Medicaid Research Support Tools Gerri Barosso, RD, MPH, MS - PowerPoint PPT Presentation

Medicaid Research Support Tools Gerri Barosso, RD, MPH, MS Technical Advisor University of Minnesota

Overview  Available resources and where to find them: ˗ Medicaid program description ˗ State coverage and plan information ˗ State Drug utilization files ˗ Managed Care participation rates ˗ Medicaid statistics ˗ Data support on the CMS web site: » FAQ for MAX files » Data Anomalies Database » Data Validation tables ˗ Additional Non-CMS resources  New MAX data files  URLs on the section handout 2

Medicaid Program NATIONAL  CMS/Medicaid.gov ˗ Program information by topic ˗ Eligibility, benefits, cost sharing, etc.  House Ways and Means Committee ˗ Green Book, Ch 15, 2003, published 2004 ˗ Increasing level of detail ˗ Medicaid disappears in the 2008 book  Kaiser Family Foundation ˗ Medicaid Resource Book » Last updated July 2002 » Detailed explanation of aspects of program, include index ˗ Medicaid Primer » Latest June, 2010 » Historical Dec 2008, Mar 2007, July 2005 3

Medicaid Program NATIONAL (CONT)  Kaiser Family Foundation ˗ “Medicaid Resource Book” Many reports on duals, Medicare, SCHIP ˗  Urban Institute ˗ analyses of proposed/implemented programs on a variety of issues  National Pharmaceutical Council ˗ Annual publication on state prescription drug benefits ˗ State contacts specific to drug benefit ˗ 1963-2005, 2007  National Academy for State Health Policy ˗ Current initiatives, recent program changes 4

State-Specific Program Information  Medicaid waiver information ˗ Medicaid.gov web site » overview of waiver types » access to brief descriptions of state-specific waivers  State Medicaid plans ˗ Kaiser Family Foundation » Review within state or across states » Jan 2003, Oct 2004 , Oct 2006 and Oct 2008 » Source: documents submitted to CMS  Some state Medicaid agency sites 5

State-specific MANAGED CARE PARTICIPATION  CMS MCO enrollment statistics ˗ Current: July 1, 2010 ˗ Note: not a calendar year, not a federal fiscal year » Trend table 2000 to 2009 » State penetration rates July, 2010 » Definitions included in National Summary Report ˗ Utility » Descriptions of plans » Enrollment by plan by county » Assess amount of data available » Percent of MA population likely to have FFS claims » Dual eligible MCO enrollment 6

State-specific MCO PROGRAM DESCRIPTIONS  Descriptions of state MCO programs ˗ June 30, 2009 ˗ Services covered by specific MCO programs ˗ Types of professionals qualified to be primary care providers ˗ Voluntary or mandatory enrollment by eligibility group, excluded groups 7

Managed Care Participation Example of need for enrollment by plan type: 8

Managed Care Participation 9

Managed Care Participation 10

Managed Care Participation  Alternative to assess effect on data in MAX files ˗ Data Validation Table Excel Workbook » Currently available MAX data years » Download from CMS web site ˗ PS file spreadsheet » Enrollment - Anytime during calendar year » By aggregated eligibility group (aged, disabled, child, adult) » OR…By type of managed care (HMO/HIO, dental, etc) - In June of calendar year of MAX file » Ever enrolled by aggregated eligibility groups 11

Medicaid Statistics  All sources ˗ No geography smaller than state ˗ Enrollment, expenditures , utilization by broad type of service ˗ No diagnosis or procedure level data  Highlights: ˗ MAX chartbooks, 2002, 2004, 2008 data ˗ CMS Medicare/Medicaid Statistical Supplement » Some trend tables 1975-2009 ˗ Medicaid Prescription Utilization, 1999, 2001-2008 » Reporting by 18 broad therapeutic classes » Some tables in Excel format ˗ MSIS data tables, 1999-2009 » Anomalies information included Kaiser Family Foundation: State Medicaid Fact Sheets ˗ » Create custom comparisons, eg: national: to state, state: to state » Export as .pdf 12

Medicaid Statistics MSIS DATA MART  MSIS Data Mart ˗ Generally same variables as MSIS statistics site » Create crosstabs, nested rows/columns ˗ Register as a user for access ˗ Need to understand variable definitions ˗ Create tables using COGNOS Powerplay ˗ FFY 2010, 32 states , access 08-07-2012 ˗ MSIS Data Anomalies report is included ˗ Recommend using Internet Explorer vs Mozilla/Firefox or Safari 13

Medicaid Statistics MSIS DATA MART 14

Medicaid Data STATE DRUG UTILIZATION FILES  Downloadable data files  FFY1991-2011 Q4, by state, quarter, NDC code ˗ May vary by state, as is distribution  Zipped files, extract to text format  Read into Access, SAS, SPSS  Utility ˗ Determine frequency of use, power for analyses ˗ Background statistics for grant proposals » Trend data, regional comparisons 15

State Drug Utilization Files 16

NDC Information  FDA ˗ Smaller number of codes ˗ May not be as current ˗ Therapeutic class no longer maintained  Commercial products such as ˗ First Data Bank ˗ Wolters Kluwer Medi-Span  Any other resources? 17

MAX Data Support Resources  MAX Data Documentation ˗ Variable crosswalk tables, additions, deletions ˗ Data Validation Tables » Pre-acquisition to select states, anticipate utility of MAX » Post-acquisition to check results » Background stats for grant proposals: enrollment, MCO, Duals, utilization, payments, charges » Measure calculation methodology now available ˗ Data Anomalies Database » Noted during MAX production » Issues in code mapping, limited number of values for variables such as procedure or dx codes, unexplained variation across years » General plus state- and file-specific 18

MAX Data Support Resources ANALYTIC GUIDANCE REPORTS  Buccaneer, CMS data distribution contractor ˗ Max Data User Guide ˗ Getting Started with MAX Data Files ˗ Options in Determining Dual Eligibles 19

MAX Data Support Resources MSIS DOCUMENTATION  MSIS data dictionary ˗ Documentation on the source of MAX data ˗ Some useful detail » ATTACHMENT 3 - Comprehensive Eligibility Crosswalk - Includes details of subgroups, the federal code or public law citation for the coverage » ATTACHMENT 4 - Types of Service Reference - As defined by the Code of Federal Regulation » ATTACHMENT 5 – Program Type References 20

MAX data Support Resources MEDICAID ISSUE BRIEFS  Analysis of MAX data or anticipation of program change effects  Current briefs include: ˗ Enrollee changes anticipated in 2014 ˗ Patterns in enrollment of children ˗ Medicaid managed care and long term care ˗ Movement of children from Medicaid to CHIP ˗ Usability of MAX 2007 IP/RX Encounter data ˗ Enrollment gaps ˗ Prescription drug use 21

MAX Data Support Resources ENVIROMENTAL SCANNING AND PROGRAM CHARACTERISTICS  Medicaid and CHIP program characteristics ˗ Centralized source ˗ Information gathered from many of those resources presented here » Eligibility criteria, waivers, managed care, benefits, reimbursement » 1394 variables included » Data user guide and examples  Downloadable  Current version 2005 data onward  Next update in CY 2013 22

MAX Data Support Resources MAX PROVIDER CHARACTERISTICS FILE  MAX traditionally included only state provider IDs  NPI added in MAX 2009  MAXPC available for 37 or 51 jurisdictions ˗ Downloadable ˗ Variables include: NPI, legacy IDs, name/address, creditionals, national specialty taxonomy code, counts of claims by provider, counts of beneficiaries by provider ˗ Documentation includes data dictionaries, validation tables and anomalies 23

MAX Data BEYOND TRADITIONAL CLAIMS/ENROLLMENT  MAX Date of Death ˗ DOD generally poorly reported via MSIS to MAX PS ˗ SSA Death Master File DOD » Added to MAX PS beginning MAX 2007 » Dates through Dec 31 st of MAX file year  MAX Date of Death Auxiliary File ˗ Released as a “current” file ˗ Now available: DODs for those enrolled 1999 through 2008 ˗ DODs current through Oct 29, 2011 ˗ Linked to MAX via Bene_ID 24

MAX Data BEYOND TRADITIONAL CLAIMS/ENROLLMENT (CONT)  Mini-MAX ˗ National 5%, cross-sectional sample Stratified by state and eligibility group ˗ ˗ Oversamples smaller states and subpopulations ˗ Removed some MAX variables to reduce file size  CMS documentation includes a user guide ˗ Details of file development ˗ Analysis considerations  Availability ˗ Currently for CY 2008 via the Research Identifiable File request process Buccaneer record layouts pending ˗ 25

ResDAC Data Assistance  ResDAC web site ˗ Data documentation links ˗ CMS data release policy updates ˗ Data request documents ˗ Updates on data availability  One-on-one assistance ˗ 888.973.7322 ˗ resdac@umn.edu 26