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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?
Georgia Tech Contributors
Gentili, M., Serban, N., Harati, P., O'Connor, J., Swann, J. (2018) Quantifying Disparities in Accessibility and Availability of Pediatric Primary Care with Implications for Policy, Health Services Research, 53(3), 1458-1477.
Hilton, R., Zheng, Y., Serban, N.(2018) Modeling Heterogeneity in Healthcare Utilization Using Massive Medical Claims Data, Journal of the American Statistical Association, 113(521), 111-121.
Lee, I., Monahan, S., Serban, N., Griffin, P., Tomar, S. (2017) Estimating the Cost Savings of Preventive Dental Services Delivered to Medicaid-Enrolled Children in Six Southeastern States, Health Services Research, in press.
Zheng, Y., Serban, N. (2018) Clustering the Burden of Pediatric Chronic Conditions in the United States using Distributed Computing, Annals of Applied Statistics, Vol. 12, No. 2, 915-939.
Serban, N., Tomar, S. (Accepted June 2018) ADA Health Policy Institute’s Methodology Overestimates Spatial Access to Dental Care for Publicly Insured Children, Journal of Public Health Dentistry, in press.
Pujol, T., Serban, N., Swann, J., Kottke, M. (Accepted August 2018) Determining the Uptake of CDC MEC Guidelines for Contraceptive Usage of Chronically Ill Women, Preventive Disease Control, in press.
Moran, A., Serban, N., Danielson, M., Grosse, S. (Accepted August 2018) Assessing Adherence to Evidence-based Care Practices for Preschool Children Diagnosed with ADHD in the Medicaid System, Psychiatric Services, in press.
Smith, A., Serban, N., Fitzpatrick, A. (Submitted July 2018), Asthma Prevalence Among Medicaid-enrolled Children, Journal of Allergy and Clinical Immunology: In Practice, under 2nd review.
Moran, A., Garcia, E., Cummings, J., Serban, N. (Submitted July 2017) Healthcare Outcome Measurements for Medicaid-enrolled Children Diagnosed with Depression. Administration and Policy in Mental Health Services Research, under 2nd review.
Johnson, B., Serban, N., Griffin, P., Tomar, S. (Submitted March 2018) Does Silver Diamine Fluoride Reduce Caries Treatment Expenditures in US Children? Journal of Public Health Dentistry, under 2nd review.
Serban, N., Bush, C., Tomar, S. (Submitted August 2018) Medicaid Capacity for Pediatric Dental Care. Journal of the American Dental Association, under 1st review.
Cao, S., Gentili, M., Griffin, P., Griffin, S., Serban, N. (2017). Disparities in Access to Preventive Dental Care between Publicly and Privately Insured Children in Georgia. Preventive Disease Control, 14:170176.
Johnson, B., Serban, N., Griffin, P., Tomar, S. (2017) The Cost-Effectiveness of Three Interventions for Providing Preventive Services to Low-Income Children, Community Dentistry and Oral Epidemiology, 45(6), 522-528.
Hilton, R., Zheng, Y.R., Fitzpatrick, A., Serban, N. ( 2017) Uncovering Longitudinal Health Care Behaviors for Millions of Medicaid Enrollees: A Multistate Comparison of Pediatric Asthma Utilization, Medical Decision Making, 38(1):107-119.
Harati, P., Gentili, M., Serban, N. (2016) Projecting the Impact of the Affordable Care Act Provisions on Accessibility and Availability of Primary Care for the Adult Population in Georgia, Journal of the American Public Health, 106(8):1470-6..
M. Nobles, N. Serban, J. Swann (2014), Spatial Accessibility of Pediatric Primary Healthcare: Measurement and Inference, Annals of Applied Statistics, 8 (4), 1922-1946.
Griffin, P.M., Lee, H., Scherrer, C., Swann, J.L. (2014), “Balancing Investments in Federally Qualified Health Centers and Medicaid for Improved Access and Coverage in Pennsylvania”, Health Care Management Science, Vol. 17, pp. 1-17.
Centers for Disease Control and Prevention, Atlanta, GA, "Health Analytics at Georgia Tech: From Information to Knowledge to Decision Making", N. Serban, J. Swann, May, 2014. Download