HCRS Helps Policymakers Understand and Predict Healthcare Use

During the past year HCRS has developing an ongoing relationship with RTI International, an independent not-for-profit research institute that does important work for the Agency for Healthcare Research and Quality (AHRQ) and other Federal healthcare agencies. We have supported RTI in two research studies activities.

• Medical Expenditure Panel Survey (MEPS) coding. MEPS is a large scale survey of families and individuals, their medical providers, and employers across the United States that is the Federal government’s go-to source of information on the cost and use of health care and health insurance coverage. RTI’s role is to analyze raw data from the surveys to create the information that policymakers need. HCRS helps in the analysis by turning written descriptions of care from doctors and hospitals into medical codes, making it possible for biostatisticians to aggregate and manipulate the data.  The data are then shared with government and other health policy researchers such as the Kaiser Family Foundation. The Kaiser Family Foundation finding illustrated at right, like many such findings in non-government organization policy research, is based on MEPS data.
•  Medicare Advantage Predictive Model DRG mapping. Federal officials use a mathematical model to predict future use of health care services in Medicare managed care plans (“Medicare Advantage”).  The prediction becomes part of the payment the managed care plan receives for taking care of each member. The current model was built using ICD-9 codes. We were asked to make the model accommodate ICD-10 coding by “backward mapping” ICD-10 coded data to ICD-9.