Hi all,
Bernie's question (8:55 a.m. in the thread below) -- "Medicaid is sometimes
capitated and sometime not. Is this information available from the Capricorn
sites." -- may be divided into two questions:
1) What level of granularity and accuracy is available in the payor
(and/or "financial class") fields in each CAPriCORN institution's source
database (EHR or related repository)?
2) What level of granularity might each institution be willing to provide
for our city-wide mapping project?
In my experience, even the most granular values stored by an institution in its
EHR/repository are not always clear-cut as to whether the patient's Medicaid
coverage was capitated or not.
Some records are clear-cut: e.g., "ILLINICARE HEALTH PLAN MEDICAID MCO" is
Medicaid managed care.
Some records are clear-cut as long as one knows the local environment well:
e.g., "NEXTLEVEL HEALTH MCO" is Medicaid managed care even though it does not
say the word "Medicaid."
But some records have insurance labels that are vague (intentionally or
unintentionally) as to capitation: e.g., "MEDICAID IL - STATUS PENDING." Also,
values are sometimes truncated, etc.
Also some Medicaid records, in my view, should be placed into a third category
(an "other" category): e.g., "MEDICAID SPENDDOWN."
Some health care institutions have financial/reimbursement offices and systems
that may have more detailed information than the EHR/repository does about the
insurance status for each encounter, but those separate systems (if not already
being used in the ETL processes) would require substantial work (and local
approvals) to access.
thank you,
marc
________________________________
From: Kho, Abel <[email protected]>
Sent: Friday, January 20, 2017 1:25 PM
To: Bernard Black; Dan Connolly; [email protected]
Cc: Sparapani, Rodney; Marc Brian Rosenman; Laura Jarmila Rasmussen-Torvik;
Theresa L. Walunas
Subject: Re: Medicaid types
I'm going to pull in Theresa who works most closely with Medicaid office in our
group.
________________________________
From: Bernard Black <[email protected]>
Sent: Friday, January 20, 2017 1:24 PM
To: Kho, Abel; Dan Connolly; [email protected]
Cc: Sparapani, Rodney; Rosenman, Marc (NU); Rasmussen-Torvik, Laura (NU)
Subject: RE: Medicaid types
Abel and Marc: March may be able to tell us for Northwestern, but what do we
know about Medicaid in Illinois?
In some states, Medicaid is all/essentially all capitated, in some it is mostly
fee for service, in some states, there is more variance.
What is known about Illinois Medicaid?
Bernie
*************************************************************
Bernard S. Black
Chabraja Professor, Northwestern University
Pritzker Law School and Kellogg School of Management
375 East Chicago Ave., Chicago IL 60611
[email protected]<mailto:[email protected]>
tel: law: 312-503-2784<tel:312-503-2784>; Kellogg
847-491-5049<tel:847-491-5049>; cell: 847-807-9599<tel:847-807-9599>
papers on SSRN at:
http://ssrn.com/author=16042<https://urldefense.proofpoint.com/v2/url?u=http-3A__ssrn.com_author-3D16042&d=CwMFAw&c=yHlS04HhBraes5BQ9ueu5zKhE7rtNXt_d012z2PA6ws&r=6iGCNUxWN1otnhD8dl2Tsa4-b4Xql3efbfa6ed3bY3Y&m=v8CmeixW3DFjVZPz_nynJ2PnbE2mUa1PAeXcUMGSvlo&s=w43Vp-IBPID4Jt93MlroqwI-nXEdczDIHxCXmJHUrQ0&e=>
************************************************************
From: Kho, Abel [mailto:[email protected]]
Sent: Friday, January 20, 2017 10:27 AM
To: Bernard Black <[email protected]>; Dan Connolly
<[email protected]>; [email protected]
Cc: Sparapani, Rodney <[email protected]>; Marc Brian Rosenman
<[email protected]>
Subject: Re: Medicaid types
I don't know the answer to this but I suspect Marc may be able to know this
based on the work he is doing now to get a handle on the diversity of insurance
types.
________________________________
From: Bernard Black
<[email protected]<mailto:[email protected]>>
Sent: Friday, January 20, 2017 8:55 AM
To: Dan Connolly; [email protected]<mailto:[email protected]>
Cc: Sparapani, Rodney; Rosenman, Marc (NU); Kho, Abel
Subject: Medicaid types
Medicaid is sometimes capitated and sometime not.
Is this information available from the GPC sites? It would be useful to have
this, if knowable.
Abel: Same question for the Capricorn sites.
Capitated plans can be called "managed care", or "health maintenance
organization (HMO)" and perhaps other names.
Thank you,
Bernie
*************************************************************
Bernard S. Black
[email protected]
Nicholas J. Chabraja Professor, Northwestern University
Pritzker School of Law
Institute for Policy Research
Kellogg School of Management, Finance Dep't
Law School: 375 East Chicago Ave., Chicago IL 60611
IPR: 2040 Sheridan Road, Evanston IL 60208 (my office: 2046 Sheridan)
Kellogg: 2001 Sheridan Road, Evanston IL 60208
tel: law: 312-503-2784; IPR: 847-491-8730; cell: 847-807-9599
papers on SSRN at:
http://ssrn.com/author=16042<https://urldefense.proofpoint.com/v2/url?u=http-3A__ssrn.com_author-3D16042&d=CwMFAw&c=yHlS04HhBraes5BQ9ueu5zKhE7rtNXt_d012z2PA6ws&r=UogPJ7VYoAeiC8NNwyY5AxLx8QgaRiMcicgAv7oi3tc&m=zsaQNqx0nXg7eX_PveOai99CBTHNK0pHQ1S0iO27DoY&s=5l05-hPTfi2lqIPL2Uo1XlY80idKfmuD0zH19n07m98&e=>
************************************************************
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