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Medicaid managed care encounter data: what, why, and where next?
1Mathematica Policy Research, Inc., Washington, DC 20024, USA.
Health Care Financing Review
|February 1, 1997
Summary
Managed care now covers 23% of Medicaid enrollees. The shift from fee-for-service (FFS) to capitation eliminates traditional data sources, impacting policy research and requiring new encounter data strategies.
Area of Science:
- Health Services Research
- Health Policy
- Health Informatics
Background:
- Managed care enrollment in Medicaid has reached 23%.
- The transition to capitation payment models has replaced the traditional fee-for-service (FFS) system.
- This shift impacts the availability of administrative data crucial for policy planning and research.
Purpose of the Study:
- To provide an overview of encounter data requirements for managed care plans.
- To identify challenges and issues associated with providing and analyzing encounter data.
- To offer recommendations for improving encounter data systems.
Main Methods:
- Review of documentation from states and the Health Care Financing Administration (HCFA).
- Interviews with representatives from nine states and HCFA.
Main Results:
- Managed care's growth necessitates new data collection methods beyond FFS.
- Significant challenges exist in the provision and analysis of current encounter data.
- Variability in data requirements and quality across states was observed.
Conclusions:
- Recommendations are provided for HCFA, states, and managed care plans.
- Improving encounter data systems is crucial for effective policy and research.
- Standardization and enhanced data quality are key for future analysis.