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Related Concept Videos

Health Information Technology and Healthcare Information System01:30

Health Information Technology and Healthcare Information System

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Health Information Technology (HIT)
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
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Methods of Documentation VI: Case Management Model01:15

Methods of Documentation VI: Case Management Model

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The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic...
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Methods of Documentation VII: EMR01:30

Methods of Documentation VII: EMR

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Electronic Medical Records (EMRs) primarily center around electronically documenting patients' health information within a single healthcare organization or practice. They contain essential clinical data related to a patient's medical history, diagnoses, medications, treatment plans, lab results, and other pertinent information relevant to the specific encounter or episode of care. EMRs are designed to streamline documentation and workflow processes within individual healthcare...
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Documentation in Long-Term and Home Healthcare Setting01:29

Documentation in Long-Term and Home Healthcare Setting

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Documentation in long-term care facilities and home healthcare settings is crucial for ensuring continuous, coordinated, and comprehensive care for patients. Each setting has its specific documentation processes and tools:
Long-Term Care Facilities
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Kaplan-Meier Approach01:24

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The Kaplan-Meier estimator is a non-parametric method used to estimate the survival function from time-to-event data. In medical research, it is frequently employed to measure the proportion of patients surviving for a certain period after treatment. This estimator is fundamental in analyzing time-to-event data, making it indispensable in clinical trials, epidemiological studies, and reliability engineering. By estimating survival probabilities, researchers can evaluate treatment effectiveness,...
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Methods Of Healthcare Delivery System

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At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
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Measuring resource use in Medicare Advantage using Encounter data.

Jeah Jung1, Caroline Carlin2, Roger Feldman3

  • 1Department of Health Policy and Administration, College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania, USA.

Health Services Research
|September 12, 2021
PubMed
Summary
This summary is machine-generated.

Medicare Advantage (MA) Encounter data completeness was assessed, finding 83 of 380 contracts had high data quality. This enables reliable measurement of resource use for MA enrollees, particularly those with cancer.

Keywords:
Encounter dataMedicare Advantagedata assessmentresource usestandardized prices

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Area of Science:

  • Health Services Research
  • Health Economics
  • Data Science in Healthcare

Background:

  • Medicare Advantage (MA) enrollment is growing, necessitating accurate methods to assess healthcare resource utilization.
  • Medicare Encounter data offers a rich source of information but requires validation for completeness and accuracy.
  • Understanding resource use in MA is crucial for cost-effectiveness and quality improvement initiatives.

Purpose of the Study:

  • To evaluate the completeness of MA Encounter data for measuring healthcare resource use.
  • To establish a methodology for assessing the validity of Encounter data against other sources.
  • To estimate the resource utilization among MA enrollees, specifically those with cancer.

Main Methods:

  • Compared MA Encounter data with Medicare Provider Analysis and Review (MedPAR) and Healthcare Effectiveness Data and Information System (HEDIS) data.
  • Calculated completeness based on inpatient stay percentages and discrepancies in ambulatory/emergency department visit rates.
  • Utilized Traditional Medicare (TM) payment rates to standardize resource use estimation for cancer patients.

Main Results:

  • Identified 83 out of 380 MA contracts (21.8%) demonstrating high data completeness.
  • Estimated total resource use per MA enrollee with cancer at $14,715 in 2015.
  • Detailed service-specific resource use: $5,342 inpatient, $5,932 professional, and $3,441 outpatient facility services.

Conclusions:

  • Validating MA Encounter data completeness is essential for reliable research on MA resource use.
  • Encounter data is a feasible tool for measuring MA resource utilization, compensating for missing payment information.
  • Further refinement of methods using Encounter data is needed to comprehensively understand care provision in MA plans.