Health Outcomes Survey (HOS) fielding is finally here! HOS results and outcomes have a profound impact on health plan quality performance, and while HOS measures are important, these measures have implications and impact on other measures as well, such as CAHPS and HEIDS.
What is HOS and Why is it Important?
Looking Ahead: HOS & Star Ratings
The name of the game is to be proactive, not reactive, particularly as we see an emphasis on HOS improvement in subsequent years.
HOS will account for 3% of a plan’s summary score in 2025, 7% of the score in 2026, 11% in 2027, and 12% in 2028. The rise in summary score percentages is due to the return of key retired measures:
- Improving or Maintaining Physical Health PCS
- Improving or Maintaining Mental Health MCS, at first returning with 1X weight, and then increasing to their original 3X weighting.
- In addition, existing measures will increase in weighting.
It’s been historically hard to collect and understand data following fielding, let alone encourage members to complete the survey. Developing a strategy around better understanding your population, anticipating needs, delivering the right tools and resources, and encouraging member survey completions required a data-driven approach to engagement.
By leveraging machine learning and AI to analyze millions of profiles, we’re able to predict behavior through pattern recognition based on past behaviors, events, and demographics. Thus, we’re able to assign each member a risk score across HOS measures and uncover who is and is not likely to respond.
When looking at the two measures that are being reintroduced, 1 in 2 Likely negative HOS raters are potentially case management eligible, meaning that those who have no HOS issues have a 93% lower admission risk. Conversely, 52% of responders with 2 or more HOS issues are in the top 10% admission risk in the next 6 to 12 months. This shows us that members responding poorly to the HOS survey are likely needing additional plan resources and support.
Additionally, members who respond saying they have physical or mental decline (roughly 42% of the population) have multiple chronic conditions. Members who respond saying they have no mental or physical health decline (approximately 22%) have multiple chronic conditions. When coupling multiple chronic conditions in addition to a behavioral health comorbidity we see roughly 22% members responding to HOS claiming mental or physical decline, compared to ~11% of members responding saying they do not have physical or mental decline. When looking at data for preventable emergency department (ED) visits, we see a higher rate of members with preventable admissions (nearly 1.5X) higher among those responding negatively to the HOS survey. 1 in 4 members are using the ED when they don’t have to.
This data shows us that members who respond negatively to these measures are more likely to have multiple chronic conditions, emphasizing the need for plans to intervene and offer the right support, resources and management.
Key Takeaways
- Members responding negatively to the HOS are presenting with more complex clinical profiles
- Members responding negatively have higher preventable ED visits
- There is a sizable overlap with negative HOS responders and other critical health plan metrics: HOS and CAHPS, HOS & preventable ED utilization, HOS & care management
- Members responding negatively to HOS have higher identified or suspected SDoH issues
By identifying the need for intervention and identification, we can begin taking a close look at population-wide needs and deploy targeted interventions to determine who needs what and when.
With segmenting your population into personas based on predictions, we can identify based on measure-level risk factors who should receive what touchpoint, through which channel and at what time.
Make it easy, make it actionable, make it personalized. Proxy or previous year data, utilization of benefits, who is using what, when and where. For those who can’t get what they need, it’s important to reach out to them and provide the right support to enable them to feel empowered and cared for to improve their health and their perception of their health status, not only to improve plan quality performance, but to also improve health outcomes, experience, and build lasting and impactful relationships across your membership, at scale.
