Assessing the usability of MAX 2008 encounter data for comprehensive managed care.

Abstract

Background: As growing numbers of Medicaid enrollees receive health benefits through comprehensive managed care, researchers and policymakers seeking to understand the service use of these enrollees must rely on encounter data.

Objective: To assess the availability, completeness, and quality of physician, clinic, and outpatient service (OT), inpatient (IP), and prescription drug (RX) encounter claims to judge the usability of the 2008 Medicaid Analytical eXtract (MAX) encounter data.

Data: 2008 MAX encounter data, which are derived from the state-submitted Medicaid Statistical Information System (MSIS) files.

Methods: For each basis of eligibility (BOE) group in each state that had at least ten percent participation in comprehensive managed care and submitted at least 200 encounter claims, the completeness and quality of the OT, IP, and RX encounter data were evaluated using comparison metrics created from the full-benefit, non-dual fee-for-service (FFS) population across all states with substantial FFS participation. Data that met both the completeness and quality criteria were considered usable.

Results: The completeness and the quality of the encounter data were high. The encounter data were considered usable for a least one BOE category for 22 of the 25 states that submitted OT encounter data, 20 of the 24 states that submitted IP data, and 13 of the 15 states that submitted RX data.

Conclusions: Most states that have comprehensive managed care plans are reporting OT, IP, and RX encounter data. Of those data, the majority are complete and of comparable quality to FFS data for adults, children, the disabled, and aged populations.