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With more than 85% of their Medicaid population served by a managed care plan, Oregon officials knew they would face more than the normal hurdles in trying to integrate medical assistance data with public health information. The first task would be a painstaking audit to verify the accuracy and completeness of the encounter data required from managed care plans.
"It took a while," concedes Joan Kapowich, manager of the analysis and evaluation unit in the state’s Office of Medical Assistance.
But it was worth the time and trouble. An audit of encounter data collected during 1996 and early 1997 turned up workable results—a 74% accuracy rate in diagnosis coding and a 32% percent data omission rate.
"And we know the data has gotten more complete since," says Ms. Kapowich.
The state of Oregon is in the second year of a five-year data development grant from the Centers for Disease Control and Prevention. With approximately $250,000 annually, the state’s Medicaid and public health agencies are exploring how to integrate Medicaid program data with information available from various public health programs for health policy purposes.
Public health officials are hoping Medicaid encounter data will allow them to improve prevention and other public health interventions in three priority areas: diabetes, tobacco use, and childhood immunizations. In addition, timely and accurate encounter data will allow public health officials to use Medicaid enrollees as a sentinel population for tracking the effects of managed care on the population as a whole. The demographics of Oregon’s Medicaid clients makes the group well-suited for the purpose. During a given year, one in seven of Oregon’s residents uses the Medicaid system, and eligibility extends to populations beyond the traditional mothers and babies.
Early in the project, a newspaper reporter unwittingly gave state health officials a lesson in the importance and difficulties of linking Medicaid and public health data. To calculate the percentage of abortions funded by the state’s Medicaid program, the reporter divided Medicaid’s count of abortions by public health’s surveillance data on the total number of procedures.
The published percentage was twice as large as the intuitive estimate among health care providers and officials.
"We had a management meeting that same day," says Jennifer Woodward, who manages the data project within the Department of Health. The meeting kicked off a three-month effort to uncover and correct the Medicaid procedures that resulted in the overcount.
Before the first data-sharing programs could even get under way, officials from public health and Medicaid spent time getting to know one another.
"You’d think we were bosom buddies. We’re not quite," says Ms. Kapowich. Differences in culture, work styles, philosophies, and even language had to be ironed out before the two departments could fashion cooperative health interventions. After a year laying the groundwork, the state agencies now are developing initiatives that will look at diabetes care and services and maternal and child health.
Even beyond the scope of the CDC project, state officials are seeing a halo effect from the cooperative arrangement. When the Department of Public Health found that Oregonians on Medicaid smoke at a rate roughly double that of the state’s population as a whole—44% vs. 22%—it sparked a smoking intervention initiative between the Medicaid program and its 24 medical and dental managed care contractors.
Contact Ms. Kapowich at (503) 945-6500 and Ms. Woodward at (503) 731-4124.