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

2. 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. 3 Chronic Condition Data Warehouse 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. 4 Chronic Condition Data Warehouse Population: 2005 - Forward 100% Medicare beneficiaries Linked with historical data Random 5% sample flags Current data

5. 5 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

6. 6 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 Depression Diabetes Alzheimer's Disease, Related Disorders, or Senile Dementia Alzheimer's Disease onlyGlaucoma Atrial FibrillationHeart Failure Cancer, Female BreastHip/Pelvic Fracture Cancer, ColorectalIschemic Heart Disease Cancer, ProstateOsteoporosis Cancer, LungRheumatoid Arthritis/Osteoarthritis Cancer, Endometrial Cataract Stroke/Transient Ischemic Attack Chronic Kidney Disease

7. 7 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 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. 8 Chronic Condition Data Warehouse www.ccwdata.org

9. 9 Chronic Condition Data Warehouse 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. 10 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

11. 11 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)

12. 12 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)

13. 13 Chronic Condition Data Warehouse Chronic Condition Summary File Summary of a beneficiarys 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. 14 Chronic Condition Data Warehouse 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. 15 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 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. 16 Chronic Condition Data Warehouse 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. 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 Chronic Condition Data Warehouse Coverage Options for Examination of Prevalence in CCW

18. 18 Chronic Condition Data Warehouse 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 met 1 = Claims met, coverage not met 2 = Claims not met, full coverage met 3 = Claims and full coverage met

19. 19 Chronic Condition Data Warehouse Difference in Prevalence for Beneficiaries with AMI in 2005 (Various Coverage Options) DenominatorNumeratorPercent No coverage restrictions2,232,52817,8190.80 1. Full coverage1,633,16516,5941.02 2. Partial coverage1,648,17516,6811.01 3. Point in time coverage1,678,33214,8980.89 4. Person years with coverage1,676,00317,8611.06

20. 20 Chronic Condition Data Warehouse Prevalence of Select Chronic Conditions and Multiple Chronic Conditions (2006)

21. 21 Chronic Condition Data Warehouse Prevalence of Chronic Conditions in Medicare FFS Population BeneficiariesPrevalence Total FFS Sample1,603,392100.0% Condition Alzheimers/Dementia172,31310.7% Chronic Kidney Disease169,06110.5% Chronic Obstructive Pulmonary Disease174,55110.9% Heart Failure283,01817.7% Diabetes405,29725.3% Cardiovascular (AMI, IHD, Afib, stroke)586,63836.6% Cancer (lung, prostate, female breast, colorectal)102,3476.4% # Conditions None649,85640.5% One431,09126.9% Two261,87016.3% Three or More260,57516.3%

22. 22 Chronic Condition Data Warehouse Percentage of Beneficiaries with Multiple Chronic Conditions

23. 23 Chronic Condition Data Warehouse Comparisons (Odds Ratios) for Likelihood of Visits By Care Setting and Number of Conditions

24. 24 Chronic Condition Data Warehouse Average Per Beneficiary Medicare Payment for Selected CCW Conditions

25. 25 Chronic Condition Data Warehouse

26. 26 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

27. 27 Chronic Condition Data Warehouse 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. 28 Chronic Condition Data Warehouse Part D Denominator File Current 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 beneficiarys 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. 29 Chronic Condition Data Warehouse 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. 30 Chronic Condition Data Warehouse Questions? Visit these web sites for additional information! Research Data Assistance Center www.resdac.umn.edu E-Mail: resdac@umn.edu Phone: 1-888-9-ResDAC or 1-888-973-7322 Iowa Foundation for Medical Care www.ccwdata.org E-Mail: ccwdata@ifmc.org Phone: 1-800-383-2856, ext. 8357 Visit us at AcademyHealth booth #311!