Medicare/Medicaid

SDI, Plymouth Meeting, Pa., a leading provider of innovative health care data products and analytic services, is the source for data contained in the Public Payer Digest. SDI uses rigorous survey methodology in producing reports and validating data.

This Digest features HMO information gathered by mail and telephone surveys between February and June 2009. Mail questionnaires are refined every year to reflect changes in industry operations, and include questions specific to the Medicare and Medicaid populations.

Managed care data in this Digest derive from a census of the HMO industry. HMO and hospital utilization data, gathered from state health licensing agencies, federal government sources and telephone or mail surveys, are effective as of December 31, 2008. When data were not available from all plans, a smaller sample was used. Hospital procedural/diagnoses discharge data are from the SDI National Patient Profile™, while prescription metrics are from SDI's Vector One®: Payer platform.

Medicare and Medicaid managed care information was gathered from operating HMOs and other types of managed care organizations recognized by the Centers for Medicare & Medicaid Services (CMS). SDI used information from CMS's 2008 Medicaid Managed Care Enrollment Report to capture the total number of Medicaid recipients in managed care programs. The Medicaid demographic data shown are as of midyear 2008.

SDI often telephones MCOs to validate and clarify information obtained from them. SDI also compares its data with those published in other sources, including trade associations in the managed care industry, periodicals and journals, and state regulatory agencies. SDI does this to ensure that its database includes an accurate account of Medicare and Medicaid managed care.

For the first time, disease data included in this report were generated using health care professional and institutional insurance claims. SDI also gathered data on prescription activity from the National Council for Prescription Drug Programs (NCPDP). These data represent the sampling of prescription activity from a variety of sources, including retail chains, mass merchandisers and pharmacy benefit managers, and come from a near census of more than 59,000 pharmacies in the U.S. Cash, Medicaid, and third-party transactions are tracked.

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Hospital Inpatient

The SDI Hospital Procedure/Diagnosis (HPD) Database contains an extensive set of hospital inpatient discharge records, including actual diagnoses and procedures data for about 75% of all discharges nationwide. The HPD inpatient database reports the numbers of procedures performed on patients discharged from a hospital. Most states report at least nine diagnostic and six procedure codes from each discharge record.

SDI uses Medicare procedure counts and additional hospital-level information to estimate procedure counts for the remaining 25% of discharges-the non-Medicare hospital discharge information in non-reporting states. The hospital inpatient data provided in the Public Payer Digest are current as of end-of-year 2007.

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Long-Term Care

The definition of nursing homes included in the Public Payer Digest encompasses only freestanding long-term care facilities providing skilled and unskilled care. No long-term care facilities attached to hospitals or long-term care or sub-acute beds within hospitals are included, as they are typically licensed by states as part of hospitals and their beds are counted as hospital beds. Also, no intermediate care facilities or mental retardation (ICF/MR) homes are included in the nursing home data in this Digest. These data were effective as of end-of-year 2008.

Hospital-based SNF data for this report are based on information from the SDI Hospital Profiling Solution©. Hospital utilization data were compiled between midyear 2007 and midyear 2008, and were effective as of December 31, 2007.

These data were gathered from state health licensing agencies, federal government sources and telephone or mail surveys. Hospital procedural/diagnosis discharge data are from the SDI National Patient Profile©, and ALF data are from the SDI Healthcare Market Index©. Updated LTCPP data are from the SDI Long-Term Care Pharmacy Provider Profiling Solution©.

Detailed information on corporate affiliations was used to compile the profile of the home care industry. This information is based on data from the SDI Home Health Market/Chains Profiling Solution©. Data were effective as of end-of-year 2008. All identified home health care agencies and home health care chains are contacted annually by telephone and by mail for survey information.

SDI compares its data with those gathered by other organizations, including trade associations, periodicals and journals, state licensing information and the Centers for Medicare and Medicaid Services (CMS).

A final review process takes place, before and during production of this report, between SDI and Forte Information Resources LLC, Denver, Colo., a leading provider of publishing and communications products and services for the health care industry.

Sanofi-aventis, as sponsor of this report, maintains an arm's length relationship with the organizations that prepare the Digest and carry out the research. The desire of sanofi-aventis is for the Care Digest Series® to be completely independent and objective.

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