The Health Outcomes Survey (HOS) is a critical part of how the Centers for Medicare and Medicaid Services (CMS) evaluates the quality of Medicare Advantage (MA) plans across the U.S. However, the resulting data goes way beyond just Star Ratings, as it can show crucial information about the experiences of patients receiving care through MA plans, and the health outcomes from this care.
Below, we’ll break down what the HOS is, why it matters, and how you can improve your overall scores by incorporating tools that motivate patients to make healthy behavioral changes.
What Is the Health Outcomes Survey (HOS) — And Why Should Health Plans Care?
The Health Outcomes Survey is a self-reported survey that collects physical and mental health information from Medicare Advantage participants.
The yearly survey randomly selects a number of participants from every MA contract. These patients are interviewed twice: once at the start of the survey and again two years later to gauge changes in their health status.
The goal of the HOS is to determine how well a health plan helps its patients improve or maintain their health. HOS data directly reflects the quality of care associated with each MA plan, allowing CMS to monitor plan performance and identify areas for improvement.
Since HOS data feeds directly into Medicare's Star Ratings, HOS results also have a profound impact on the business outcomes of MA plans. Care centers and plans with good performance and star ratings are eligible for bonus payments and initiatives.
Importance of Health Outcome Surveys and How to Measure Them
The HOS is a crucial tool for measuring health outcomes, as it centers on and gauges the actual health trajectory of patients, not just service utilization or satisfaction. It's an objective indicator of how well an MA plan can serve its members over time.
Providers willing to take a closer look at all this data will find a comprehensive picture of a patient's experiences. HOS data reaches that which traditional quality metrics can't cover: the actual health journey of a patient.
Tracking all these variables will quickly reveal and pinpoint specific areas for improvement, as well as unmet health needs.
Who is Eligible for the HOS Survey?
HOS participants are selected at random (as part of health inequity solutions) and include every segment of a plan, ranging from chronic patients to newcomers. Participation is optional and voluntary, and the respondents are surveyed both times through mail.
As for which plans are eligible, the CMS establishes that only MA plans with over 500 enrollees are mandated to participate in the HOS.
Ethical & Operational Considerations
Handling the HOS involves certain operational and ethical guidelines that ensure that the surveys are not tampered with.
The CMS, for example, imposes a "blackout period" near the official HOS, prohibiting lookalike surveys and coaching on its questions. Notifying patients and encouraging them to respond is valid, but health plans should never attempt to influence final answers.
Another key consideration is confidentiality and privacy protocols. The CMS has a specific set of Quality Assurance Guidelines (QAG) that must be respected to ensure the data is reliable and unbiased.
Care centers that wish to use HOS questions for their own internal surveys must obtain permission from CMS, as the survey questions are copyrighted.
How the Health Outcomes Survey Is Administered
The HOS administration process is handled by the CMS and the National Committee for Quality Assurance (NCQA). Each MA plan that is required to participate must find a CMS-approved survey vendor to handle the logistics of the surveys.
Every year, the CMS randomly picks a sample of survey participants from each MA contract with more than 500 enrollees. These cohorts then receive a follow-up survey two years later.
Participants will receive a survey by mail with the Health Outcomes Survey questions and, two years later, the follow-up survey. If they fail to respond at any point, they'll also receive a phone call asking them to refer to the mailed questionnaire.
The logistics behind HOS surveys are relatively simple — so what actually drives good scores?
In essence, plan managers must strive to help members stay healthy and improve their conditions over time. Plans that excel in care coordination, symptom management, preventive strategies, and patient outreach are likely to yield better HOS outcomes.
The HOS is specifically designed to avoid biases and manipulations of any kind, so good scores are primarily driven by good care.
What Star Ratings Domains are Influenced by HOS?
HOS results influence Medicare Advantage Star Ratings (Part C) in five specific measure domains. Three of these are known as the Healthcare Effectiveness Data and Information Set (HEDIS) Effectiveness of Care measures, while the other two are functional health measures:
- Monitoring Physical Activity (HEDIS)
- Improving Bladder Control (HEDIS)
- Reducing the Risk of Falling (HEDIS)
- Improving or Maintaining Physical Health (Functional health)
- Improving or Maintaining Mental Health (Functional health)
It's important to note, however, that while the functional health measures do appear on the annual HOS Performance Measurement Report, they aren't yet incorporated into the Star Ratings calculations.
How to Improve HOS Scores: Step-by-Step Framework
Improving HOS scores requires plans to have a proactive mindset, simultaneously targeting clinical quality, member behavior, and CMS compliance.
- Identify Low-Performers: By analyzing current and past HOS data, plan managers can pinpoint pain points and weak links. This will help create targeted interventions for specific departments and behaviors.
- Choose High-Impact Behaviors: Some areas of care need to be prioritized in order to have a bigger effect on health outcomes. For example, medication adherence has a massive influence on health status.
- Deploy Engagement Tools: Once target behaviors are identified, plans should start actively engaging members to make meaningful changes. Sustained, tech-enabled engagement is the way to go, taking advantage of digital health and behavioral science.
- Measure and Refine: After the interventions are done, plans should once again measure progress to further refine each area of care. Improvement is a permanent process, and care centers shouldn't wait until HOS scores come around to act.
The specifics will vary from plan to plan and from care center to care center, but the core concept still remains: good scores can only be achieved through data-driven value-based care.
Benefits of Improving HOS Scores
Improving HOS scores yields multiple benefits across the board.
As we already mentioned, better HOS outcomes will raise Star Ratings, opening up new possibilities for bonus payments. This can translate into extra revenue, which can be further reinvested into enhanced benefits for members and better care quality.
At the same time, improvements in HOS scores inevitably mean healthier patients, often leading to reduced healthcare utilization. Patient retention and member satisfaction will also improve, as members will feel both seen and cared for.
In essence, improving HOS scores is a win-win for everyone involved.
Real-World Success Stories and Case Studies
At Wellth, we strive to help care centers improve HOS scores and Star Ratings through member behavior and engagement.
For example, while working alongside Coordinated Behavioral Care, an organization dedicated to improving access to mental health care in New York, our team noticed that many members of this organization had difficulty adhering to their treatments correctly. Through the use of empathy-driven, personalized behavioral incentive plans combined with AI technology and each member's smartphone camera, the whole population managed to realize an 85% daily medication adherence rate, as well as an 100% attendance rate for their follow-up appointments.
AdventHealth DeLand, on the other hand, was facing costly CMS penalties due to high readmission rates. After introducing behavioral economics tools, it was able to reduce readmission rates from 19% to 8%.
Another similar case came to be while our team worked with two UPenn acute care hospitals. By implementing daily reminders and financial incentives, we were able to sustain medication adherence over the course of three months.
These improvements do more than just elevate survey scores — they enhance patient quality of life. But by reckoning the impact of support on health, care centers can ultimately ensure good HOS scores.
Member Engagement and Behavior: Key Drivers of HOS Success
All of the above stories show a clear lesson: member engagement and daily behavior directly influence care outcomes. Technical and clinical quality just isn't enough — centers need effective patient engagement strategies that support healthy outcomes.
At Wellth, we firmly believe that tech-enabled daily engagement far outperforms one-time interventions. Behavioral science tells us that, to form new habits, people need daily cues and reinforcement. Instead of relying on a single doctor's visit to get the point across, care centers should find a way to prompt important messages every day while promoting completion and habit creation.
When engagement is continuous, digital platforms open the door for issues to be found earlier. For example, when patients consistently miss daily check-ins, this can alert professionals that a patient may be feeling discouraged or troubled about the treatment.
Our behavioral platform supports consistent follow-ups while also using a rewards system that encourages members to keep performing healthy behaviors.
The Future of Mock HOS Surveys: Embracing Digital Tools for Greater Efficiency
Waiting on annual results is never going to paint a full, comprehensive picture of what's going on inside a care center. Mock HOS surveys, as such, are becoming more and more important to prepare for and improve Medicare Health Outcomes Survey outcomes.
Pulse surveys, which are shorter than a full HOS, can be coupled with analytics and AI to get real-time feedback on areas that need improvement. This simultaneously allows clinicians and other professionals to reach out to patients who are at high risk of worse outcomes.
In the future, it's possible that CMS will modernize HOS too, which would allow for digital tools that improve member engagement and open the door to advanced analytics.
Interpreting Survey Results: What They Reveal About Your Health Plan
Survey results are a goldmine of insight into your plan's strengths and weaknesses, so care centers should dive deeper than surface scores.
HEDIS measures can indicate a need to provide education, outreach, risk assessment programs, and safety checks, as they are related to fall risk, bladder control, and physical activity. The functional measures may be more useful for evaluating social determinants of mental health and other long-term pain points in the patient experience of care and Health Outcomes Survey scores.
Care managers should also try to interpret trends over time by comparing current scores with those of previous years. Improvements take time, and avoiding tunnel vision is essential for allocating resources correctly.
Once new areas of improvement are noticed, it's time to get to work. At Wellth, we're set on achieving better Star Ratings through behavioral economics.
Ready to improve your HOS outcomes? Take a look at how our solutions have helped hundreds of patients nationwide.
