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

Area of Science:

• Health Services Research
• Public Health Policy
• Health Informatics

Background:

• Increasing enrollment in Medicaid managed care necessitates reliance on encounter data for service use analysis.
• Understanding service utilization requires accurate and complete encounter data.

Purpose of the Study:

• To evaluate the usability of 2008 Medicaid Analytical eXtract (MAX) encounter data.
• Assess the availability, completeness, and quality of outpatient (OT), inpatient (IP), and prescription drug (RX) claims.

Main Methods:

• Utilized 2008 MAX encounter data from state-submitted Medicaid Statistical Information System (MSIS) files.
• Evaluated data completeness and quality for OT, IP, and RX claims using comparison metrics against fee-for-service (FFS) data.
• Data were deemed usable if they met both completeness and quality criteria for specific eligibility groups.

Main Results:

• Encounter data demonstrated high completeness and quality.
• Usable data were available for a majority of states: 22/25 for OT, 20/24 for IP, and 13/15 for RX.
• The data were usable for at least one basis of eligibility (BOE) category in most reporting states.

Conclusions:

• Most states with comprehensive Medicaid managed care plans successfully report encounter data.
• The majority of reported encounter data (OT, IP, RX) are complete and comparable in quality to FFS data.
• MAX encounter data are a valuable resource for analyzing service use across diverse Medicaid populations.