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Data Needs Follow Up 

 

Dear Potential Care Coordination Partner:

As the New Year begins and Illinois’ Care Coordination Innovations Project prepares to release its first solicitation, we are working hard to prepare data for prospective Care Coordination Partners to use in designing better coordinated healthcare services.

The Care Coordination Innovations Project will support the creation of Coordinated Care Entities (CCEs) and Managed Care Community Networks (MCCNs) that will ally healthcare organizations across the spectrum of patient needs. HFS foresees that the move to coordinated care will increase healthcare quality and reduce costs through innovative, evidence-based care coordination strategies. We understand that data is essential to the development of such strategies. We will start providing the data after the release of the January 2012 solicitation.

HFS will provide data tables (‘a data set’) based on organizations’ specific requests for information on clearly defined Medicaid-eligible populations within the state of Illinois. We will ask organizations to identify a number of key attributes of target populations and healthcare providers, including geographical region, age, eligibility, and/or medical specialty, before they receive data. The data will be pulled from a state-wide database of recipient enrollment data, provider data, and adjudicated claims for Medicaid services provided from January 1, 2010, to December 31, 2010.

Data will be provided in two phases. During the first phase, HFS will provide information on Medicaid populations, including data on demographic characteristics and county and zip code of residence; recipients’ public aid categorizations, including dual, pediatric, and waiver eligibilities; and service use patterns. Information on healthcare providers will include their location (specific to county and zip code), identifiers, and reimbursement type, as well as the services that they have provided to recipients in the experience period. The data set will also include medical diagnosis flags representing broad categories of affected body systems and disease severity, as based on Chronic Illness and Disability Payment System (CDPS) standards. In Phase II, HFS will add detailed information on long-term care, emergency department usage, inpatient hospitalizations, and prescription pharmaceutical claims. During the second phase, medical diagnoses and inpatient service types as described by Diagnosis Related Group (DRG) and other codes will also be available.

The data will not include populations not enrolled in Medicaid. Enrollees who have not accessed any services or submitted any adjudicated claims during the experience period will be shown without medical diagnosis flags and medical service data. Special subpopulations defined by non-medical attributes (such as prisoners or homeless persons) are also not available as identifiable populations. Data for the city of Chicago will be available via a clustering of all zip codes that fall entirely within the city boundaries, but is not a free-standing unit of analysis available for request. While the data will exclude directly identifiable patient information, the data will not meet Health Insurance Portability and Accountability Act (HIPAA) standards for fully ‘de-identified’ data and prospective partners wishing to access data must sign a Data Use Agreement compliant with HIPAA rules on limited data sets.

Prospective Care Coordination Partners can submit data requests when they submit a Letter of Intent (LOI) following the release of the January solicitation. Potential partners will also have an opportunity to describe technical assistance needs in an attachment to their LOI. In the months prior to the Request for Proposal (RFP) submission deadline, a series of seminars and Webinars will be available to assist prospective partners in understanding data analysis (as well as management and policy issues) relevant to their proposals.

Use of HFS-provided data is not required for the LOI or the final proposal, but is likely to contribute significantly to the impact of the funded CCE or MCCN by allowing healthcare organizations to predict patient needs. Use of additional, non-HFS-provided healthcare data is permitted in LOIs and final proposals, given the aim of developing healthcare coordination for a clearly defined Medicaid-eligible population within the state of Illinois.

Finally, a word of thanks. The content and format of the data set has been developed after reviewing organizations’ responses to our request for information on potential data needs this October. HFS is grateful for a wide range of input from over 100 healthcare and community organizations. These comments were very useful in the data set design.

We hope you will find access to data and technical assistance useful in developing your proposal. We welcome your questions and comments on this process.