The Healthcare Effectiveness Data and Information Set (HEDIS) Patient-Level Detail (PLD) files are a set of standardized healthcare quality measures designed to provide information for reliable comparison of health plan performance. The HEDIS PLD data are submitted annually by Medicare Advantage (MA) Organizations, Cost Plans, and Demonstration Plans and contribute to the assignment of CMS Star Ratings for MA plans.

The HEDIS Measures file is a person-level file that includes information about all HEDIS measures, except the Plan All-Cause Readmission measure, which is included in HEDIS File 2. It represents beneficiaries enrolled in each MA plan/contract during the year. The file contains indicator variables for whether the beneficiary met the denominator and numerator requirements for each of the HEDIS measures, as well as weights for some measures.

The HEDIS Medicare Advantage Plan All-Cause Readmissions (PCR) File (referred to as File 2 in the file name) is a patient-level file that contains all variables pertinent to the PCR measure. There is a separate record for each acute inpatient hospital discharge during the year.

The MD-PPAS file assigns Medicare providers to medical practices based on the tax identification numbers and elaborates on the Centers for Medicare & Medicaid Services (CMS) provider specialty classification. This provider-level dataset is built around two identifiers: the national provider identifier (NPI) and the tax identification number (TIN).

CMS has created a set of analytical files that contain data from the Medicare Shared Saving Program. There are two separate files in this data set:

• The Shared Savings Program Beneficiary-Level Research Identifiable File (RIF)
• The Shared Savings Program Provider-Level RIF

CMS has created a set of analytical files that contain data from the Medicare Shared Saving Program. There are two separate files in this data set:

• The Shared Savings Program Beneficiary-Level Research Identifiable File (RIF)
• The Shared Savings Program Provider-Level RIF

CMS has created an analytical file that contains information about providers who are participating in the Comprehensive ESRD Care (CEC) Model. A related file, the CEC Beneficiary RIF, contains identifying information about the beneficiaries assigned to a provider who is participating in the CEC Model. 

The CEC Provider Performance Year RIF files contain PY finder files for the providers participating in the ESRD Seamless Care Organization (ESCO). 

The Value Modifier (VM) Beneficiary-Level Research Identifiable File (RIF) includes one record for each beneficiary who was attributed to a practice subject to the VM based on the given performance year. Using the RIF data, researchers can examine differences in beneficiary characteristics, costs across practices, and the stability of beneficiaries attributed to a specific practice across time. Program and participation information can be found on the CMS website.

The Value Modifier (VM) NPI Practice-Level Research Identifiable File (RIF) includes one record for each eligible professional associated with a practice subject to the VM based on the given performance year. Using the RIF data, researchers can examine practice specialty composition, size, and practice changes across performance years.

The Value Modifier (VM) Practice-Level Research Identifiable File (RIF) includes one record for each practice that was subject to the VM based on the given performance year. Using the RIF data, researchers can examine trends in cost and quality performance and identify factors supporting higher quality at lower cost.

The VM Practice-Level RIF contains Quality and Resource Use Report (QRUR) and VM information. Program and participation information can be found on the CMS website.

The Centers for Medicare and Medicaid Services (CMS) has created a set of files that contain Pioneer Accountable Care Organizations information. There are three separate files in the set:

• Provider-includes one record for each facility or professional participating provider
• Beneficiary-each record represents an individual beneficiary who was associated with a Pioneer ACO
• Settlement-one record for each Pioneer ACO provides information on the post-performance year financial settlement