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Assessing Medicaid Claims Data as an Additional Data Source for Surveillance. Rachel Wiseman, MPH Texas Department of state health services Andy mauney ; Jeff Taylor, MPH; Kristen kellogg ; Katelyn hammond. Project Objectives.

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assessing medicaid claims data as an additional data source for surveillance

Assessing Medicaid Claims Data as an Additional Data Source for Surveillance

Rachel Wiseman, MPH

Texas Department of state health services

Andy mauney; Jeff Taylor, MPH; Kristen kellogg; Katelyn hammond

project objectives
Project Objectives
  • Identify previously unreported cases of select notifiable conditions
  • Determine if Medicaid data can be used as additional surveillance source
    • Volume of unreported patients by condition
    • Effort required to evaluate unreported Medicaid claims
    • Percent change in disease counts by adding Medicaid data
methods
Methods

Request all Medicaid inpatient claims data for six month period

Identify Medicaid patients with ICD-9 codes for selected notifiable conditions

Search NBS for patients identified in Medicaid

Request medical records for all unreported Medicaid patients

Determine if patient meets CSTE case definition

Add patients that meet case definition to NBS

Educate facilities on reporting requirements

january june 2012 results
January-June 2012 Results

*Applied to case count for same time period.

^Applied to case count for cases <1 year old.

lessons learned
Lessons Learned
  • Medicaid claims data has potential for disease surveillance
  • Billing data prone to errors
    • Vaccine administration miscoded as disease
    • Patients/dates of service not found by facilities
  • Programming ICD-9 codes correctly is CRITICAL
  • Gaps in providers reporting varicella patients
project validation and expansion
Project Validation and Expansion

Measure same objectives

Use same methods

Expand the number of notifiable conditions evaluated

Validate chickenpox findings, expand age group

Use different six month period

july december 2012 results
July-December 2012 Results

*compared to same six month period in same age group

varicella comparison
Varicella Comparison

*Compared to Jan-Jun 2012 for cases <1 year old

^Compared to July-Dec 2012 for cases <19 years old

  • Seasonality, vaccine may explain difference in Medicaid claim volume
  • Shingles diagnoses miscoded as chickenpox may explain difference in percent meeting case definition
  • These factors do not explain difference in percent increase to case count
lessons learned again
Lessons Learned, Again
  • Medicaid claims data has potential for disease surveillance
    • Perhaps only for specific diseases: varicella, tetanus
  • Billing data still prone to errors
    • Coding is VERY loose
      • Example: No distinction between acute disease (paralytic polio) and chronic disease (sequelae from polio 30 years ago)
  • Still gaps in providers reporting varicella patients
conclusions
Conclusions
  • Medicaid claims data can identify previously unreported cases of select notifiable conditions
    • Varicella, tetanus
  • Medicaid data can be used as additional surveillance source
    • Volume of unreported patients by condition is variable
      • Does not necessarily reflect burden of disease
    • Effort required to evaluate unreported Medicaid claims is low for most conditions
    • Percent change in disease counts by adding Medicaid data is variable
next steps
Next Steps

Done:

Implemented monthly investigation into Medicaid claims for varicella (<19 years old) and tetanus

To Do:

Pilot pertussis project to feed “real time” claims data directly into NBS for investigation by health departments

Create plan for addressing deficiency in chickenpox reporting in a systematic fashion

Explore claims for vaccines to enhance vaccine history capture

Explore hepatitis B claims with prenatal visit claims

special thanks
Special Thanks

To Texas Medicaid & Healthcare Partnership for providing us with access to Medicaid data

To the University of Texas Public Health Internship program, specifically to Dr. Leann Field and Andy Tang.