209013 TBI prevalence, service utilization and costs among Medicaid beneficiaries in Michigan

Tuesday, November 10, 2009

Cheribeth U. Tan-Schriner, PhD , Center for Data Management and Translational Research, Michigan Public Health Institute, Okemos, MI
Clare Tanner, PhD , Center for Data Management and Translational Research, Michigan Public Health Institute, Okemos, MI
Debera H. Eggleston, MD , Office of Medical Affairs, Medical Services Administration, Michigan Department of Community Health, Lansing, MI
Medicaid data have the potential to provide critical information on the prevalence, characteristics, service provision, and cost of care of patients with specific injuries or health conditions. This retrospective study first analyzed Michigan Medicaid data from FY2002-06 of patients with a TBI claim. All TBI and non-TBI claims for a subgroup of TBI hospitalized cases were further analyzed to determine the TBI-related services and costs over time.

From FY2002-06, a total of 129,153 Medicaid enrollees in Michigan received TBI-related services. Only 12% had a TBI-related hospitalization while most incurred services in emergency departments or outpatient settings. Males predominated among the more severe TBI cases, while both sexes were almost equally represented in the non-hospitalized population. Among the less severe cases, 51% were children under 15. 43% of hospitalized cases had diagnoses indicating skull fracture, laceration/contusion of the brain, and/or brain hemorrhage. Over 90% of strictly ED cases had diagnoses of unspecified head injury, unspecified brain injury, and/or concussion; and 50% underwent a CT scan. Medicaid FFS paid out $19.8 million annually for TBI-related services, of which 90% were incurred by more severe cases. Longitudinal analysis of hospitalized cases showed a high number of re-hospitalizations (49%) and ED visits (58%) within two years following the initial TBI-related hospitalization.

Cost estimations presented in the study are based only on the FFS claims since the MHP contracts are capitated and therefore bills are not submitted for each service. The actual cost of TBI to Medicaid is certainly much higher.

Learning Objectives:
Participants in this session will be able to (1) describe the magnitude and characteristics TBI cases among the Medicaid population as reported through paid claims for services, (2) identify TBI-related services and procedures utilized by Medicaid beneficiaries, (3) discuss the immediate as well as cost of care for and service use by an individual with TBI over time, and (4) identify the benefits and limitations of using Medicaid data for conducting health service research.

Keywords: Traumatic Brain Injury, Medicaid

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been involved in several research and data analysis projects in the areas of traumatic brain injury and long-term care for the past 10 years
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.