1. Building the Data Infrastructure to Improve Health Care for Dual Eligibles: The Role of Health Reform and a New Comparative Effectiveness Research Initiative
Rosaly Correa-de-Araujo, MD, MSc, PhD
Deputy Director
Office on Disability/Office of the Secretary
U.S. Department of Health and Human Services
2010 SNP Alliance Annual Meeting
Washington, D.C., October 28, 2010

2. Dual Eligibles
9 million, costly segment of beneficiaries for both Medicare and Medicaid ($250M/year)
Most severely disabling: chronic physical and/or mental, multiple co-morbidities
Co-morbidity common, more likely in older duals
Service use high, Medicare & Medicaid care coordination challenging
Per capita spending of Medicare and Medicaid higher w/ multiple chronic conditions (mental/cognitive)
With multiple co-morbidity, more heavily reliance on Medicare for hospital services and Medicaid for LTSS
Source: KFF Report, July 2010

3. Dual Eligibles Challenge
Poor understanding on how spending distributes across both Medicare and Medicaid
Poor Coordination
Increased cost
Decreased quality
Challenge
Program incentives encourage avoiding cost rather than coordinating care.

4. Policy Implications
Coordination of both Medicare and Medicaid funding is a major problem in access to and delivery of quality care for duals eligibles.
Nevertheless, both Medicare and Medicaid programs contribute to meeting the needs for acute and supportive services for this population.

5. Policy Implications Opportunities under Health Reform
Reauthorization of Medicare Special Needs Plans (SNPs) through 2013
Expanded Medicaid HCBS
New Medical Home Grant Program
CMS Federal Coordinated Health Care Office
CMS Centers for Innovation
Section 4302 – Health Disparities and Disability Standards for Data Collection

6. Special Needs Plans (SNPs)
Valuable partnership w/ State Medicaid
Full array of Medicare, Medicaid, supplemental benefits in a single plan
Diverse population, opportunity for high-quality person-centered care
Accountable integrated care organizations:
cost control
improved outcomes and enhanced quality of life
data gathering and sharing
implementation site for models of care
development and implementation of quality indicators

7. FY 2011 - Person Centered Health Research
American Recovery and Reinvestment Act Comparative Effectiveness Research
$7 million (May FY )
FY Person Centered Health Research
CORE ACTIVITIES
Identify and review existent evidence
Build a data warehouse
Establish criteria and standards
Develop and prioritize research questions
Disseminate findings

8. Person-Centered Care Providers’ Experience
Clinical , Functional Status & Circumstances
Scientific Evidence
Persons with Disabilities Preferences
Providers’ Experience
Providers’ Experience

9. Disability Data Infrastructure
Federal costs with programs - $226 billion/year
Data inconsistent, program specific, no accurate analysis
Who and how many are benefiting?
To what extent people draw on multiple programs?
What specific services are provided and to whom?
How effective are they? What are the outcomes?
Are there state variations over time?
How are services integrated?

10. CMS-ResDAC Medicare Data Research Identifiable Files (RIFs)
Part D Denominator Files
Standard Analytical Files (SAFs)
Denominator Files
Part D drug Event (PDE) Files
Medicare Provider Analysis & Review Files (MedPAR)
Research identifiable files allow a state to match Medicare and Medicaid utilization data for individual dual eligible beneficiaries to get a full picture of the services that a particular person may have used over a period of time. Specific identifiers are also available such as date of birth, age, race, sex, residence information. Because these identifiers are regulated by federal laws, rules, and regulations, research identifiable files can be difficult to access. Research identifiable files can serve as rich sources of information on Medicare utilization and costs for dual eligibles. However, states should be aware that these data do not include claims paid by sources other than fee-for-service Medicare. As a result, dual eligibles receiving care through managed care organizations (e.g., Medicare Advantage) and actual Part D claims information are not included in these files.
Beneficiary Annual Summary Files (BASF)
Chronic Conditions Summary Files

11. CMS-ResDAC Medicare Data Limited Dataset
LDS MEDPAR Files
LDS Standard Analytical Files (SAF)
LDS Denominator Files
The limited data set files also contain individual-level health information, but exclude the specific identifiers found in the research identifiables files. However, LDS data are still considered identifiable data sets even though specific identifiers are not included.
The limited datasets are much easier to obtain but a number of variables (e.g., age, service dates, zip codes, etc) are either encrypted, grouped into ranges, or left blank, making it difficult to use for individual-level analysis.

12. Linking Medicare to Medicaid Data to Improve Dual Eligibles Care
Beneficiaries ID number
Unduplication of services
Utilization & cost analysis: Medicare Claims to Medicaid crossover data
Medicare only information
Medicaid only information
Medicare & Medicaid service use & costs
Future
Outcomes data?

13. Disability Data Infrastructure
The Center of Excellence will:
Work with CMS Chronic Conditions Warehouse database
Identify and link existing sources of disability related datasets
Medicare Current Beneficiary Survey (MCBS) and
Medicare’s National Claims History File
Examining screening and preventive services , satisfaction with care, access to care and out-of-pocket expenditures according to ability to perform routine daily activities for people with
Disabilities

14. CMS CCW Upcoming Upgrades
100% of Medicare claims data back to 1999
Medicaid data for dual eligible beneficiaries back to 1999
Cause of death from death certificates back to 1999
Provider characteristics data
Medicare risk scores
Census track information to help estimate income
Gooding data to address access issues
More chronic conditions flags
Enhanced race codes
Enhanced analytical capabilities
Enhanced ability to extract data by diagnoses and procedures

15. Final Thoughts on CER – Center of Excellence
Plenty of opportunities to increase data availability to support health services research – effectiveness & CER studies
Better understanding of access to, quality, effectiveness of care
Conduct research that will tell us what treatments, intervention, and models of care work best. SNPs as great setting to study care coordination.
Collection, sharing, merging, integration of Medicare and Medicaid data to support better coordination
Identify, implement quality indicators that better reflect HCBS, care coordination, and measure what is important for dual eligibles
Not a short-term effort, long-term partnerships among Federal, State, and private sector.

16. THANK YOU! Rosaly.correa@hhs.gov (202) 205-1104
(202)
THANK YOU!