Medicare Stars Health Outcomes Survey

1. What is the decision or change you are facing or struggling with where a summary of the evidence would be helpful?

Maintaining and improving physical and mental health of our members is at the heart of [redacted: organization name]’s mission, and these outcomes are prioritized in the Medicare Stars measures. We believe that the best way to improve the physical and mental health of our members is to provide great health care, and to the extent possible address the upstream behavioral, social and environmental determinants that profoundly influence health outcomes. We have a solid track record of providing the highest quality care with historical 5-star performance and have industry-leading performance on preventive services.

Our question of interest: Which health care system-feasible interventions result in change in self-reported health measures, specifically the VR-12/SF-12 items?

We spoke with AHRQ in June regarding the challenges of the Medicare Stars health outcomes survey items and shared the similar issues we heard from our discussions with other leading health care systems. We also shared the results of our internal evidence review, and we were advised to develop a proposal for an evidence map. Our internal evidence review showed interventions resulting in improvements to self-reported physical or mental health include: cognitive behavioral therapy, self-management and treatment adherence, group and peer support, mindfulness-based stress reduction. We also reviewed HSAG’s "Final Report on Analysis of Key Drivers of Improving or Maintaining Medicare HOS Scores", and believe an evidence map will provide a much-needed summary of the evidence.

2. Why are you struggling with this issue?

Leading health plans have tried many approaches and have found ongoing difficulty identifying programs that impact these generic self-reported physical and mental health measures. Part of the issue has to do with sampling uncertainty and unreliability of the measures, as described in Leading health plans have tried many approaches and have found ongoing difficulty identifying programs that impact these generic self-reported physical and mental health measures. Part of the issue has to do with sampling uncertainty and unreliability of the measures, as described in a recent study published in Medical Care by Rose et al, entitled the “Feasibility of Distinguishing Performance Among Provider Groups Using Patient-reported Outcome Measures in Older Adults with Multiple Chronic Conditions”. The other part of the issue is the relative shortage of evidence of the impact of health care interventions on these generic outcomes, which are profoundly influenced by factors outside of health care.

3. What do you want to see changed? How will you know that your issue is improving or has been addressed?

We are hoping to learn what evidence-based interventions a health system can implement that can impact self-reported physical and mental health. We will know our interest area is being addressed as we learn of specific interventions that we are able to test and evaluate impact on our Medicare members’ self-reported physical and mental health.

4. When do you need the evidence report?

Thu, 07/01/2021

5. What will you do with the evidence report?

Opportunity to learn from an in-depth review of the evidence and literature to inform our approach for supporting patients’ physical and mental health. We are interested in learning what health care system- feasible interventions improve patient reported outcomes (including self-reported physical and mental health), so we can better understand how to impact MCS and PCS scores. Note: we recognize that this is an atypical evidence request. Rather than an investigation of the evidence of the impact of an intervention, we are starting with an important outcome, and exploring the evidence of the impact of interventions on that outcome. As discussed at the HCSRN meeting in Portland last April, this might be an important new focus of investigation for AHRQ.

Supporting Document

Title or short description:

Interventions to Change Self-reported Health

(Optional) About You

If you are you making a suggestion on behalf of an organization, please state the name of the organization:

Kaiser Permanente

May we contact you if we have questions about your nomination?

Yes

Title: Senior Director