1 June 8, 2008 CMS Chronic Condition Data Warehouse.

1

June 8, 2008

CMS Chronic Condition Data Warehouse

2

Chronic Condition Data Warehouse

Background• Medicare Modernization Act of 2003, Section 723,

mandated a plan to “improve the quality of care and reduce the cost of care for chronically ill Medicare beneficiaries”

• Essential component of plan was to establish a research database that contains fee-for-service Medicare claims data and assessments, linked by beneficiary, across the continuum of care

• Claims and assessment data linked to Medicare eligibility/enrollment data

3


Population: 1999-2004• Random 5% sample of Medicare beneficiaries (e.g.,

claims-based sampling methodology)• Eligible for and enrolled in Medicare on or after January 1,

1999 through the most current period• Health Insurance Claim (HIC) number where the eighth

and ninth digits are in the set {05, 20, 45, 70, 95}• Qualified for 5% sample, therefore, remained part of the

ongoing CCW sample (includes ever-qualifying beneficiaries from January 1, 1999 forward, i.e., an enhanced or person-based 5% sample)

4


Population: 2005 - Forward• 100% Medicare beneficiaries• Linked with historical data• Random 5% sample flags• Current data

5


Linkage Across the Continuum of Care• All CCW data files linked by assignment of a unique,

unidentifiable beneficiary link key for ease of analysis across data files (unique link keys replace HIC numbers)

• Allows for cross-sectional and longitudinal research from 1999 forward

• Allows linkage across the continuum of care to construct patient-centric views of enrollment and service utilization

• Link keys encrypted prior to delivery to the researcher, for privacy protection

6


Chronic Condition CategoriesResearchers may request data for 21 predefined chronic condition categories, allowing for timely data extraction:

Acute Myocardial Infarction Chronic Obstructive Pulmonary Disease

Depression

DiabetesAlzheimer's Disease, Related Disorders, or Senile Dementia

Alzheimer's Disease only Glaucoma

Atrial Fibrillation Heart Failure

Cancer, Female Breast Hip/Pelvic Fracture

Cancer, Colorectal Ischemic Heart Disease

Cancer, Prostate Osteoporosis

Cancer, Lung Rheumatoid Arthritis/Osteoarthritis

Cancer, Endometrial

Cataract

Stroke/Transient Ischemic Attack

Chronic Kidney Disease

7


Key Features• Patient-centric data files linked by unique beneficiary key,

across the continuum of care (deidentified and encrypted prior to delivery to researcher)

• Readily available chronic condition cohorts, customized cohorts (defined by researcher), and other categorization schemes

• Easy to use data files designed specifically for researchers (e.g., limited data set, SAS® input and label statements, frequency output, etc.)

• Services from 1999 forward

8


www.ccwdata.org

9


Web Site – Statistical Summaries• Available to general public (pdf format)• Resource for high level, summary statistics by

segmentation variables (e.g., predefined CCW chronic conditions, utilization summary information, demographic, and/or enrollment factors)

• Helpful for finding quick facts• Useful with exploring sample size options

10


Data Files Available Upon Request from CMS• Enrollment/eligibility data• Administrative claims

– Fee-for-service institutional claims for inpatient, outpatient, skilled nursing facility, hospice, and home health agency settings

– Fee-for-service non-institutional claims for physician/supplier and durable medical equipment

11


Data Files Available Upon Request from CMS (cont.)• Assessment data

– Minimum Data Set (MDS) - nursing facilities– Outcome and Assessment Information Set (OASIS) -

home health agencies– Inpatient Rehabilitation Facility Patient Assessment

Instrument (IRF-PAI) – Swing bed data

• CCW (CMS) Denominator (100% or 5% sample)• Beneficiary Summary File• Chronic Condition Summary File• Medicare Current Beneficiary Survey (MCBS)

12


Beneficiary Summary File• Annual beneficiary summary file containing demographic

and enrollment data• Includes data for beneficiaries in the requested cohort or

other specified population who were:– Ever part of the CCW 5% sample – Documented as being alive for some part of the

reference year – Enrolled in Medicare Part A or B at some point during

the reference year (may also have been enrolled in managed care)

13


Chronic Condition Summary File• Summary of a beneficiary’s chronic conditions (if any) by

year• Indicator variables for presence of a CCW condition during

that year– End of year– Mid-year– Ever occurred (1999 to current)

• Includes beneficiaries in requested cohort (or other specified population)

14


Data Request Options

• Standard (e.g., based on predefined chronic condition cohort criteria, 5% sample for a given year, etc.)

• Custom (e.g., researcher-defined cohort based on demographic or clinical information such as diagnosis or procedure codes, etc.)

• Finder file (e.g., based on known beneficiary identifiers, types of services, etc.)

15


Data Request Process1. Researcher contacts Research Data Assistance Center

(ResDAC) and/or IFMC for assistance with data request packet.

2. Researcher submits data request packet to CMS.3. CMS approves data request, researcher submits payment

to CMS, and CMS forwards approval to IFMC as notification to fulfill request.

4. IFMC processes, encrypts, and delivers data package to researcher.

5. Copy of data package archived.

16


Considerations when Requesting CCW Data• Broad criteria for CCW conditions• Medicare coverage restrictions (see CCW Technical

Guidance Paper on web site)• Inclusion of control or comparison group (chronic

condition indicator variables can make this simple)• Claims maturity

17

• Full coverage - The beneficiary has Part A, Part B and no HMO coverage for the full surveillance period (or until the time of death, if the beneficiary died in the year)

• Partial coverage - The beneficiary has some Medicare Part A and/or B coverage (or much, depending on how the coverage criteria are specified), and may or may not have some managed care coverage

• Point in time coverage - The beneficiary has coverage during the month of interest – (e.g., for July, the midpoint of the year)

• Person years with coverage - Each beneficiary with any coverage to count toward the denominator, for however many months (or proportion of a year) they have the coverage of interest


Coverage Options for Examination of Prevalence in CCW

18


Calculating Prevalence• Determine what is sufficient coverage for surveillance

period• Once study cohort is identified, determine who has

condition of interest• CC indicator variables for each of 21 conditions, with

four possible values:0 = Neither claims nor coverage met1 = Claims met, coverage not met2 = Claims not met, full coverage met3 = Claims and full coverage met

19


Difference in Prevalence for Beneficiaries with AMI in 2005 (Various Coverage Options)

Denominator Numerator Percent

No coverage restrictions 2,232,528 17,819 0.80

1. Full coverage 1,633,165 16,594 1.02

2. Partial coverage 1,648,175 16,681 1.01

3. Point in time coverage 1,678,332 14,898 0.89

4. Person years with coverage 1,676,003 17,861 1.06

20


Prevalence of Select

Chronic Conditions and

Multiple Chronic Conditions (2006)

21

Chronic Condition Data WarehousePrevalence of Chronic Conditions in Medicare FFS Population

Beneficiaries Prevalence

Total FFS Sample 1,603,392 100.0%

Condition

Alzheimer’s/Dementia 172,313 10.7%

Chronic Kidney Disease 169,061 10.5%

Chronic Obstructive Pulmonary Disease 174,551 10.9%

Heart Failure 283,018 17.7%

Diabetes 405,297 25.3%

Cardiovascular (AMI, IHD, Afib, stroke) 586,638 36.6%

Cancer (lung, prostate, female breast, colorectal) 102,347 6.4%

# Conditions

None 649,856 40.5%

One 431,091 26.9%

Two 261,870 16.3%

Three or More 260,575 16.3%

22


Percentage of Beneficiaries with Multiple Chronic Conditions

22.9%

6.7%

28.6%25.5%

28.5% 29.2%

50.7%

69.1%

58.4%

67.8%

40.8% 39.9% 39.9%

31.0%

17.9%

10.5%

30.7%

23.7%

26.3%

20.4%

31.5%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Alz/Dementia CKD COPD HF Diabetes Cardiovascular Cancer

Only Condition One Other Tw o or More

23

Chronic Condition Data WarehouseComparisons (Odds Ratios) for Likelihood of Visits

By Care Setting and Number of Conditions

3.0 3.7 2.9

6.79.5

6.3

21.7

33.5

16.3

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

INP SNF HHA

One Tw o Three or More

24


Average Per Beneficiary Medicare Payment for Selected CCW Conditions

$0

$2,500

$5,000

$7,500

$10,000

$12,500

$15,000

$17,500

$20,000

$22,500

$25,000

Alz/Dementia CKD COPD HF Diabetes Cardiovascular Cancer

Only Condition One Other Tw o or More

25


Medicare Payments byNumber of Conditions

Three or More49.5%

Tw o 20.8%

One 18.4%

None 11.3%

Beneficiaries by Number of Conditions

None 40.5%

One 26.9%

Tw o 16.3%

Three or More16.3%

26


Research Potential Using CCW Data

• Supports increased need for chronic disease research as aging population increases

• Allows longitudinal analyses of Medicare utilization, expenditures, quality of care, and health outcomes across continuum of care

• Provides researchers with low cost, easy-to-use data files

• Flexible data extract system allows researchers to request only minimum data needed for studies

27


Potential Enhancements for CCW

• Part D drug event data (minimum data necessary)

• Enhanced Summary Files:

– Condition-specific statistics in form of beneficiary-level (deidentified) analytical file (see next slide)

– Care setting/timeline summary file

– Claims summary files

• SAS code for deriving denominators

28

Chronic Condition Data WarehousePart D Denominator FileCurrent CMS Denominator File to be augmented with the following Part D

information:• Part D Plan Type - Monthly indicators showing Part D plan type

(e.g., Medicare Advantage Part D, stand-alone Prescription Drug Plan, regional PPO, or not enrolled) and count of number of months in plan

• Beneficiary Liability - Monthly indicators of Part D cost sharing (e.g., monthly premium, annual deductible, co-payment or coinsurance rate, catastrophic cost-sharing)

• Retiree Drug Subsidy - Monthly indicators showing whether a beneficiary’s former employer was entitled to retiree drug subsidy for providing drug coverage equivalent to Part D drug benefit and count of number of months in year

• Dual Entitlement - Monthly indicators of state-reported Medicare/Medicaid dual entitlement status and count of number of months in year

• Race/Ethnicity – Enhanced race/ethnicity code based on CMS race code, name, and residence using imputation algorithm developed by the Research Triangle Institute

29


Diabetes Analytical File (Kennell and Associates, Inc.)

• Beneficiary-level analytic file containing statistics on prevalence, comorbidities, utilization, cost of care

• Enables researchers to receive a single data file to answer basic questions about diabetes without having to use multiple files

• Allows for analysis of the diabetic population for a number of comorbidities

30


Questions? Visit these web sites for additional information!

Research Data Assistance Centerwww.resdac.umn.eduE-Mail: [email protected]: 1-888-9-ResDAC or 1-888-973-7322 Iowa Foundation for Medical Carewww.ccwdata.org E-Mail: [email protected]: 1-800-383-2856, ext. 8357

Visit us at AcademyHealth booth #311!

1 June 8, 2008 CMS Chronic Condition Data Warehouse.

Documents

Transcript of 1 June 8, 2008 CMS Chronic Condition Data Warehouse.