Healthcare Effectiveness Data and Information Set (HEDIS) File 2: Plan All-Cause Readmission (PCR) Measure

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.

What does this file include? (variable highlights)

  • Readmission indicator
  • Chronic condition weight

Each record represents a hospitalization for a beneficiary in the calendar year (CY). Beneficiaries with multiple hospitalizations will have multiple records in this file.

Beneficiaries can be linked to other beneficiary data via the BENE_ID and to plan information via the HEDIS_CONTRACT_ID and HEDIS_PLAN_ID variables.

Healthcare Effectiveness Data and Information Set (HEDIS) File 1: Measures File (does not include Plan All-Cause Readmission measure)

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.

What does this file include? (variable highlights)

  • Colorectal cancer screening
  • Comprehensive diabetes care (multiple measures)
  • High risk medication usage

Each record represents the experience of a beneficiary in a specific plan for the calendar year (CY). Beneficiaries enrolled in more than one plan during the CY will have multiple records in this file.

Beneficiaries can be linked to other beneficiary data via the BENE_ID and to plan information via the HEDIS_CONTRACT_ID and HEDIS_PLAN_ID variables.

2020 Medicaid and CHIP Data Now Available

CMS is pleased to announce that updated Medicaid T-MSIS Analytic Files (TAFs) for service year 2020 are now available. The TAF research files* contain data on Medicaid and Children's Health Insurance Program (CHIP) beneficiary demographics, program enrollment, service use, and payments. They are designed to meet the diverse research needs of the Medicaid and CHIP data user community. In November 2021, CMS made "preliminary" TAF enrollment and claims files for service year 2020 available to researchers.

Becky Vick

Becky Vick has over 20 years’ experience working with various types of data. For nearly ten years, she worked with large-scale demographic data at the Minnesota Population Center housed within the University of Minnesota; then transitioned to healthcare data as a Healthcare Economics Consultant at UnitedHealthcare within their Medicare Advantage line of business.

Master Beneficiary Summary File (MBSF): 30 CCW Chronic Conditions Segment

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.

What does this file include? (variable highlights)

  • Two flags for each chronic condition:
    • First occurrence date
    • End of year indicator

Special considerations

  • The algorithms used to assign the flags are available from the CCW website.
  • Algorithms requiring a multiple-year look back period are completed without requiring the researcher to order multiple years of data.
  • Algorithms search data from Medicare Fee-For-Service (FFS) claims.
  • This file is a segment that can be requested in addition to the Master Beneficiary Summary File (MBSF) base file.
  • The algorithms for the 30 CCW Chronic Conditions data file use only ICD-10-CM diagnosis codes. The first full calendar year that is used to identify conditions is 2016.
  • Three new conditions are added compared with the 27 CCW version.
  • The changes to the algorithms compared with the 27 CCW version are noted on the individual variable pages and detailed descriptions of changes can be found in the Chronic Conditions File Enhancements white paper.

William Saykao

William Saykao joined ResDAC in January 2022. He has a Bachelors of Arts in Psychology from University of Wisconsin-Madison. His previous work experience includes being a lab assistant helping with research design and final drafts.

Emma Riebel-Paszkiewicz

Emma Riebel-Paszkiewicz joined ResDAC in January 2022. She holds a Bachelor of Arts in Psychology from New York University and a Master of Public Health in Public Health Administration and Policy from the University of Minnesota. She has a professional background providing community-based mental health services in the Twin Cities metro area.

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