Uses and Limitations of Medicare Advantage Encounter Data

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Summary

In a recent post on the Health Affairs Blog, we examine the potential uses and limitations of Medicare Advantage (MA) encounter data.

CMS defines encounter data as the data necessary to characterize the context and purposes of each item and service provided to a Medicare enrollee by a provider, supplier, physician, or other practitioner.

Policy analysts and researchers have suggested 3 major uses of encounter data:

  1. Understanding program costs
  2. Comparing the quality of MA relative to fee-for-service Medicare
  3. Gaining insight into provider behavior and use patterns

In the post, which was co-authored by James Michel of Better Medicare Alliance, we discuss how encounter data compares with other data sets available to researchers and how key limitations and challenges with the data will dictate its use. We find that while there is significant potential for encounter data to offer new insights into MA, limitations inherent in the data mean that it may not yet be sufficient to fully evaluate plan performance or beneficiary outcomes.

Read the full Health Affairs Blog post.

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