CMS Chronic Condition Data Warehouse June 4, 2007

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 1

Chronic Condition Data Warehouse Population: 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) 2

Chronic Condition Data Warehouse Population: Forward 100% Medicare beneficiaries Linked with historical data Random 5% sample flags Current data 3

Chronic Condition Data Warehouse 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 4

Chronic Condition Data Warehouse Chronic Condition Categories Researchers may request data for 21 predefined chronic condition categories, allowing for timely data extraction: Acute Myocardial InfarctionChronic Obstructive Pulmonary Disease Congestive Heart Failure Diabetes Alzheimer's Disease, Related Disorders, or Senile Dementia Alzheimer's Disease onlyGlaucoma Atrial FibrillationHip/Pelvic Fracture Cancer, BreastIschemic Heart Disease Cancer, ColorectalMajor Depression Cancer, ProstateOsteoporosis Cancer, LungRheumatoid Arthritis/Osteoarthritis Cancer, Endometrial Cataract Stroke/Transient Ischemic Attack Chronic Kidney Disease 5

Chronic Condition Data Warehouse 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 Beneficiary Summary File Chronic Condition Summary File 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 Manageable 5% sample; 100% data for larger subsets or samples 6

Chronic Condition Data Warehouse 7

Chronic Condition Data Warehouse Web Site – Statistical Summaries Available to general public (pdf format) Produced by IFMC staff 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 8

Chronic Condition Data Warehouse Web Site – Statistical Summaries 9

Chronic Condition Data Warehouse Statistical Summaries – Beneficiary Demographics 10

Chronic Condition Data Warehouse Statistical Summaries – Population Statistics 11

Chronic Condition Data Warehouse Statistical Summaries – Assessment data 12

Chronic Condition Data Warehouse 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 13

Chronic Condition Data Warehouse 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) 14

Chronic Condition Data Warehouse 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) 15

Chronic Condition Data Warehouse Chronic Condition Summary File Summary of a beneficiary’s chronic conditions (if any) by year Flag indicator for presence of a CCW condition during that year Includes beneficiaries in requested cohort (or other specified population) 16

Chronic Condition Data Warehouse Data Request Options Standard (e.g., based on predefined chronic condition cohort criteria, entire 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, etc.) Introductory pricing for 5% sample 17

Chronic Condition Data Warehouse Data Delivery Options Data loaded to USB hard drive or DVD (no tapes!) Flexible for use with different operating systems (e.g., Windows, Linux, etc.) SAS read-in statements 18

Chronic Condition Data Warehouse Data Request Process 1.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 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. 19

Chronic Condition Data Warehouse Considerations when Requesting CCW Data 1.Consider broad criteria for predefined chronic condition cohorts (indicating beneficiary probably has condition of interest); may require narrowing for analyses 2.Determine whether to restrict cohort based on Medicare coverage criteria 3.Decide whether to include a control or comparison group (chronic condition flags can make this simple) 4.Consider claims maturity 20

Chronic Condition Data Warehouse CCW Chronic Condition Flags For each chronic condition, an annual condition flag in the Chronic Condition Summary File includes the following values: 3 = Met full coverage criteria (Part A and B, no HMO) for entire look-back period (varies by condition) and claims diagnosis criteria 2 = Met full coverage criteria (Part A and B, no HMO) for entire look-back period (varies by condition) and did not meet claims diagnosis criteria 1 = Had intermittent coverage (any partial coverage combination of Part A or B, or HMO) for the look-back period and met claims diagnosis criteria 0 = Had intermittent coverage (any partial coverage combination of Part A or B, or HMO) for the look-back period and did not meet claims diagnosis criteria Note: Coverage required only up to month of death. 21

Chronic Condition Data Warehouse Defining CCW Cohorts: Use CC Summary File flags Example: Study diabetes health services in 2005 with control group of non-diabetes health services -Cohort of CC diabetes flag = 3 -Control of CC diabetes flag = 2 Use Beneficiary Summary File variables to further define (or supplement) cohorts using additional demographics, partial coverage options, HMO coverage, etc. Note: CCW does not contain managed care claims. 22

1 Twenty-one chronic conditions have been predefined by CMS for timely, efficient extraction of CCW data files. 2 Counts based on beneficiaries who were alive on January 1, 2005 and enrolled in Part A or Part B for at least one month during the reference year. 3 Reference period represents the look-back time period during which a beneficiary qualified for a condition. 23

Chronic Condition Data Warehouse 24 Types of coverage used for these analyses: Full 1YR (no break in coverage) Months PtA + Months PtB – Months HMO = 24 Partial 1YR (minimal break in coverage) Months PtA + Months PtB – Months HMO  22 January PtA & PtB & no HMO in January of reference year July PtA & PtB & no HMO in July of reference year Any At least one month PtA or PtB

Beneficiary Demographics by Type of Coverage in 2005* Chronic Condition Data Warehouse *Based on 5% Medicare sample. 25

Chronic Condition Data Warehouse * Based on 5% Medicare sample. ** Any coverage includes beneficiaries who may not have sufficient coverage to meet the chronic condition diagnosis criteria. Number of Beneficiaries with Chronic Condition(s) in 2005* by Type of Coverage 0 200, , , ,000 0 ** Number of Chronic Conditions Number of Beneficiaries Full 1YRPartial 1YRJuly Any 26

Chronic Condition Data Warehouse *Based on 5% Medicare sample. Number of Beneficiaries with Acute Myocardial Infarction in 2005* by Age and Type of Coverage 0 2,000 4,000 6,000 8,000 10,000 12,000 < > 85 Age (in years) Number of Beneficiaries Full 1YRPartial 1YR July Any 27

Chronic Condition Data Warehouse *Based on 5% Medicare sample. 28

Chronic Condition Data Warehouse *Based on 5% Medicare sample. 29

Chronic Condition Data Warehouse CCW Cohort Considerations: Effect of coverage selections varies by: 1.Demographics (e.g., age) 2.Condition 3.Look-back period Equal opportunity for observing diagnosis of interest in control group as in cohort ResDAC/IFMC Review Board can assist with refining selection criteria 30

Chronic Condition Data Warehouse *Includes total Medicare fee-for-service payments; extrapolated from 5% Medicare sample. 31 Total Medicare Payments ($275 Billion) in 2005 by Claim Type and Number of Chronic Conditions

Chronic Condition Data Warehouse Percent of Medicare Payments* for Beneficiaries with Diabetes in 2005 by Claim Type Percent of Claims* for Beneficiaries with Diabetes in 2005 by Claim Type *Includes total Medicare fee-for-service payments/claims for beneficiaries identified as having diabetes; based on 5% Medicare sample. 32

Chronic Condition Data Warehouse *Includes total Medicare fee-for-service payments/claims for beneficiaries identified as having diabetes; based on extrapolation from 5% Medicare sample. 33

Chronic Condition Data Warehouse 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 34

Chronic Condition Data Warehouse Potential Enhancements for CCW Part D enrollment and drug event data (pending federal regulation) Enhanced Summary Files: –Beneficiary Summary File –Chronic Condition Summary File –Condition-specific statistics in form of beneficiary- level (deidentified) analytical file –Care setting/timeline summary file SAS code for deriving denominators 35

Chronic Condition Data Warehouse Questions? Visit these web sites for additional information! Research Data Assistance Center Phone: ResDAC or Iowa Foundation for Medical Care Phone: , ext Visit us at AcademyHealth booth #305!