1. 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

2. 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

3. 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

4. January-June 2012 Results Pts in Medicaid Found in NBS MR requests
MR rec’d
Met case definition
% increase to case count*
Pertussis 83
38 (46%) 45
39 (87%)
1 (3%)
0.3%
Tetanus 8
7 (88%)
1 (14%)
100%
Salmonellosis
51 (61%) 32
28 (88%)
6 (21%)
0.2%
Varicella
<1 yo 28
25 (89%)
23 (92%)
23.2%^
*Applied to case count for same time period.
^Applied to case count for cases <1 year old.

5. Analysis of Objectives
Identified unreported claims?
Volume of unreported claims
Effort required to investigate
Percent change in count
Pertussis
Yes
High
Very Low
Tetanus
Low
Very High
Salmonellosis
Medium
Varicella
<1 yo

6. 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

7. 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

8. July-December 2012 Results
Pts in Medicaid
Found in NBS
MR requests
MR rec’d
Met case definition
% increase to count
Botulism 1
1 (100%) --
CJD 8
7 (88%)
Diphtheria 9
5 (63%)
Hepatitis A 64
7 (11%) 57
44 (77%)
Legionellosis 2
2 (100%)
Listeriosis 3
3 (100%)
Measles
Polio 29 26
18 (69%)
Rubella/CRS 17 16
13 (81%)
Smallpox
8 (100%)
Tetanus 6
6 (100%)
Varicella <19 68
9 (13%) 59
56 (95%)
46 (82%)
8.1%*
Vibriosis 22 19
12 (63%)
*compared to same six month period in same age group

9. Varicella Comparison Pts in Medicaid Found in NBS MR requests MR rec’d
Met case definition
% increase to case count
Varicella
<1 yo 28
25 (89%)
23 (92%)
23.2%*
Varicella <19 68
9 (13%) 59
56 (95%)
46 (82%)
8.1%^
*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

10. Analysis of Objectives
Identified unreported claims?
Volume of unreported claims
Effort required to investigate
Percent change in count
Botulism
Yes
Low --
CJD
Medium
Diphtheria
Hepatitis A
High
Legionellosis No
Listeriosis
Measles
Polio
Rubella/CRS
Smallpox
Tetanus
Varicella <19
Vibriosis

11. 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

12. 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

13. 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

14. 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.