but this
population accounts for 42% of Medicare spending
Chronic Conditions Dashboard – State and HRR Mapping
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The mapping tabs allow
users to visualize variation
in per capita spending, ER
visits per 1,000, and 30
day readmission rates
across geography and
chronic condition count.
Bar graphs allow for
comparison of key
measures across
condition counts.
●
Source:
Public use files compiled by OIPDA using the Chronic
Conditions Warehouse (CCW)
●
Our goal was to create a simplified form of the available data that
would allow novice users to compare standardized spending
across states and service types.
●
This dashboard was initially released on June 4, 2013. Future
iterations may include additional health measures and drilling
functionality
●
Demo
Medicare Geographic Variation Dashboard
Samuel C. “Chris” Haffer, Ph.D.
Data Development & Services Group
Office of Information Products & Data Analytics - CMS
Baltimore, Maryland
Liberating Claims Data:
Medicare Claims Public Use Files (PUFs) &
Medicare Data Sharing Program
●
CMS Data are a National Resource
●
Access has been limited
●
Transparency/Open Government
●
Innovation:
CER/PCOR
Data Entrepreneurs
Information Intermediaries
While strictly protecting beneficiary
confidentiality….
Increase access to CMS claims
data through the creation of de-identified
data sets …
While strictly protecting beneficiary
confidentiality!!!!
●
Challenge
Create a set of BASIC or slim/thin files
Comply with the HIPAA “safe harbor” standard
Test the utility of the files for research
●
Outcome
14 Basic PUFs – Inpatient, Outpatient, SNF, DME, Hospice, HHA, PDE,
Carrier (Reference Years 2008 and 2010)
●
Challenge
Increase utility of the files for research
Comply with the HIPAA “safe harbor” standard
Use More Data
●
Outcome
8 Profile PUFs – Chronic Conditions, Prescription Drug, Institutional
Provider, Physician/Supplier (Reference Years 2008 and 2010)
●
Challenge
Unmet Needs of Phase 1 and Phase 2 PUFs
Comply with the HIPAA “safe harbor” standard
●
Outcome
DE-SynPUF – (20 Samples x 8 Files each) – Inpatient, Outpatient,
Carrier, PDE, Beneficiary Summary (Reference Years 2008, 2009,
2010)
Data Entrepreneurs’ Synthetic PUF for
Medicare Claims Data (DE-SynPUF)
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GOAL:
• Increase access to realistic Medicare claims data files in a
timely and less expensive manner to spur the innovation
necessary to achieve the goals of better care for beneficiaries
and improve the health of the population.
USES:
• train researchers on the use and complexity of conducting
analyses with CMS claims data prior to initiating the process to
obtain access to actual CMS data;
• support safe data mining innovations that may reveal
unanticipated knowledge gains while preserving beneficiary
privacy; and,
• allow data entrepreneurs to develop and create software and
applications that may eventually be applied to actual CMS
claims data;
Data Entrepreneurs’ Synthetic PUF for
Medicare Claims Data (DE-SynPUF)
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•New type of ‘synthetic’ file useful for data
entrepreneurs for software and application
development
•Preserve detailed data structure of key variables at
beneficiary and claim levels
•Data is fully ‘synthetic’ for disclosure safety
•Limited analytic utility due to lack of preservation of
interdependence between variables
•Create file that can be certified to be released as a
Public Use File
•
5% sample of enrolled Medicare beneficiaries in 2008
•
3 years of claims (2008, 09, 10)
Inpatient
Outpatient
Carrier
PDE – Prescription Drugs
•
The synthetic beneficiaries have nearly the same number of
claims as their seeds, with very similar claim patterns
•
The data structure is very similar to the real CMS files, albeit with
a smaller number of variables
•
Programs and procedure designed using the SynPUF should be
fully functional when applied to CMS limited data sets
● Beneficiary Table • Rows: 2.4 million • Variables: 52
● Inpatient Claims Table • Rows: 1.8 million • Variables: 81
● Outpatient Claim Table • Rows: 21.4 million • Variables: 76
● Carrier Claims Table • Rows: 120 million • Variables: 142
● Prescription Drug Event Claims (PDE) Table • Rows: 157 million
• Variables: 8
We want you!!
•Download and Explore
•Conduct Exploratory Research
•Offer Constructive Feedback
•Encourage Others
Medicare Data Sharing Program: What it is.
A legal authority, allowing Medicare Parts A and B
claims data, and Part D event data to be purchased by
organizations certified by HHS as meeting certain
requirements for use in producing publicly available
provider and supplier report cards using measures of
quality, efficiency, effectiveness, and resource use.
Medicare Data Sharing for Performance Measurement
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Qualified Entity INSURANCE COMPANIES MEDICARE?
NOW FUTURE
COMPREHENSIVE CONSISTENT FAIR ACTIONABLE INSURANCE COMPANIES MEDICARE?
Section 10332 of the Patient Protection and Affordable Care Act (ACA) added
a new subsection to Section 1874 of the Social Security Act, requiring that
the Secretary:
1.
Establish a process to allow for the use of standardized extracts of
Medicare Parts A, B, and D claims data by Qualified Entities (QEs)
2.
who will evaluate and report on the performance of providers of services
and suppliers
3.
using measures of quality, efficiency, effectiveness, and resource use.
4.
Defines QEs as public or private entities that are determined by the
Secretary to be qualified to use Medicare claims data to make such
evaluations of provider/supplier performance
5.
agree to meet specific requirements regarding the transparency of their
methods and
6.
their use and protection of Medicare data.
7.
Requires Medicare claims extracts be combined with other claims
data.
8.
Specifies the only use of such data and the derived performance
information about providers and suppliers be in reports in an
aggregate form.
9.
Reports must be released and made available to the public,
10.
after first making such reports available to any identified provider or
supplier and
11.
affording an opportunity to appeal and correct errors.
12.
Instructs the Secretary to take such actions as she deems necessary
to protect the identity of individual beneficiaries, and
13.
authorizes her to establish additional requirements that she may
specify for QEs to meet, such as ensuring the security of data.
Why is the Medicare Data Sharing Program
IMPORTANT?
• INCREASES ACCESS TO MEDICARE CLAIMS DATA FOR
PERFORMANCE MEASUREMENT
- a major component in our CMS’ strategy of improving care for
individuals, achieving better health for populations, and lowering costs through improvement.
• HIGHLIGHTS CMS’ COMMITMENT TO DATA STEWARDSHIP
- protect beneficiary confidentiality
Certified Qualified Entities
Name of Lead Entity Region(s) Date of QE Certification
Oregon Health Care Quality
Corporation Oregon August 31, 2012
Health Improvement Collaborative of Greater Cincinnati
Ohio Indiana Kentucky
August 31, 2012 Kansas City Quality Improvement
Consortium
Kansas
Missouri September 4, 2012 Maine Health Management Coalition
Foundation Maine November 28, 2012
HealthInsight New Mexico January 18, 2013
California Healthcare Performance
Information System California February 6, 2013
FOR MORE INFORMATION:
Public Use Files
Basic PUFs –
www.cms.gov/bsapufs
SynPUFs -
go.cms.gov/SynPUFs
Medicare Data Sharing Program
www.cms.gov/QEMedicareData
www.QEMedicareData.org
Medicare & Medicaid Research Review
The peer‐reviewed, online research journal published by the Centers for Medicare & Medicaid Services David M. Bott, Ph.D. Editor‐in‐Chief Office of Information Products & Data AnalyticsMission Statement
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