Completeness and quality of comprehensive managed care data compared with fee-for-service data in national Medicaid claims from 2001 to 2019

Abstract

Objective: To evaluate the completeness and quality of Medicaid comprehensive managed care (CMC) data in national MAX/TAF research files.

Study setting and design: This observational study compared CMC with fee-for-service (FFS) enrollee data in 2001-2019 Medicaid MAX/TAF inpatient, outpatient, and pharmacy files. Completeness was assessed as the proportion of enrollees with any claim and mean claims per enrollee with any claim. Quality was assessed as the proportion of inpatient and outpatient claims with primary diagnosis and procedure codes and the proportion of prescription drug claims with fill dates, National Drug Codes (NDC), days supplied, and quantity dispensed. Acceptable ranges for each study measure were defined as the national FFS mean ± 2 standard deviations.

Data sources and analytic sample: We analyzed secondary data on 45 states from 2001 to 2013 (MAX) and 50 states and DC from 2014 to 2019 (TAF). The sample included adults aged 18-64 with continuous calendar-year enrollment who were eligible for full Medicaid benefits and ineligible for Medicare. We determined CMC enrollment rates and assessed data completeness and quality among state-years with ≥10% CMC penetration, comparing CMC with FFS enrollees.

Principal findings: Across 891 state-years, 194,364,647 enrollees met inclusion criteria. Of 540 state-years (60.6%) with ≥10% CMC enrollment, CMC data were largely comparable to national FFS distributions for all inpatient (n = 430; 79.6%), outpatient (n = 467, 86.5%), and prescription (n = 459, 85.0%) completeness criteria and for all inpatient (n = 449, 83.1%), outpatient (n = 511, 94.6%), and prescription (n = 528, 97.8%) quality criteria. Overall completeness (92.3%) and quality (84.6%) improved substantially by 2019.

Conclusions: Completeness and quality of CMC data were largely comparable to FFS data, with increasing state-years meeting criteria over time. Further research on national Medicaid populations should assess and address differences in data completeness and quality by plan type across states, over time, and in relation to specific study samples and measures of interest.

Keywords: Medicaid; data accuracy; data quality; fee‐for‐service plans; managed care programs.

FIGURE 1

Overall comprehensive managed care (CMC) data completeness and quality compared with fee‐for‐service (FFS) claims. Completeness measures were defined as: (1) the percentage of enrollees with any inpatient, outpatient, or prescription claim and (2) the mean number of inpatient, outpatient, and prescription claims per enrollee with any claim. Quality measures were defined as: (1) the percentage of inpatient/outpatient claims with a primary diagnosis and procedure code and (2) the percentage of prescription claims with a fill date, National Drug Code (NDC), days supplied, and quantity dispensed.

FIGURE 2

Proportion of analyzed states with low‐concern comprehensive managed care (CMC) data by year, 2001–2019. Analyzed states included only those with ≥10% CMC enrollment. The proportion of all states with either low‐concern CMC data or low CMC enrollment (<10%) is shown in Figure A15. Mean data completeness and quality were calculated as the weighted average across the study period, where weighting reflects the number of state‐years included in the analyses.