Implementation of resource use measures in Medicare Advantage

Abstract

Objective: To complement the previously illustrated method to measure resource use in Medicare Advantage (MA) using Encounter data and provide technical details and SAS code to validate Encounter data and implement resource use measures in MA.

Data sources: 2015-2018 MA Encounter, Medicare Provider Analysis and Review (MedPAR), Healthcare Effectiveness Data and Information System (HEDIS), and Traditional Medicare (TM) claims data.

Study design: Secondary data analysis.

Data collection/extraction methods: We select MA contracts with high data completeness (≤10% missing hospital stays in Encounter data and ≤±10% difference in ambulatory and emergency department visits between Encounter and HEDIS data). We randomly sample TM beneficiaries with a similar geographic distribution as MA enrollees in the selected contracts. We develop standardized prices of services using TM payments, and we measure MA resource use for inpatient, outpatient, Part D, and hospice services.

Principal findings: We report identifiers/names of contracts with high data completeness. We provide SAS code to manage Encounter data, develop standardized prices, and measure MA resource use.

Conclusions: Greater use and validation of Encounter data can help improve data quality. Our results can be used to inform studies using Encounter data to learn about MA performance.

Keywords: Encounter data; Medicare Advantage; data validation; resource use; standardized prices.