cms chronic condition data warehouse june 4, 2007

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

2


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)

3


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

4


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

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Chronic Condition CategoriesResearchers may request data for 21 predefined chronic

condition categories, allowing for timely data extraction:Acute Myocardial Infarction Chronic Obstructive Pulmonary Disease

Congestive Heart Failure

DiabetesAlzheimer's Disease, Related Disorders, or Senile Dementia

Alzheimer's Disease only Glaucoma

Atrial Fibrillation Hip/Pelvic Fracture

Cancer, Breast Ischemic Heart Disease

Cancer, Colorectal Major Depression

Cancer, Prostate Osteoporosis

Cancer, Lung Rheumatoid Arthritis/Osteoarthritis

Cancer, Endometrial

Cataract

Stroke/Transient Ischemic Attack

Chronic Kidney Disease

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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 samples7


www.ccwdata.org

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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

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Web Site – Statistical Summaries

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Statistical Summaries – Beneficiary Demographics

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Statistical Summaries – Population Statistics

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Statistical Summaries – Assessment data

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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

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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)

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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)

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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)

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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

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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

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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.

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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

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CCW Chronic Condition FlagsFor 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.22


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.

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1Twenty-one chronic conditions have been predefined by CMS for timely, efficient extraction of CCW data files.2Counts 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.3Reference period represents the look-back time period during which a beneficiary qualified for a condition.

Chronic Condition

Number of

Beneficiaries2

Reference Period

(in years)3

Acute Myocardial Infarction 27,209 1

Alzheimer's Disease 91,626 3

Alzheimer's Disease and Related Disorders or Senile Dementia 194,726 3

Atrial Fibrillation 153,939 1

Cancer, Colorectal 15,931 1

Cancer, Endometrial 2,329 1

Cancer, Female Breast 27,250 1

Cancer, Lung 15,868 1

Cancer, Prostate 39,687 1

Cataract 550,325 1

Chronic Kidney Disease 172,604 2

Chronic Obstructive Pulmonary Disease 239,467 1

Congestive Heart Failure 349,256 2

Diabetes 461,861 2

Glaucoma 208,139 1

Hip/Pelvic Fracture 22,075 1

Ischemic Heart Disease 628,481 2

Major Depression 261,438 1

Osteoporosis 278,546 1

Rheumatoid Arthritis/Osteoarthritis 415,404 2

Stroke/Transient Ischemic Attack 113,281 1

None of the conditions 759,108

Number of Medicare Beneficiaries in 5% Sample for 2005 by Chronic Condition1

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25

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*


*Based on 5% Medicare sample.26

Age Full Partial January July Any

< 65 249,063 254,887 261,077 270,580 349,167

65 16,048 21,328 17,220 48,265 107,316

66-75 675,756 684,816 700,203 692,055 911,322

76-85 498,175 503,731 512,023 494,859 634,288

> 85 183,263 185,461 187,348 172,573 230,435

Race Full Partial January July Any

White 1,386,624 1,408,142 1,427,028 1,425,827 1,870,224

Black 154,508 158,329 163,980 164,216 220,950

Asian 21,192 21,715 22,198 22,779 37,313

Hispanic 31,849 33,200 35,166 35,132 53,325

N Am Native 6,907 7,023 7,143 7,300 9,209

Other 18,837 19,387 19,893 20,696 37,171

Unknow n 2,388 2,427 2,463 2,382 4,336


* 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

400,000

600,000

800,000

0** 1 2-3 4+

Number of Chronic Conditions

Nu

mb

er o

f B

enef

icia

ries

Full 1YR Partial 1YR July Any

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*Based on 5% Medicare sample.

Number of Beneficiaries with Acute Myocardial Infarctionin 2005* by Age and Type of Coverage

0

2,000

4,000

6,000

8,000

10,000

12,000

< 65 65 66-75 76-85 > 85

Age (in years)

Nu

mb

er o

f B

enef

icia

ries


28



29

Number of Beneficiaries with Colorectal Cancerin 2005* by Age and Type of Coverage

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

< 65 65 66-75 76-85 > 85

Age (in years)

Nu

mb

er o

f B

enef

icia

ries




30

Number of Beneficiaries with Diabetes in 2005*by Age and Type of Coverage

0

50,000

100,000

150,000

200,000

< 65 65 66-75 76-85 > 85

Age (in years)

Nu

mb

er o

f B

enef

icia

ries

Full 2YR Partial 2YR Full 1YR July Any


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

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*Includes total Medicare fee-for-service payments; extrapolated from 5% Medicare sample.

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Total Medicare Payments ($275 Billion) in 2005by Claim Type and Number of Chronic Conditions

020406080

100120140160180

0 1 2-3 4+

Number of Chronic Condition(s)

To

tal M

ed

ica

re P

ay

me

nt

($ B

illio

ns

)

DMERC Carrier Hospice Outpatient HHA SNF Inpatient


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.

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Inpatient46%

SNF7%

HHA5%

Outpatient12%

Carrier24%

DMERC4%

Hospice2%

Carrier75%

Outpatient13%

DMERC9%

Hospice<1%

Inpatient1%

HHA1%SNF

1%


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

34

Number of Medicare Beneficiaries* with Diabetes andTotal Medicare Payment Amounts by Year

$113.5$102.2

$90.3

0

2

4

6

8

10

2003 2004 2005

Nu

mb

er

of

Be

ne

fic

iari

es

(in

Mill

ion

s)

$0

$20

$40

$60

$80

$100

$120

To

tal P

ay

me

nt

Am

ou

nt

($ B

illio

ns

)

Number of Beneficiaries Payment Amount


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

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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

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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

37 Visit us at AcademyHealth booth #305!

cms chronic condition data warehouse june 4, 2007

Documents

assessment data

sample flagscurrent

limited data set

service medicare claims

timely data extraction

data files unique link

medicare beneficiarieslinked

ongoing ccw sample