Opportunities To Use Medicaid Data to Conduct Health Services Research Ana Lòpez – De Fede, PhD USC Institute for Families in Society Division of Medicaid Policy Research October 13, 2016

Impact of Medicaid Child Population on Hospitals — American Academy of Pediatrics, March 2015 Children & Medicaid Medicaid covers 33 million children nationwide. Approximately 20% of children have special health care needs, and 44% of them are covered by public insurance. 60% of children enrolled in Medicaid live in households where at least one household member works. Historically, children represent half of all Medicaid enrollees, but they account for only 25% of Medicaid dollars spent.

Impact of Medicaid Child Population on Hospitals — American Academy of Pediatrics, March 2015 Impact of Medicaid on Hospitals In South Carolina, children on Medicaid make up 48.4% of a pediatrician’s Patient Base 1. Although they comprise less than 5% of the nation’s total hospitals, children’s hospitals provide about 47% of all inpatient care for children on Medicaid and almost all the hospital care required by children with complex conditions.

Impact of Medicaid Child Population on Hospitals — American Academy of Pediatrics, March 2015 Impact of Medicaid on Hospitals On average, each children’s hospital devotes more than half its inpatient care (57% of inpatient days) to children assisted by Medicaid. On average, Medicaid reimburses children’s hospitals only 77% of the cost of care provided, including Disproportionate Share Hospital payments. If cuts or caps are adopted at the federal or state level, payment rates could decrease further.

Medicaid Data & Analytic Linked Components MPR Medicaid Data & Analytic Linked Components

Medicaid Data & Analytic Linked Components Medicaid Providers MPR Medicaid Data & Analytic Linked Components

Medicaid Data & Analytic Linked Components Professional Organizations: SC LLR Professional Boards, CMS Provider of Services, National Provider Identifier Registry; Hospital Affiliation MPR Medicaid Data & Analytic Linked Components

Medicaid Data & Analytic Linked ESRI Spatial and Attribute Data MPR Medicaid Data & Analytic Linked Components

Medicaid Data & Analytic Linked Medicare Dual Eligible DHEC Immunization Data MPR Medicaid Data & Analytic Linked Components Claims & Encounters Lab Results

Medicaid Data & Analytic Linked MPR Medicaid Data & Analytic Linked Components CHIPRA

Medicaid Data & Analytic Linked MPR Medicaid Data & Analytic Linked Components State Agency Provider Services

Medicaid Data & Analytic Linked MPR Medicaid Data & Analytic Linked Components Hospital Designations Environmental Data

Medicaid Data & Analytic Linked MPR Medicaid Data & Analytic Linked Components Community Directories

Medicaid Data & Analytic Linked MPR Medicaid Data & Analytic Linked Components SC Geographic Information Council

Medicaid Data & Analytic Linked MPR Medicaid Data & Analytic Linked Components Boundary Data: Zip Code and Census Tract Designations

Medicaid Data & Analytic Linked MPR Medicaid Data & Analytic Linked Components HSRA Designations and Catchment

Medicaid Data & Analytic Linked MPR Medicaid Data & Analytic Linked Components Attribute Data: Census Data and Zip Code Updates

Medicaid Data & Analytic Linked Eligibility/ Family Recipient File MPR Medicaid Data & Analytic Linked Components

Medicaid Data & Analytic Linked DHEC Recipient Mortaility Status MPR Medicaid Data & Analytic Linked Components

Medicaid Data & Analytic Linked Professional Organizations: SC LLR Professional Boards, CMS Provider of Services, National Provider Identifier Registry; Hospital Affiliation Medicaid Providers DHEC Recipient Mortality Status Medicare Dual Eligible ESRI Spatial and Attribute Data DHEC Immunization Data Eligibility/ Family Recipient File MPR Medicaid Data & Analytic Linked Components Claims & Encounters Attribute Data: Census Data and Zip Code Updates Lab Results HSRA Designations and Catchment CHIPRA Boundary Data: Zip Code and Census Tract Designations Hospital Designations Environmental Data State Agency Provider Services Community Directories SC Geographic Information Council

MPR Available Research Tools and Analytic Capacity

MPR Available Research Tools and Analytic Capacity HEDIS NCQA Certified Software with Beta Testing Capacity and New Measures Benchmarking

MPR Available Research Tools and Analytic Capacity Clinical Risk Stratification Tools 3M CRG; DXG MPR Available Research Tools and Analytic Capacity

MPR Available Research Tools and Analytic Capacity GeoDa Spatial Statistical Software MPR Available Research Tools and Analytic Capacity

MPR Available Research Tools and Analytic Capacity ARHQ Software CCS and PQI

MPR Available Research Tools and Analytic Capacity Certified Survey Research Geographic Aggregation Tool

MPR Available Research Tools and Analytic Capacity Certified Survey Research

MPR Available Research Tools and Analytic Capacity Tableau®

MPR Available Research Tools and Analytic Capacity SAS; STATA; Spatial Microsimulation with R; SQL

MPR Available Research Tools and Analytic Capacity Address Products

MPR Available Research Tools and Analytic Capacity ESRI ArcGIS Desktop, Server, Extensions, ARCGIS Online

MPR Available Research Tools and Analytic Capacity Compass Navigator Development and Testing HEDIS-LIKE Measures Benchmarking

MPR Available Research Tools and Analytic Capacity GeoDa Spatial Statistical Software Clinical Risk Stratification Tools 3M CRG; DXG MPR Available Research Tools and Analytic Capacity Compass Navigator Development and Testing HEDIS-LIKE Measures Benchmarking Certified Survey Research HEDIS NCQA Certified Software with Beta Testing Capacity and New Measures Benchmarking SAS; STATA; Spatial Microsimulation with R; SQL ESRI ArcGIS Desktop, Server, Extensions, ARCGIS Online ARHQ Software CCS and PQI Address Products Tableau® Geographic Aggregation Tool

Applying Medicaid Data to Health Services Research Activities The Institute of Medicine, defines Health Services Research (HSR) as an inquiry to produce knowledge about the . . . Structure, e.g., physician workforce; structure of the delivery system Process, e.g., use of different types of services, access Effects (outcomes), e.g., changes in health, functional status, severity of condition, satisfaction with care, cost of care, quality of life . . . of personal health services.

schealthviz.sc.edu

CONTACT Phone Online Email (803)777-5789 ifs.sc.edu/MPR adefede@mpr.sc.edu