Strengthening Medicaid Data Systems for Effective Decision Making
Medicaid’s growth has led to an ever-increasing need for better information about enrollment, covered services, and payments to physicians, hospitals, and other health care providers. Timely, accurate, detailed, and comprehensive data help program administrators and policymakers forecast and manage costs, track access to services, monitor program performance, ensure quality of care, deter fraud, and develop new policies.
The new national database for Medicaid and the Children’s Health Insurance Program (CHIP), known as the Transformed Medicaid Statistical Information System (T-MSIS), will provide person- and service-level information on everyone eligible and enrolled in Medicaid and CHIP. It will serve as the backbone for research and policy analysis on these public health care programs for people with low incomes and disabilities.
Mathematica has released an issue brief identifying current opportunities to use emerging data systems and a companion fact sheet exploring new data available from T-MSIS. In sum, state and federal program administrators can use T-MSIS data to conduct new analyses to answer critical questions, including the following:
- What are the services that different groups of Medicaid and CHIP beneficiaries—children, people with disabilities and chronic illnesses, and dual beneficiaries—use? How do new programs or waivers affect service use, costs, and quality?
- How can we better measure the value of the care that beneficiaries receive, both in fee-for-service and in managed care? How is spending related to quality of care?
- How can we efficiently manage expensive episodes of care for beneficiaries with complex or chronic illnesses and ensure appropriate transitions (such as moving from the hospital to home)?
- How can we compare the performance of different managed care organizations beyond the measures currently reported in the Healthcare Effectiveness Data and Information Set and the Consumer Assessment of Healthcare Providers and Systems?
Mathematica has convened a Moving Medicaid Data Forward series of forums to help researchers, policymakers, and agency staff understand the available utilization data, useful analytical tools, and existing resources. Click here to learn more about this series of forums.