Medicaid is a government insurance program for families and individuals with low income and resource. The Medicaid program is directed by the Centers of Medicare & Medicaid Services (CMS). Recent policy changes in this program are implemented under the Patient Protection and Affordable Care Act (2010). Because Medicaid provides care for about 70 million children and low income adults, understanding and managing the on-going health policies for people enrolled in this program can be the catalyst of change to a more efficient, effective and equitable healthcare system.
Medicaid Claims Data - CMS Research Identifiable Files (RIF)
We have acquired Medicaid files from Centers for Medicaid and Medicare Service (CMS), which contain Medicaid claims data including Personal Summary File, Inpatient File, Other Therapy File and Prescription File. We have available the MAX files from 2005 to 2009 for 14 states (GA, NY, PA, TN, NC, MN, CA,FL, AL, MS, SC, LA, AK, TX) and all 2010-2020 MAX & TAF files available for all states. We have implemented a data environment to protect, manage and analyze these data while complying with HIPPA and CMS data safeguard regulations. We have also implemented the infrastructure data backbone to petition the data into a relational database allowing fast queries from this large source of information. The research group uses these data to derive models to understand and manage the complexity of the Medicaid system.
Resources
What We Do - Selected Projects
Dental Care Access for Children in the United States:
Children with untreated dental caries experience adverse outcomes impacting their overall health, school absence, and emergency care. Thus Assessing dental care access for children has been key to oral health policy making, specifically, in understanding oral health disparities. In this study, we evaluated dental care access at the community level, using extensive data and mathematical modeling that accounted for uncertainty in dental care supply and demand. The access modeling was used to draw inferences on the impact of increasing dentists’ availability in public insurance programs. The access analysis was applied to 48 states and the District of Columbia. We complemented the results with state reports and a web data portal, providing access measures and maps with downloadable data.
Engagement in psychosocial services among youth
Prior studies have identified low rates of engagement in mental health (MH) services among Medicaid-enrolled children in clinic settings. Yet, little is known about whether the delivery of in-home MH care (where the clinician travels to the child’s home) improves engagement for this population. This study examines the association between the delivery of in-home psychosocial care and engagement in care among Medicaid-enrolled youth.
Opioid Utilization After Cardiac Surgery Hospitalization in the Pediatric Population
Pain management for children after cardiac surgery relies heavily on narcotic drugs. Wide variation in opioid prescribing in pediatrics has resulted in over- and under-prescribing, racial disparities, deleterious neurodevelopmental effects, and development of narcotic dependence. The focus of this research is to determine the variation of outpatient opioid prescribing across the United States in post-operative pediatric cardiac patients.
Adherence to Recommended Care Guidelines for Preschool-Aged Children Diagnosed with ADHD
Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood. Clinical guidelines recommend behavior therapy as the first-line treatment for preschool-aged children with ADHD. The objective of this study is to evaluate longitudinal patterns of services received by Medicaid-enrolled children aged 2–5 years with ADHD.
Provider-level Caseload of Psychosocial Services for Children
Although it is a recommended treatment, many Medicaid-insured children with mental health conditions do not receive psychotherapy services, in part due to low provider Medicaid participation. Existing studies of psychotherapy supply, however, do not distinguish the supply available to the Medicaid-insured. In this project, we estimated the annual caseload of providers, practices, and clinics for psychosocial services (including psychotherapy) to the Medicaid-insured.
Comparing Health Outcomes between Infants Born to Adult and Teen Mothers
The focus of this research is on the health and wellbeing of infants during the first year of life, comparing health outcomes of infants born to teenage mothers to those born to adult mothers nationwide.
Treating Medicaid-insured Children with Pediatric Feeding Disorders
Intensive multidisciplinary intervention (IMI) represents a well-established treatment for pediatric feeding disorders (PFDs), but program availability represents an access care barrier. We develop an economic analysis of IMI for weaning from gastronomy tube (G-tube) treatment for children diagnosed with PFDs from the Medicaid programs’ perspective, where Medicaid programs refer to both fee-for-service and managed care programs.
Profiling Care Pathways for Pediatric Asthma
Care for pediatric asthma is complex because of its differential impact depending on several confounding factors including age, provider of care, severity of the condition, access to care, and environment. There are different actions of asthma care, from doing nothing, to obtaining care from a primary care physician (PCP) or asthma specialist, or simply visiting emergency departments (ED) when severe. In this research project, our overarching objective is to describe underlying asthma care pathways for children in the Medicaid program. For each pathway, we evaluate utilization and cost to suggest potential policy and network interventions.
Predicting Health Costs and Variations Geographically
We focus on predictive health at the system level, where we study health costs and variations in costs geographically for the Medicaid population. Such variation in cost (particularly when high), can point to behaviors at the patient, provider, or healthcare infrastructure levels that can be targeted for future improvements. Our overall research question is to what extent costs vary geographically, and what factors are associated with increased costs in the system?
Publications
Published by the Health Analytics Group
Fundora, M.P., Kalicheti, M., Zhao, G., Maher, K., Serban, N. (2024) "Opioid Utilization After Cardiac Surgery Hospitalization in the Pediatric Medicaid-insured Population", Journal of Pediatrics, vol 265, 113809.
Serban, N., Ma, S., Yu, J., Anderson, A., Pospichel, K., Solipuram, S., Tomar, S. (2024) "Dental Care Access for Children in the United States", Journal of the Public Health Dentistry, doi: 10.1111/jphd.12635
Girodano, N.A., Zhao, G.., Kalicheti, M., Schenker, M.L., Wimberly, Y., Rice, C.W., Serban, N. (2024) "Opioid Utilization After Trauma Hospitalization in the Medicaid-insured Adults", Frontiers in Public Health, vol 12.
Kim, D., Cuffe, S.P.,Naylor, M.W., Keskinocak, P., Serban, N. (2024) "Adherence to Clinical Practice Guidelines and FDA Approved Psychotropic Medication to Treat Medicaid-insured Children with ADHD", Psychiatric Services, 75(11):1151-1156.
Ma, S., Serban, N., Dehaghnian, A., Tomar, S. (2023), "The Impact of Dentists’ Availability in Delivering Dental Care in Florida Elementary Schools", Journal of Public Health Dentistry, 83 (1), Pages 60-68.
Cummings, J., Shellman, M., Stein, B., Asplund, J., Lin, H., Serban, N. (2022) "Association between in-home services and engagement in psychosocial services among Medicaid-enrolled youth", Journal of the American Academy of Child & Adolescent Psychiatry, 61(11), pages 1351-1361.
Serban, N, Anderson, A., Oberst, G., Edupuganti, N., Ramachandran, R., Solipuram, S., Lu, T. (2022), "Assessment of Dentist Participation in Public Insurance Programs for Children in the US", JAMA Open Network, 5(7):e2221444.
Serban, N., Ma, S., Pospichel, K., Wang, L. (2022) "Evaluating Access to Pediatric Dental Care in U.S. Southeast States with Implications for Policy Making", Journal of the American Dental Association, Apr;153(4): 330-341.e12.
Curry, S., Serban, N. (2021) "Accounting for uncertainty in policy decision making: Improving access to pediatric dental care", Health Services Research, 56(2):214-224.
Pujol, T., Serban, N., Swann, J., Kottke, M. (2021) "Assessing Health and Wellness Outcomes of Infants Born to Adolescent Mothers", Journal of Maternal and Child Health, 25(5):821-831.
Serban, N., Harati, P., Munoz Elizondo, J.M., Sharp, W. (2020) "An Economic Analysis of Intensive Multidisciplinary Interventions for Treating Medicaid-insured Children with feeding disorders", Medical Decision Making, vol 4, issue 5.
Harati, P., Cummings, J., Serban, N. (2020) "Provider-level Caseload of Psychosocial Services for Medicaid-Insured Children", Public Health Reports, 135(5):599-610.
Smith, A., Serban, N., Fitzpatrick, A. (2019), Asthma Prevalence Among Medicaid-enrolled Children, Journal of Allergy and Clinical Immunology: In Practice, 7(4):1207-1213.
Serban, N. (2019). Healthcare System Access: Measurement, Inference and Intervention, John Wiley & Sons, NJ.
Lee, I., Monahan, S., Serban, N., Griffin, P., Tomar, S. (2017) Estimating the Cost Savings of Preventive Dental Services Delivered to Medicaid-Enrolled Children in Six Southeastern States, Health Services Research, in press.
Pujol, T., Serban, N., Swann, J., Kottke, M. (Accepted August 2018) Determining the Uptake of CDC MEC Guidelines for Contraceptive Usage of Chronically Ill Women, Preventive Disease Control, in press.
Hilton, R., Zheng, Y., Serban, N.(2018) Modeling Heterogeneity in Healthcare Utilization Using Massive Medical Claims Data, Journal of the American Statistical Association, 113(521), 111-121.
Johnson, B., Serban, N., Griffin, P., Tomar, S. (Submitted March 2018) Does Silver Diamine Fluoride Reduce Caries Treatment Expenditures in US Children? Journal of Public Health Dentistry, under 2nd review.
Zheng, Y., Serban, N. (2018) Clustering the Burden of Pediatric Chronic Conditions in the United States using Distributed Computing, Annals of Applied Statistics, Vol. 12, No. 2, 915-939.
Gentili, M., Serban, N., Harati, P., O'Connor, J., Swann, J. (2018) Quantifying Disparities in Accessibility and Availability of Pediatric Primary Care with Implications for Policy, Health Services Research, 53(3), 1458-1477.
Moran, A., Serban, N., Danielson, M., Grosse, S. (Accepted August 2018) Assessing Adherence to Evidence-based Care Practices for Preschool Children Diagnosed with ADHD in the Medicaid System, Psychiatric Services, in press.
Serban, N., Bush, C., Tomar, S. (2018) Medicaid Capacity for Pediatric Dental Care. Journal of the American Dental Association, 150(4), 294-304.
Serban, N., Tomar, S. (2018) ADA Health Policy Institute’s Methodology Overestimates Spatial Access to Dental Care for Publicly Insured Children, Journal of Public Health Dentistry, Vol 78, Issue 4, 291-295.
Johnson, B., Serban, N., Griffin, P., Tomar, S. (2017) The Cost-Effectiveness of Three Interventions for Providing Preventive Services to Low-Income Children, Community Dentistry and Oral Epidemiology, 45(6), 522-528.
Hilton, R., Zheng, Y.R., Fitzpatrick, A., Serban, N. ( 2017) Uncovering Longitudinal Health Care Behaviors for Millions of Medicaid Enrollees: A Multistate Comparison of Pediatric Asthma Utilization, Medical Decision Making, 38(1):107-119.
Cao, S., Gentili, M., Griffin, P., Griffin, S., Serban, N. (2017). Disparities in Access to Preventive Dental Care between Publicly and Privately Insured Children in Georgia. Preventive Disease Control, 14:170176.
Harati, P., Gentili, M., Serban, N. (2016) Projecting the Impact of the Affordable Care Act Provisions on Accessibility and Availability of Primary Care for the Adult Population in Georgia, Journal of the American Public Health, 106(8):1470-6..
M. Nobles, N. Serban, J. Swann (2014), Spatial Accessibility of Pediatric Primary Healthcare: Measurement and Inference, Annals of Applied Statistics, 8 (4), 1922-1946.
Griffin, P.M., Lee, H., Scherrer, C., Swann, J.L. (2014), “Balancing Investments in Federally Qualified Health Centers and Medicaid for Improved Access and Coverage in Pennsylvania”, Health Care Management Science, Vol. 17, pp. 1-17.
Rouse, W.B., Serban, N. (2014). Understanding and Managing the Complexity of Healthcare, MIT Press.