Presentation on theme: "RACHEL WISEMAN, MPH TEXAS DEPARTMENT OF STATE HEALTH SERVICES ANDY MAUNEY; JEFF TAYLOR, MPH; KRISTEN KELLOGG; KATELYN HAMMOND Assessing Medicaid Claims."— Presentation transcript:
RACHEL WISEMAN, MPH TEXAS DEPARTMENT OF STATE HEALTH SERVICES ANDY MAUNEY; JEFF TAYLOR, MPH; KRISTEN KELLOGG; KATELYN HAMMOND Assessing Medicaid Claims Data as an Additional Data Source for Surveillance
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 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 Pts in Medicaid Found in NBS MR requests MR rec’d Met case definition % increase to case count* Pertussis8338 (46%) 4539 (87%) 1 (3%)0.3% Tetanus8087 (88%)1 (14%)100% Salmonellosis8351 (61%) 3228 (88%) 6 (21%)0.2% Varicella <1 yo (89%) 23 (92%)23.2%^ *Applied to case count for same time period. ^Applied to case count for cases <1 year old.
Analysis of Objectives Identified unreported claims? Volume of unreported claims Effort required to investigate Percent change in count PertussisYesHigh Very Low TetanusYesLow Very High SalmonellosisYesMedium Very Low Varicella <1 yo YesMediumLowMedium
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 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 Pts in Medicaid Found in NBS MR requests MR rec’d Met case definition % increase to count Botulism1011 (100%)0-- CJD8087 (88%)0-- Diphtheria9085 (63%)0-- Hepatitis A647 (11%)5744 (77%)0-- Legionellosis22 (100%)-- Listeriosis33 (100%)-- Measles1011 (100%)0-- Polio (69%)0-- Rubella/CRS (81%)0-- Smallpox8088 (100%)0-- Tetanus6066 (100%)0-- Varicella <19689 (13%)5956 (95%)46 (82%)8.1%* Vibriosis (63%)0-- *compared to same six month period in same age group
Varicella Comparison Pts in Medicaid Found in NBS MR requests MR rec’d Met case definition % increase to case count Varicella <1 yo (89%) 23 (92%)23.2%* Varicella <19689 (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
Analysis of Objectives Identified unreported claims? Volume of unreported claims Effort required to investigate Percent change in count BotulismYesLow -- CJDYesLowMedium-- DiphtheriaYesLow -- Hepatitis AYesHighLow-- LegionellosisNo-- ListeriosisNo-- MeaslesYesLow -- PolioYesMediumLow-- Rubella/CRSYesMediumLow-- SmallpoxYesLow -- TetanusYesLow -- Varicella <19YesHighLow VibriosisYesMediumLow--
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 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 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 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.