Presentation on theme: "Rachel Wiseman, MPH Texas Department of state health services"— Presentation transcript:
1Assessing Medicaid Claims Data as an Additional Data Source for Surveillance Rachel Wiseman, MPHTexas Department of state health servicesAndy mauney; Jeff Taylor, MPH; Kristen kellogg; Katelyn hammond
2Project ObjectivesIdentify previously unreported cases of select notifiable conditionsDetermine if Medicaid data can be used as additional surveillance sourceVolume of unreported patients by conditionEffort required to evaluate unreported Medicaid claimsPercent change in disease counts by adding Medicaid data
3MethodsRequest all Medicaid inpatient claims data for six month periodIdentify Medicaid patients with ICD-9 codes for selected notifiable conditionsSearch NBS for patients identified in MedicaidRequest medical records for all unreported Medicaid patientsDetermine if patient meets CSTE case definitionAdd patients that meet case definition to NBSEducate facilities on reporting requirements
4January-June 2012 Results Pts in Medicaid Found in NBS MR requests MR rec’dMet case definition% increase to case count*Pertussis8338 (46%)4539 (87%)1 (3%)0.3%Tetanus87 (88%)1 (14%)100%Salmonellosis51 (61%)3228 (88%)6 (21%)0.2%Varicella<1 yo2825 (89%)23 (92%)23.2%^*Applied to case count for same time period.^Applied to case count for cases <1 year old.
5Analysis of Objectives Identified unreported claims?Volume of unreported claimsEffort required to investigatePercent change in countPertussisYesHighVery LowTetanusLowVery HighSalmonellosisMediumVaricella<1 yo
6Lessons LearnedMedicaid claims data has potential for disease surveillanceBilling data prone to errorsVaccine administration miscoded as diseasePatients/dates of service not found by facilitiesProgramming ICD-9 codes correctly is CRITICALGaps in providers reporting varicella patients
7Project Validation and Expansion Measure same objectivesUse same methodsExpand the number of notifiable conditions evaluatedValidate chickenpox findings, expand age groupUse different six month period
8July-December 2012 Results Pts in MedicaidFound in NBSMR requestsMR rec’dMet case definition% increase to countBotulism11 (100%)--CJD87 (88%)Diphtheria95 (63%)Hepatitis A647 (11%)5744 (77%)Legionellosis22 (100%)Listeriosis33 (100%)MeaslesPolio292618 (69%)Rubella/CRS171613 (81%)Smallpox8 (100%)Tetanus66 (100%)Varicella <19689 (13%)5956 (95%)46 (82%)8.1%*Vibriosis221912 (63%)*compared to same six month period in same age group
9Varicella Comparison Pts in Medicaid Found in NBS MR requests MR rec’d Met case definition% increase to case countVaricella<1 yo2825 (89%)23 (92%)23.2%*Varicella <19689 (13%)5956 (95%)46 (82%)8.1%^*Compared to Jan-Jun 2012 for cases <1 year old^Compared to July-Dec 2012 for cases <19 years oldSeasonality, vaccine may explain difference in Medicaid claim volumeShingles diagnoses miscoded as chickenpox may explain difference in percent meeting case definitionThese factors do not explain difference in percent increase to case count
10Analysis of Objectives Identified unreported claims?Volume of unreported claimsEffort required to investigatePercent change in countBotulismYesLow--CJDMediumDiphtheriaHepatitis AHighLegionellosisNoListeriosisMeaslesPolioRubella/CRSSmallpoxTetanusVaricella <19Vibriosis
11Lessons Learned, AgainMedicaid claims data has potential for disease surveillancePerhaps only for specific diseases: varicella, tetanusBilling data still prone to errorsCoding is VERY looseExample: No distinction between acute disease (paralytic polio) and chronic disease (sequelae from polio 30 years ago)Still gaps in providers reporting varicella patients
12ConclusionsMedicaid claims data can identify previously unreported cases of select notifiable conditionsVaricella, tetanusMedicaid data can be used as additional surveillance sourceVolume of unreported patients by condition is variableDoes not necessarily reflect burden of diseaseEffort required to evaluate unreported Medicaid claims is low for most conditionsPercent change in disease counts by adding Medicaid data is variable
13Next StepsDone:Implemented monthly investigation into Medicaid claims for varicella (<19 years old) and tetanusTo Do:Pilot pertussis project to feed “real time” claims data directly into NBS for investigation by health departmentsCreate plan for addressing deficiency in chickenpox reporting in a systematic fashionExplore claims for vaccines to enhance vaccine history captureExplore hepatitis B claims with prenatal visit claims
14Special ThanksTo Texas Medicaid & Healthcare Partnership for providing us with access to Medicaid dataTo the University of Texas Public Health Internship program, specifically to Dr. Leann Field and Andy Tang.