Medicaid Health Care Claims Institute for Health Policy Bill Given, PhD Kathleen Oberst, RN, PhD Director of Research Michigan State University April 7, 2016

1. Big Data Use: Medicaid Health
Care Claims
Institute for Health Policy
Bill Given, PhD
Kathleen Oberst, RN, PhD Director of Research

2. College of Human
Medicine
Aron Sousa, MD
Division of Public
Health
Dean Sienko, MD, MS
Institute for
Health Policy
Dean Sienko, MD, MS
Bruce Bragg, MPH
Health Policy
Dennis Paradis, MPH
Quality
Improvement
Debra Darling, BSN, RN, CCM
Health Services
Research
Kathleen Oberst, RN, PhD

3. Institute for Health Policy (IHP)
 Mission – improve healthcare for all MI residents
 Outreach and policy analyses
 Quality improvement initiatives
 Research projects
 Collaborative role with:
 Policy makers, State agencies (e.g. MDHHS)
 Variety of healthcare organizations and non-profits
across Michigan
 MSU and other Universities

4. Data Supporting Work
 Predominantly claims/encounter based
 Ex: Medicaid eligibility, enrollment, utilization
 PROS
• Relatively confident that procedures performed
• Relatively confident that relevant diagnoses documented
• FFS claims have some cost information available
 CONS
• Time lag before data available – 3-6 months, upwards of a
year
• Clinical information missing (i.e. lab values)
• Encounters lack cost data
• Health care coverage affects completeness of data

5. Data Supporting Work
 Clinical/assessment data
 Ex: MDS on LTC residents or Inter-RAI on MI Choice
participants, EMRs
 PROS:
• Clinical information available
• Independent of health care coverage processing
• Social, cognitive and functional information
• Medications
 CONS:
• Less standardized
• Available on small groups
• Variation by practice setting

6. Bill Given
bill.given@hc.msu.edu
Kathleen Oberst
kathleen.oberst@hc.msu.edu
Thank You!