Howell EM.
AHSR FHSR Annu Meet Abstr Book. 1996; 13: 83-4.
Mathematica Policy Research, Inc., Washington, DC 20024-2512, USA.
RESEARCH OBJECTIVES: Managed care is increasingly becoming a preferred administrative vehicle for states to control their Medicaid budgets and assure access to and coordination of services. Managed care now serves 23% of the Medicaid population. One consequence of the shift to capitation is that the fee-for-service billing mechanism that has generated much of the administrative data used in policy planning and research no longer exists, at least not universally nor for all Medicaid services. This paper provides an overview of the types of encounter data currently being required of plans and the problems and issues with providing and analyzing such data. METHODS: The study uses information provided by HCFA and nine of the states which have had some of the earliest experience with obtaining encounter data as a substitute for fee-for-service billing data. These states are Arizona, California, Hawaii, Maryland, Minnesota, New York, Rhode Island, Tennessee, and Washington. In these states we reviewed documentation of state data requirements and spoke with individuals in some of the states about their experiences over the past few years as they have struggled to implement useful reporting systems. We also spoke with individuals in states (for example Massachusetts) which have chosen to require aggregate reports from plans as an alternative to encounter data. Together these states had just over 50 percent of the Medicaid beneficiaries who were in managed care in June 1994. PRINCIPAL FINDINGS: Working mostly independently of each other, HCFA, and other payers, each state that we spoke with had developed a variable list for what is to be included in its encounter data set. Over the same recent period of time (1993-95), a parallel effort has been underway at HCFA to define a uniform encounter data set (known as "McData") for both the Medicare and Medicaid programs. Most of the McData variables are required by the nine states surveyed. Encounter data systems are still in a developmental stage in all the states we talked to with the exception of Arizona, which has been working for a decade on their system. While some other states have a long history of contracting with HMOs (e.g., California, Minnesota, and New York), the recent major expansions of such states into Medicaid managed care have only recently forced them to "get serious" with developing their encounter data systems. CONCLUSIONS: Some of the lessons learned for producing useful research data from encounter files include the following: 1) regular communication between providers, plans, states, and HCFA is essential; 2) there must be clear specifications for required data that do not change very often; 3) when data are received, they must be carefully reviewed and edited. The edits used for fee-for-service billing data may not be appropriate; and 4) developing useful encounter data is a time-consuming, labor-intensive effort. Putting resources into such efforts early will prevent problems later. These lessons apply to all levels of an encounter data system. A plan must follow such steps as it relates to its providers. Similarly, a state needs to address the same issues in relating to participating plans. And finally HCFA, to the extent that it receives data from states on a mandatory or voluntary basis, will need to develop a similar approach to data cleaning and analysis.
Publication Types:
Keywords:
- Arizona
- California
- Data Collection
- Fee-for-Service Plans
- Hawaii
- Health Maintenance Organizations
- Health Services Needs and Demand
- Managed Care Programs
- Maryland
- Massachusetts
- Medicaid
- Medicare
- Minnesota
- New York
- Rhode Island
- Tennessee
- Washington
- economics
- hsrmtgs
Other ID:
UI: 102222231
From Meeting Abstracts