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Implementation of resource use measures in Medicare Advantage
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
|April 12, 2022
Summary
This study validates Medicare Advantage (MA) Encounter data and provides SAS code for resource use measurement. Improved data quality enhances understanding of MA performance.
Area of Science:
- Health Services Research
- Health Economics
- Data Science
Background:
- Medicare Advantage (MA) plans are increasingly prevalent, necessitating accurate methods to assess their resource utilization.
- Existing methods for measuring MA resource use may not fully leverage available Encounter data.
- Validation of Encounter data is crucial for reliable performance evaluation.
Purpose of the Study:
- To provide technical details and SAS code for validating MA Encounter data.
- To implement resource use measures in MA using validated Encounter data.
- To complement existing methods for assessing MA resource utilization.
Main Methods:
- Utilized MA Encounter, MedPAR, HEDIS, and Traditional Medicare (TM) claims data from 2015-2018.
- Selected MA contracts with high data completeness based on missing hospital stays and visit discrepancies.
- Developed standardized prices using TM payments and measured MA resource use across various service types.
Main Results:
- Identified and reported MA contracts exhibiting high data completeness.
- Provided functional SAS code for Encounter data management, price standardization, and resource use measurement.
- Demonstrated a methodology for assessing MA resource use.
Conclusions:
- Enhanced validation and utilization of Encounter data can significantly improve data quality for MA research.
- The developed methods and code facilitate more accurate studies on MA performance.
- Findings support informed decision-making regarding MA plan oversight and quality improvement.
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