Medicaid Managed Care - U.S. Senate Special Committee on Aging

Encounter Data Analysis
Shows Potential in Quality
Control Applications
362
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Oregon and Tennessee are experiencing collection and validation
problems similar to those Arizona experienced initially. In each of these
states, staff spent considerable time editing the data, working with health
plans to overcome problems, working to resolve significant data reject and
coding problems, and implementing validation strategies. In Oregon and
Tennessee, relatively complete and usable data elements were not
available until almost 2 years after enrollment begant. 5
State use of encounter data in quality reviews is also limited to some
extent by the lack of a recognized standard for what level of care is
considered appropriate for people with disabilities. In addition, quality
measures for chronic and disabling conditions are just now being
developed. Current federal and privately funded research and
development in the field of quality analysis will provide states with more
definitive criteria to use in their analyses.
While assembling adequate databases is difficult and expensive, the effort
can yield substantial results in terms of the ability to monitor programs
The types of studies that could be conducted using person-level encounter
data include tracking patterns of services by health plan or eligibility
group, identifying providers serving special needs populations, and
tracking the movement of high-cost patients among health plans.
Encounter data could also be analyzed to reveal patterns of under- or
overutilization. Although linkig such patterns to quality of care in all
cases is limited by the lack of recognized standards, patterns of service
use can reveal access problems. For example, Arizona officials analyzed
encounter data and found very low use of dental services among all
beneficiaries. The access problem was resolved when state officials
removed the requirement that beneficiaries receive a referral from their
primary care provider before obtaining dental care.
Encounter data for Oregon's disabled enrollees are just becoming
available for analysis. 5 As a result, no studies are yet under way. However,
state officials listed the following as possible uses for encounter data
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