"Bright Spots" are stories about successes. Originally used as a reporting tool, we are sharing them now to highlight the great work being done by our staff and our partners. This month's Bright Spot was written by Christine Kemp, P² Collaborative’s Community Health Improvement Coordinator.
Bright Spot: Medicaid Claims Analysis Using Salient Software
Can you provide us with some background?
The P² Collaborative values data services as an essential component of the product portfolio we provide to our partners. Our assistance is often sought to help organizations in the community assess the health needs that exist and develop ways to measure and track improvement strategies, particularly in the realm of healthcare utilization and expenditures. Many of these organizations are limited in their technical resources to fully assess the true impact of the important work they do.
What problem or issue were you trying to solve?
One of the more pressing concerns in the realm of data services was the lack of access to timely, reliable data about healthcare utilization and expenditures in the community, particularly Medicaid claims. Previously, organizations such as the P² Collaborative would have to complete a lengthy Medicaid claims request process from the New York State Department of Health (NYSDOH) fraught with bureaucratic hurdles to access data which could be up to three or four years old. Therefore, it was difficult to track more real-time effects of innovations in healthcare delivery on the populations served, especially in the safety-net Medicaid member population.
What successes have you had so far? What results?
In an unprecedented act of data transparency, NYSDOH made available access to real-time analysis of Medicaid claims through expanding its license of the Salient software system, which is used by the health department to accurately manage its claims data in the state Medicaid Data Warehouse (MDW). Through licensure, P² Collaborative would act as a legal subsidiary of NYSDOH with the same level of real-time access to Medicaid claims data that NYSDOH had, with an additional protection of being unable to view the claims at a PHI level. Through financial support of the Health Foundation for Western and Central New York, P2 was granted this license in January 2014.
What were the greatest challenges? How did you overcome these?
The greatest challenge in this process was learning how to understand the vast expanse of the Medicaid claims “universe”. Akin to learning another language, common knowledge about aspects of healthcare innovation and program delivery now had to be translated into the way in which it was conceptualized via the information contained on a Medicaid claim form. Extensive time was spent testing out sample analyses in the system, and this help tremendously in building familiarity and comfort.
Describe the outcomes, value, results, and impact of this project.
Two P² staff members and a business associate from Buffalo State College attended two sessions of two days’ worth of Salient software training at the MDW. These sessions were extremely valuable and taught beyond the software to shed light on the many changes that are part of NYSDOH’s Medicaid Redesign Team initiatives.
Having access to Medicaid claims data in real time – new information is added to the MDW weekly – will prove to be an invaluable resource as Medicaid innovation becomes more prevalent in the Western New York region.
Was there an “ah-a” moment or lesson learned?
One of the more surprising elements of the Salient training process was the recognition that Medicaid claims are not as standardized as one may think. Pursuant to the “garbage-in garbage-out” philosophy, ease of retrospective analysis is directly related to the completeness and standardization of prior claim submission across the hundreds of thousands of Medicaid billing entities across the state.
What advice do you have for others facing similar problems?
If you encounter barriers to getting the knowledge you know you need – it never hurts to push (and push) for those barriers to be taken away.