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Medicaid is a government insurance program for families and individuals with low income and resource. The Medicaid program is directed by the Centers of Medicare & Medicaid Services (CMS). Recent policy changes in this program are implemented under the Patient Protection and Affordable Care Act (2010). Because Medicaid provides care for about 50 million children and low income adults, understanding and managing the on-going health policies for people enrolled in this program can be the catalyst of change to a more efficient, effective and equitable healthcare system.
What We Do
Medicaid Claims Data - CMS Research Identifiable Files (RIF)
We have acquired Medicaid Analytic eXtract (MAX) files from Centers for Medicaid and Medicare Service (CMS), which contain Medicaid claims data including Personal Summary File, Inpatient File, Long Term Care File, Other Therapy File and Prescription File. The data range from 2005 to 2010 for 14 states, including GA, NY, PA, TN, NC, MN, CA,FL, AL, MS, SC, LA, AK, TX. We have implemented a data environment to protect, manage and analyze these data while complying with HIPPA and CMS data safeguard regulations. We have also implemented the infrastructure data backbone to petition the data into a relational database allowing fast queries from this large source of information. The research group uses these data to derive models to understand and manage the complexity of the Medicaid system.
Pediatric Asthma is one of the most severe conditions for children in Georgia. To evaluate the impact of interventions, or to design interventions to have the greatest impact with limited resources, it is useful to develop an asthma baseline. We propose to quantify a set of measures around pediatric asthma for the Medicaid population. Our initial baseline includes elements related to outcomes and costs, for geographical areas and subpopulations within the state of Georgia (called analysis of “small area variations”).
Profiling Care Pathways for Pediatric Asthma
Care for pediatric asthma is complex because of its differential impact depending on several confounding factors including age, provider of care, severity of the condition, access to care, and environment. There are different actions of asthma care, from doing nothing, to obtaining care from a primary care physician (PCP) or asthma specialist, or simply visiting emergency departments (ED) when severe. In this research project, our overarching objective is to describe underlying asthma care pathways for children in the Medicaid program. For each pathway, we evaluate utilization and cost to suggest potential policy and network interventions.
Predicting Health Costs and Variations Geographically
We focus on predictive health at the system level, where we study health costs and variations in costs geographically for the Medicaid population. Such variation in cost (particularly when high), can point to behaviors at the patient, provider, or healthcare infrastructure levels that can be targeted for future improvements. Our overall research question is to what extent costs vary geographically, and what factors are associated with increased costs in the system?