The IAP Data Analytics team is developing a series of data tools that will provide easy-to-use and publicly available solutions for states, including states that are not currently participating in IAP. These solutions focus on enhancing a state’s ability to identify relevant program populations, integrate Medicare-Medicaid data to improve care coordination, and develop data analytic capacity through direct data analytic support. Our goal is to support states’ data analytic needs, with a focus on the four IAP program areas: (1) substance use disorders (SUD); (2) beneficiaries with complex care needs and high costs (BCN); (3) physical and mental health integration (PMH); and (4) community integration via long-term services and supports (CI-LTSS). For this month’s commentary, we will share information about several toolkits under development and touch upon the Medicare-Medicaid data integration support we are offering states. As our IAP data analytic work unfolds, we will continue to share more detailed information.
Data Analytics Tools
One of our major areas of emphasis is developing a series of toolkits related to the four program areas. The goal of these toolkits is to provide transparent, straightforward, and adaptable data analytic solutions that states can easily implement in their local environments. Currently, there are two tools under development which focus on the SUD and BCN program areas.
The SUD tool we are developing centers on identifying Medicaid beneficiaries with SUD and examining the quality of their SUD-related care. The identification component of the tool is mapped to CMS’s chronic conditions algorithms and the ten Diagnostic and Statistical Manual addiction categories (e.g. alcohol, cannabis, etc.). There is also an evaluation component to the tool that examines factors such as utilization, therapy, prescription drug prescribing patterns, and medication-assisted therapy to determine if Medicaid beneficiaries are receiving the appropriate care for their SUD.
The BCN tool has a different approach in that it focuses on providing interested states with a data-based foundation for defining and identifying their BCN population. We recognize that selecting an approach for identifying BCNs can be difficult, with more than 30 accepted definitions of BCNs currently available. Our goal is to explore the various definitions in relation to Medicaid data to help states understand which definitions work best under various conditions, ranging from available datasets to provider setting. The goal of this work is to provide states that do not have a preferred, standardized approach to defining their BCN population with a tool to get them started.
All of these IAP data analytic tools will be mapped to T-MSIS so that we can leverage states’ hard work in submitting their data. These tools also signal our ongoing effort to maximize the resources we share with states; as states submit their data to CMS, we will dedicate ongoing resources to making data usable for analytic purposes. To demonstrate, for both toolkits, states can expect to receive clear instructions that details the logic of the tool, SAS code that shows how to implement the tool using T-MSIS, and a use case that demonstrates the usefulness of the tool. While we are working to develop these tools as quickly as possible, we should underscore that the complexity of this work means that these tools will be completed over the course of the next twelve months.
Medicaid-Medicaid Data Integration
In addition to creating standardized tools related to IAP’s program areas, we are also working directly with states to support their Medicare-Medicaid data integration efforts. Through this work, IAP currently works with six states to provide them with one-on-one support related to their Medicare data acquisition and integration efforts. For example, the six participating states want to link Medicare-Medicaid data sets in order to create a holistic, more comprehensive, and longitudinal view of their dually-eligible beneficiaries. These data integration efforts will directly support states in identifying opportunities to improve how care coordination is delivered for these beneficiaries. Due to the complex nature of this work, the participating states are in different stages of gaining access to Medicare data and integrating datasets. We will provide additional information about these states as their work progresses. In addition, we are working on the development of use cases that will be made available to all states.
We hope this commentary sparks your interest in the types of data analytic support and tools that we are offering states through IAP. In addition to these two areas, we have an additional data analytics support opportunity planned and will share information about that opportunity in the months ahead.