Fox KP, Herz L, Block R; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1998; 15: 145.
Government Services, The MEDSTAT Group, Ann Arbor, MI 48108, USA.
RESEARCH OBJECTIVE: State Medicaid programs have been implementing mandatory managed care programs in earnest, primarily for their AFDC or TANF populations for the last three years. These programs, often under the auspices of a waiver from HCFA (1115 or 1915b) have required the collection of encounter data for a variety of reasons but primarily because HCFA has required the information for its evaluation process. As the programs have gotten underway states have discovered that they also need encounter data for program compliance, quality assurance, and rate setting. But receiving accurate, complete encounter data from the Managed Care Organizations is not simple; MCOs are often unprepared or unwilling to send the information requested by the states. Finally, most states are technically unprepared for the challenge of collecting, validating, and using the encounter data which they receive. The result of this combination of problems is a collective sense that this task is "undoable"; there will never be valid encounter data for Medicaid. STUDY DESIGN: At the same time as these problems were surfacing HCFA funded a three-year contract with The MEDSTAT Group to provide technical assistance to states which have been awarded 1115 waivers to ensure that these states did collect data, as required by the waiver evaluations. Under this contract MEDSTAT detailed a clear strategy for how a state could have a successful encounter data collection and use process. We have developed and tested a survey data instrument which assesses where states are in the encounter data collection process. Results of the findings of this survey instrument are returned to each state in the form of an action plan. Our goal is to determine whether states given clear information about which parts of the encounter data collection process they have missed can correct their problems and become successful. PRINCIPAL FINDINGS: Early findings indicate that the data collection instrument is able to identify clear gaps in the process outlined in the technical assistance contract. No problem has been identified at a state which was not detailed in the strategy; rather states are skipping steps which initially they did not view as important. For instance, states must review with each MCO the specific data elements which need to be submitted and reach consensus with each MCO of its understanding of the definition of these data elements. States which missed this step discovered that MCOs interpreted data elements differently. In other situations states discovered if they missed giving feedback to the MCOs about what problems were discovered in the data submissions and how they could be corrected that the MCOs had little or no incentive to make corrections and resubmissions. States which return to the complete process for encounter data submission and use are able to correct problems and become successful. IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: Having complete, accurate, and timely encounter data will be critical to the successful implementation and operation of Medicaid Managed Care Programs but all evidence points to the fact that success hinges on an early start and adherence to all parts of the process. Success is not tied to sanctions; states with sanctions in their MCO contracts do not have improved encounter data submission performance. States which focus on encounter data collection as an Information Systems (IS) problem and not as a key policy issue are more likely to encounter problems. Rather, states with a clear vision of how the information will be used once collected seem to be more successful. Further, if states do not begin to collect these data, there will be little foundation on which to rest an enhanced approach to the type of information which might be collected from MCOs.
Publication Types:
Keywords:
- Aid to Families with Dependent Children
- Contracts
- Data Collection
- Managed Care Programs
- Medicaid
- economics
- hsrmtgs
Other ID:
UI: 102234262
From Meeting Abstracts