The Entity file is one of a set of three file types (entity, provider, beneficiary) included for each model. An Entity is the Model Participant that has applied for and been accepted to participate in the model or is required by mandate to participate. The Entity has the direct relationship with CMMI and is held fiscally responsible for meeting a model’s performance goals. An Entity can be a Medicare group practice, an Accountable Care Organization, a State, or other organizations or groups of organizations.

The Practice List file contains the list of all practices enrolled in the model, including an indicator if the practice is active and the number of files submitted for the practice.

The Oncology Care Model (OCM) operated from July 2016-June 2022 and aimed to provide higher quality, precisely coordinated oncology care at the same or lower cost to Medicare.

The Million Hearts® Cardiovascular Disease (CVD) Risk Reduction Model was a randomized controlled trial that sought to bridge a gap in cardiovascular care by providing targeted incentives for health care practitioners to engage in beneficiary CVD risk calculation and population-level risk management. Instead of focusing on the individual components of risk, participating organizations engaged in risk stratification across a beneficiary panel to identify those at highest risk for atherosclerotic cardiovascular disease (ASCVD).

The Beneficiary Demographic file contains all beneficiary demographic information entered via manual entry and upload to the model data collection registry. Additionally, partial beneficiary data that was created through the semi-annual beneficiary alignment validation process is also included and could be considered a data input method. The file is at the beneficiary level, with one record for each beneficiary. It’s possible for the same beneficiary to appear in the file twice, if two or more organizations tried to enroll the same beneficiary.

The Acute Hospital Care at Home (AHCAH) initiative, launched in November 2020 in response to the COVID-19 pandemic, allows Medicare-certified hospitals to treat patients with inpatient-level care at home. Data contained within the AHCAH data set was collected by CMS directly from individual hospitals on either a weekly or monthly basis depending on their participation tier, which is based on the level of experience the facility has with providing hospital at-home services.

The Provider file is one of a set of three file types (entity, provider, beneficiary) included for each model. A Provider is a Medicare provider/supplier who has an arrangement with an Entity to participate as a member of their entity group in a model.

The Provider List file contains the list of all NPIs enrolled in the model, including the activation and deactivation dates.

The Clinical and Staging file includes information about the episodes, the practice ID to which they were attributed, their beginning and end dates, their cancer types, and the clinical and staging characteristics that were required to be reported.

The Raw Clinical file contains all visit and clinical data that was uploaded to the model’s data collection registry. This data is preserved as it was uploaded, therefore it may contain data that is not relevant for the Million Hearts® registry as the measures are defined. The file is at the clinical data element level and contains one row per clinical data element per beneficiary, using industry standard codes.

Note that this file excludes all manually entered data in the Million Hearts® registry.

The CMS Innovation Center is committed to making model data more easily available to stakeholders to advance transparency on model performance and to support external research and learning. In line with this commitment, the CMS Innovation Center is releasing model participant data for use in data analysis research projects.

The Visit file contains all data extracted to create a beneficiary visit, and includes both uploaded data and manually entered data from the model data collection registry. All generated risk scores and baseline groups are contained in this file. The file is generated at the visit level, with one row for each visit for each beneficiary.

The Medicare Bayesian Improved Surname Geocoding (MBISG) research data is a snapshot file that contains race and ethnicity probabilities for Medicare beneficiaries enrolled on March 1, 2023.

The Beneficiary file is one of a set of three files types (entity, provider, beneficiary) included for each model. A Beneficiary is someone who is entitled to health services under a federal health insurance plan. A Beneficiary is associated with an Entity and is not tied to a specific Provider, but rather to the set of providers in an entity group.

The eleven model alignment files contain the point-in-time eligibility and alignment status of model beneficiaries, and a list of eligible-but-not-enrolled patients for participating practice reporting. These alignment validation files, also known as Enrollment, Validation, Alignment, and Adjudication (EVAA) files, were generated semi-annually throughout the duration of the model, each October and April. There were a total of 10 EVAA analytical cycles, between October 2017 and April 2022. The model alignment file names indicate the cycle number (01-10) and the year and month of the cycle. In addition, there is a final model alignment file that represents the alignment status of model beneficiaries at the end of the model.

The Current Clinical Status File includes information on the reported Current Clinical Status (CCS) for a patient. CCS was required to be reported at least once for each episode, as well as whenever there was a change in the CCS.

The Final Clinical file is a model-curated version of the information in the Raw Clinical data. Million Hearts® business rules are applied to the raw data and select information is extracted and translated into custom codes.

Note that clinical data excludes all “Incomplete” visits.

The Acute Hospital Care at Home (AHCAH) initiative, launched in November 2020 in response to the COVID-19 pandemic, allows Medicare-certified hospitals to treat patients with inpatient-level care at home. Data contained within the AHCAH data set was collected by CMS directly from individual hospitals on either a weekly or monthly basis depending on their participation tier, which is based on the level of experience the facility has with providing hospital at-home services.

The MBSF base segment includes beneficiary enrollment information, (A/B/C/D). Medicare Advantage (Part C) and the Prescription Drug Program (Part D) plan enrollment information is included.

The 30 CCW Chronic Conditions segment of the Master Beneficiary Summary File (MBSF) flags each Medicare beneficiary for the presence of one of 30 specific chronic conditions.

The Chronic Conditions segment of the Master Beneficiary Summary File (MBSF) flags each Medicare beneficiary for the presence of one of 27 specific chronic conditions.

The Other Chronic or Potentially Disabling Conditions segment of the MBSF flags beneficiary records for the presence of 35 chronic or potentially disabling conditions not included in the original list of 27 conditions, including:

• Mental health
• Tobacco use, alcohol and drug use
• Developmental disorders
• Disability-related conditions
• Behavioral health
• Other chronic physical conditions

The Cost and Use file segment of the MBSF includes one record for each beneficiary enrolled in Medicare in the calendar year of the file.

This segment includes cause of death information from death certificates provided through linkage with the National Death Index (NDI).

The Medicare Fee-For-Service Inpatient (IP) Claim File contains fee-for-service (FFS) claims submitted by inpatient hospital providers for reimbursement of facility costs. These claim records represent covered stays (Medicare paid FFS bills).

This file is based on information from the CMS form 1450 (UB04).