# Presentation: 377691

## MEDICAID and OTHER STATE DATA SOURCES

- <date/time>

**MEDICAID and OTHER ****STATE DATA SOURCES**

**Rachel Block**
-     Deputy Director, Center for Medicaid & State Operations, HCFA
**Barbara Rudolph**
-     Director, Wisconsin Bureau of Health Information
**Denise Love**
-     Executive Director, National Association of Health Data Organizations
- Moderator:  **Elliot Stone**, CEO, Massachusetts Health Data Consortium

## Medicaid Data Sharing

**Rachel Block**
**Deputy Director**
**Center for  Medicaid and**
** ****State Operations**
**HCFA**

## Introduction

- Data sharing and linkages are key to successful management of the Medicaid and public health programs
- HCFA is actively engaged in a variety of efforts at the Federal and State levels

## Topics of Discussion

- Main focus will be HCFA-HRSA-CDC Interagency Agreement
- Will also describe a few specific initiatives to illustrate importance/impact

## HCFA Strategic Plan

- Why is HCFA interested?
- Strategic plan - out of 5 goals, 3 involve direct and indirect relationship to public health
- Protect and improve beneficiary health status
- Purchase best value health care
- Provide leadership in public health improvement

## Interagency Agreement

- Fostering relationships with HRSA and CDC are a logical outgrowth
- October 1998 - Interagency agreement to facilitate collaborations for data sharing between State Medicaid and Health Agencies
- First product - model agreement that covers all Federal Medicaid requirements

## Additional Activities

- Technical assistance - inventory activities and models; flexibility in funding and approval processes; ongoing consultation with States and others to establish priorities
- Recent activities - immunization registries; regional workshops
- Future activities - public health and research uses; health improvement priorities

## Region 4 Survey

- Surveyed Medicaid and health agencies
- Four areas: chlamydia, immunization, lead, low birth weight
- Documented purpose, org context, issue w/ data, capacity/resources, evaluation/TA needs

## Medicare and Medicaid

- Research and operational support for Medicare/Medicaid data linkages
- PRO scope of work and special projects (nursing home immunization standing orders)

## Medicaid managed care

- BBA - regulations; QISMC
- Encounter data
- CAHPS benchmarking

## Conclusions

- Data sharing is an essential TOOL
- Need strategy to guide its use
- Significant policy issues re confidentiality and appropriate uses
- Standardization of data elements and measures will greatly facilitate the process

## MSIS Info

- Data dictionary and other technical specifications on HCFA website at www.hcfa.gov/medicaid/m2082.htm
- Primary contact is Ron North who can be reached at RNorth@hcfa.gov or 410-786-5651

## Wisconsin Health Care Data Systems:  

- <date/time>

- Wisconsin Health Care Data Systems:
-  Accessing Current and New Resources
-  for Health Services Research

- Barbara A. Rudolph, Ph.D., Director
- Bureau of Health  Information
- Division of Health Care Financing
- Department of Health and Family Services

## Why data is so important?

- <date/time>

**Why data is so important?**

**“****A popular government, without popular information, **_**or the means of acquiring it**_**, is but a prologue to a farce or a tragedy; or, perhaps both. Knowledge will forever govern ignorance. And a people who mean to be their own governors, must arm themselves with the power which knowledge gives.” – James Madison**

## Dissemination of Data and Information

- <date/time>

**Dissemination of Data and Information**

- Strategies for dissemination
- Public use data files
- Custom data analysis--including linked files
- WWW downloadable reports
- WWW data query systems--inpatient/amb
- Consumer Guide to Healthcare on WWW
- Standard and ad hoc reports

## Access to Wisconsin Data

- <date/time>

**Access to Wisconsin Data**

- Access to data limited by statutory protections, administrative rules, and confidentiality policies for small cell sizes
- Public use data sets available when user signs data use agreement form and agrees to standards of use
- No re-release of individual data elements is allowed whether public use or custom data
- For physician office data where the physician is identified the data requester will need permission of the Governor-appointed Independent Review Panel
- Some data available through free query systems on WWW

**Notes:**

Restrictions increasing due to expansion of data collection to physician offices and emergency departments.

Concerns by prpoviders about provider protection and patient protection from misuse of information.

Tradeoffs were made during legislative sessions to acquire any data from physician offices...

new IRB
Restrictions on zipcode and other data elements

## Health Care Provider Data Systems:  Administrative Data

- <date/time>

**Health Care Provider Data Systems:  Administrative Data**

- Hospital Discharge (1989--present)*
- Ambulatory Surgery from FASCs/Hospital based units  (1990--present)*
- Enhanced physician database (inpatient and ambulatory surgery)*

- Emergency Department (authorized-forthcoming)
- Physician Office Visit (authorized-forthcoming)
**Data available for purchase--see web site on last slide--also some data on website*

## Vital Records and Registries*

- <date/time>

**Vital Records and Registries***

- Birth records--mid-1800’s
- Death
- Marriage
- Divorce
- Induced abortion

-  Cancer Registry
-  Immunization   Registry
-  MMIS--Medicaid
-  MDS--Nursing Home patient registry
**Requires statutory authority*

## Linked Analysis Files

- <date/time>

**Linked Analysis Files**

- _CODES Project_: links hospital discharge data with motor vehicle crash reports*  (charges, LOS, type of vehicle, helmets/restraints used, types of injuries)
- _Prenatal Care File_:  links hospital discharge data, MMIS data, birth records  (birth weight, LOS, qtr care initiated)
- _Immunization_:  birth data and registry (used for outreach efforts)
**Available for purchase with restrictions of use*

## Health Care Provider Workforce*

- <date/time>

**Health Care Provider Workforce***

- Survey of state physicians--practice location(s), specialty, accept MA patients, training, number of other physicians in practice, etc.
- Survey of dentists--similar questions
- Survey of chiropractors
- Survey of podiatrists
**Workforce data available for purchase--no limitations*

## Facility level information*

- <date/time>

**Facility level information***

- Nursing home characteristics
- Home health agency characteristics
- Hospice characteristics
- Hospital characteristics and financial information

- Uncompensated care in hospitals

**Available for purchase--*
*no limitations*

## Population Based Data*

- <date/time>

**Population Based Data***

- Behavioral Risk Factor Survey--examines behavioral risks of the population of the state
- Family Health Survey--random state population survey on health status, health care utilization and insurance
- Population Estimates

**Some data available*

## Customers of BHI data

- <date/time>

**Customers of BHI data**

- Public Sector
- Medicaid program
- Facility Licensure program
- Social Security Admin
- Immigration
- Transportation
- Welfare
- Public health departments
- Legislators

- Private Sector
- Group purchasers of health care
- Health plans
- Healthcare providers
- Consultants
- Employers
- Researchers--medical and health services
- Students
- Consumers

## Data Uses

- <date/time>

- A Few Examples

## Medicaid program questions

- <date/time>

**Medicaid program questions**

- Are recipients getting prenatal care?
- Where are new outreach offices needed?
- How does recipient utilization of hospitals differ from non-recipients?
- Preventive services utilization compared to non-recipients

## More Medicaid Questions

- <date/time>

**More Medicaid Questions**

- What is the rate of hospitalizations for ambulatory care sensitive conditions---for MA recipients vs non-recipients?
- Are hospitalizations for ambulatory care sensitive conditions more likely to occur in areas of physician shortage?

## Private Purchasers of Health Care

- <date/time>

**Private Purchasers of Health Care**

- Custom requests include:  HCUP quality indicators for the market area of the purchaser
- Custom requests for inpatient and ambulatory HEDIS-like measures for service area combined with measures of physician penetration
- Custom requests of physician-enhanced data to determine variation in charges for frequent procedures/surgeries
- Custom requests for behavioral risk factor information matched to geographic areas where rates of cardiac surgery are high

## Policy research requests

- <date/time>

**Policy research requests**

- How many deliveries were 24 hour stays vs longer?  Was there any difference in the severity of the mother’s health status?
- Has there been a difference in hospital profit margins due to the BBA?
- Is there a difference in health status and functional ability of patients in nursing homes versus those in the community?
- What is the current rate of uninsured in Wisconsin?  How many citizens who are employed have health insurance?  What about their dependents?

## Two websites:

http://www.dhfs.state.wi.us  (Consumer Guide, reports, links to Medicaid and BadgerCare)

http://badger.state.wi.us/agencies/oci/ohci  (look under products and services--OHCI online, inpatient and ambulatory surgery data, workforce, facility level)

- <date/time>

- Two websites:
- http://www.dhfs.state.wi.us  (Consumer Guide, reports, links to Medicaid and BadgerCare)
- http://badger.state.wi.us/agencies/oci/ohci  (look under products and services--OHCI online, inpatient and ambulatory surgery data, workforce, facility level)

## State Data Sources

- AHSR 2000 Annual Meeting
- Denise Love
- National Association of Health Data Organizations

## State Data Sources

- State encounter data systems
- HCUP as a model for a nationwide system
- Opportunities for improving data systems
- Resources

## Data Availability ScaleMost and Least Developed Encounter Data Sets for Health Systems Evaluation

- Inpatient

- Ambulatory
- Surgery

- Emergency
- Department

- Primary
- Care
- Encounter

- HEDIS
- CAHPS

- Medicaid
- MC Encounter

- FFS
- Medicaid
- Encounter

## Encounter Data Improvement Cycle

- Compliance

- Edit
- Feedback

- Collection

- Coding Standards

- Analytic Standards

## Slide 34

## Statewide Data Collection:  Models

- Model 1:  State mandates and implements
- e.g. AR, AZ, CA, CT, DE, FL, LA, MA, ME, MO, NH, NM, NV, OK, PA, RI, SC, UT, WA, WI, (KS)
- Model 2:  State mandates and contracts with other agency to implement
- GA, IA, NC, TN, NE,
- Model 3:  Voluntary collection by private agency
- HI, MI, CO, MS,

## State Data Collection Activities

- IP Data

-   IP and Other Outpatient Data

-  Not Collecting:  Alabama, Alaska, DC, Idaho, Mississippi, Montana, South Dakota

- August 1999

- Inpatient and Outpatient Reporting by State,1998

## State Data Collection ActivitiesAmbulatory Surgery Data Collection by States, 1998

- Hospital Based Ambulatory Surgery

-  Hospital Based & Free-standing Ambulatory Surgery

-  Not Collecting (includes DC and RI)

- August 1999

- Figure 1

## State Data Collection Activities

- ED Data (includes RI)

-   Not Collecting

- Emergency Department Data Collection, 1998

- August 1999

## States Producing Health Plan Report CardsMandated and Voluntary 

- August 1999

## Medicaid Risk Contractor Reporting

- National Association of State Health Policy, 1999

## HCUP as a model for a nationwide system

- Partnership among states, industry, and AHRQ
- All discharge data from 22 states
- Data available for 1988-1997
- Includes clinical, demographic,  and       resource use information
- Uniform database for cross-state study

## HCUP:  Multi-state and national data products

- State Inpatient Data Base:
- All discharges
- From 22 states
- many formats to one format
- edit checks
- Over 60% of U.S. discharges
- National Inpatient Sample:
- About:
- 950 hospitals
- 6.5 million discharges, 1988-97

## Slide 43

## Emerging Data Sets:  Emergency Department

- Emergency Department Internet Query System (EDIQS)
- NCHS-funded, state-federal partnership
- Integrating National Hospital Ambulatory Medical Care Survey (NHAMCS) and state ED data
- Developing non-injury analytic framework
- Developing data dissemination tools

## Slide 45

## Opportunities for Advancing Encounter Data

- Health Insurance Portability and Accountability Act (HIPAA)
- Payer and provider data standards
- Public health and research data priorities:
- Public Health Data Standards Consortium
- Medicaid and Public Health Caucuses in X12N

## Public Health Data Standards Consortium

- Expanding public health and research involvement in existing health data standards and content organizations
- Convening and educating the public health and research communities
- Advancing essential data needs through the national standards process

## NAHDO Priorities for Encounter Data Standards (837 institutional)

- Expanded E-coding requirements
- Payer type codes
- Race/ethnicity
- Mothers Medical Record number with newborn record
- Education and outreach to health services research community

## HCUP Data

- National Inpatient Sample
- www.ahrq/gov/data/hcup
- hcup@ahrq.gov
- State Inpatient Data
- Central Distributor:  hcupsid@medstat.com

## Public Health Data Standards Consortium

- Listserv:  PH-CONSORTIUM-L
- www.cdc.gov/nchs/otheract/phdsc/phdsc.htm

## WWW.NAHDO.ORG

- State encounter data agency contacts
- Health website locator index
- Links to states
- Career, News postings
- Interactive query systems
- Listservs: DLOVE@NAHDO.ORG
- Administrative Simplification
- State-Sponsored Health Surveys net

## Slide 52