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All you need to know about Health Outcome Survey

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Health Outcome Surveys aka HOS is a patient-reported outcomes measure. It is a CMS survey (Centers for Medicare & Medicaid Services) that aims to obtain health status reports from people with Medicare. HOS is a part of an integrated system that focuses on activities to improve quality and establish accountability in Medicare-managed care. All Medicare Advantage (MA) must participate in and conduct the Health Outcome Survey.

The objective of the HOS is to collect clinically meaningful, reliable, and valid status data from the MA patients for the purpose of

  • Quality improvement activities
  • Monitor performance of health plan
  • Reward top-performing health plan
  • Improve the health of the patients
  • Public reporting

To administer the Survey, an MA plan requires a CMS-approved survey vendor. The survey tests the plan’s ability in improving the physical and mental health of the patients. The survey helps in supporting the Medicare beneficiaries make informed decisions and choices regarding health care. The gathered health data increases the MA plan focus on wellness and health outcomes.


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About the HOS survey

The HOS is conducted on a random sample of Medicare beneficiaries. The sample is drawn from each one of the participating MA plans. This implies that a baseline survey is conducted on a group each year. Two years later another survey was conducted again on the same sample of respondents.

  • Cohort 1 (group 1) was first surveyed (baseline) in the year 1998. The next survey for the same cohort was in 2000.
  • Cohort 20 received the baseline survey in 2017 and was re-surveyed in 2019.

The difference in the status data for the period of two years shows if the physical and mental health of the members improved or worsened. The difference in the report is categorized as “better, same or worse than expected”.

The Technical Expert Panel which comprises individuals with expertise in the healthcare industry refines and develops the HOS. The analysts apply the recently gathered advances to summarize the physical and mental health outcomes of the patients. Also, apply suitable techniques for risk adjustment.

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Uses of HOS

There are fives Health Outcome Survey measures:

2 functional health measures + 3 HEDIS Effectiveness of Care

The survey questions concern patient-physician relations. It helps a physician identify the areas for improvement in the patient’s health outcomes. The surveys involve questions about overall physical and mental status. The patients are also asked if they had any discussion or received any counseling from the physician.

The five measures of Health Outcome Survey or HOS are

  • Functional Health Measure:
  • Improving or maintain physical health
  • Improving or maintain mental health
  • HEDIS effectiveness care:
  • Management of urinary incontinence in Adult
  • Physical activity in older adults
  • Fall risk management
Health Outcome Survey
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Sample questions of Health Outcome Survey

Improving or maintaining physical health:

  • How would you rate your current health status?
  • Does your health limit you from:
  • Performing minor activities like walking
  • Climbing several stairs
  • How much did pain interfere with your work in the past two weeks?


You should ask questions if they suffered from physical pain. If they answer yes, follow it up with how it is affecting their ability to complete a normal physical activity that they do in their daily lives.

Identify ways to improve pain management so that your patient can achieve their recovery goal.

You can counsel them on physical therapy or rehab if required. Also, determine if your patient should consult with a pain specialist to achieve better health benefits.

Improving or maintain mental health:

  • In the last two week did you feel downhearted as a result of emotional problems?
  • Have you faced issues in doing activities that you usually enjoy due to emotional stress?
  • How much did your emotional stress/problems interfere with your social activities?


Empathizing with the patients can make them comfortable to talk about their mental health.

You can discuss with them about going for therapy if required.

If they don’t want mental health counseling, offer other ideas such as: socialize, engage more with family, own a pet, volunteer work, meditation, etc.

Also, consider a hearing test. Loss of hearing can give a sense of isolation.

Monitoring physical activity:

  • In the last 6 months, did your doctor or care provider give you a new regimen for exercise or physical activity?


Offer patients suggestions for physical activity based on their capability.

A survey cannot provide you many insights about a patient’s activity level. So, discuss with them what physical activity they engage in and talk about the health benefits.

For a patient with limited mobility, suggest they learn less strenuous yet effective exercises.

Improving bladder control for older adults:

  • Have you had trouble controlling your urine in the past six months?
  • When have you experienced trouble holding your urine during walking, exercise?
  • Do you feel pain when you urinate?
  • Is there any change in color, smell, or volume?


The topic may be personal and people may not feel comfortable discussing it. However, you must communicate professionally and inform them that it is common as we grow old. Inform them of the treatments that can help with the issue.

You can also provide them with a brochure to make them comfortable about the sensitive topic before discussing it.

Reducing the risk of falling

  • Have you had trouble keeping balance while walking?
  • Did you fall in the past six months?
  • Has your care provider given you any suggestions to treat your issues with balance or walking?


Review the medication and treatments given to the patients to check if any of that increases the chance of falling.

Suggest physical therapy and balance activities like yoga. Also, suggest patients use a walker or cane if required.

Discuss home safety and suggest installing handrails.


HEDIS Medicare HOS

  • HOS 3.0 is the current version of the Health Outcome Survey. It includes Veterans RAND 12-item Health Survey or VR-12. It involves questions concerning HEDIS Effectiveness of Care measures along with Section 4302 of the Affordable care Act. It also includes other health questions such as limitations on ADL (activities of daily living), depression, chronic conditions, pain, and quality of sleep.

    The HOS-M, i.e., Health Outcome Survey-Modified, is used to measure health problems for Medicare beneficiaries who are under the organizations of PACE, Program of All-inclusive care for the Elder.

    The HOS and HOS-M surveys can be used for either of the following purposes

    • Internal, non-commercial informational purpose
    • Participating in the official CMS survey


    • The survey used for purposes other than the ones mentioned above, one requires submitting the HOS Survey Intake Form, terms of use, and survey use request application. You cannot administer surveys such as fielding surveys for the HOS program outside the official CMS-sponsored or commercial service.
    • Survey vendors or health plans are prohibited to administer any HOS and HOS-M survey to Medicare beneficiaries eight weeks before and during HOS administration. Also during the same time period, CMS also discourages fielding surveys for the non-CMS purpose to any Medicare beneficiaries. This period of eight weeks before and during HOS administration is the Blackout Period.

    Several of the HOS, since 2012, measures have been included in the Star rating for MA quality bonus payments.

    • MA can use HOS reports to compare health plans.
    • The public and research groups use the results to gauge the performance of the MA program, to monitor the health of the patient population, and to evaluate treatment outcomes.
    • MA contracts use it for identifying areas for improvement.
    • Medicare administrators and policymakers use it to monitor MA plans.


Medicare Star Rating Timeline for 2020 and 2021

For the MA program in 2021 quality bonus payment, 2020 Medicare Part C Star Ratings will be used by CMS as the basis for the quality bonus payment.

To gather the measure two sets of HOS data will be used for the 2021 quality bonus program

  • For 2, functional health measure: HOS 2016-2018 Cohort 19 Merged Baseline and Follow Up
  • For 3, 2018 HEDIS Effectiveness of Care measure: HOS 2018 Cohort 21 Baseline and 2018 Cohort 19 Follow Up

Similarly, for the MA program in 2022 quality bonus payment CMS will use 2021 Medicare Part C Star Ratings as the basis for the quality bonus payment.

  • For 2, functional health measures: HOS 2017-2019 Cohort 20 Merged Baseline and Follow Up
  • For, 3 2019 HEDIS Effectiveness of Care measures: HOS 2019 Cohort 22 Baseline and 2019 Cohort 20 Follow Up



Medicare beneficiary is used to refer to an individual residing in the U.S., who is entitled to benefits under Medicare part A and enrolled under part B plan.

HEDIS: Healthcare Effectiveness Data and Information Set

HEDIS is a set of standardized performance measures. It is designed to provide information for comparison of health plan performance to consumers. Cancer, heart disease, diabetes, asthma, and smoking are some significant health issues that HEDIS measures relate to.

The five HOS measures consist of two functional health measures and three HEDIS Effectiveness of Care measures.

  • Improving/maintaining physical health
  • Improving/maintaining mental health
  • Monitoring physical activity
  • Improving bladder control
  • Reducing the risk of falling

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