Best Practices in Using Medicare Advantage Encounter Data for Healthcare Research
In 2018, the Centers for Medicare & Medicaid Services (CMS) first made encounter data submitted by Medicare Advantage (MA) plans available to researchers. Experts have raised concerns that these data may not be appropriate for measuring healthcare utilization or making comparisons between MA and traditional Medicare.
CMS has collected encounter data since 2012. Unlike claims submitted by providers for reimbursement, encounter data are not solely used for payment. Beginning in 2016, select encounter data are used to risk adjust plans’ payments for the health of their enrollees. Yet, concerns that the data are incomplete and sufficiently different from claims warrant caution in analysis and making comparisons to traditional Medicare.
This study, conducted by BRG with support from the Elevance Health Public Policy Institute, adds to our understanding of MA encounter data. BRG examined the importance of preparing the data for analysis and compared the data to benchmarks of service utilization to assess its completeness.
Related Public Policy Research
Using Encounter Data in Medicare Advantage Risk Adjustment
Using encounter data to recalibrate the MA risk adjustment model could make risk scores for providing care in MA more accurate, but the implications for the broader MA system are unclear.
Understanding the Medicare Advantage Program
Medicare Advantage (MA) plans provide enrollees a valuable alternative to Medicare fee-for-service (FFS) by offering out-of-pocket cost protections, additional benefits, and innovative strategies for care management and coordination.