When NYU Wagner researchers wanted to find out if noise from planes taking off from La Guardia Airport affected the well-being of people living in the neighborhoods below, they knew exactly where to look for clues: the huge data set what is the New York State Medicaid claim record. Through a unique contract with the state health department, Wagner researchers have full, yet carefully controlled, access to Medicaid information for more than 7.3 million New Yorkers, who can be leveraged to better understand how policies, public services, and social conditions affect health—and how and why residents seek or avoid care.
In this case, the data revealed that people living below La Guardia take-off trajectories suffered from increased diagnoses of cardiovascular disease, mental health/addiction emergencies and even insomnia, according to the recently published analysis. co-authored by Sherry Glied, health economist and dean of Wagner. . She and the study’s co-authors are among a small but growing number of academics making the most of the school’s one-of-a-kind Medicaid data initiative led by Professor Wagner of Health Policy. and public service John Billings with Charles Neighbors, associate professor in the Department of Population Health at NYU Grossman School of Medicine. Billings laid the groundwork for this project after years of working with Medicaid data to identify the most frequent users of hospital emergency departments and how to reduce costly recidivism. (His seminal study came out in 2009.)
Like divers probing the depths of the ocean, a highly skilled team of HEAL analysts are helping Billings and Neighbors probe this reservoir of relevant data in response to requests from the wider research community, policy makers and care administrators. health. As part of the initiative, Wagner is a research center for the Robert Wood Johnson Foundation’s “Culture of Health” project, which examines how education, housing, transit, public services and d Other social determinants can affect the health of communities and individuals.
New York University News spoke with Glied about the Medicaid Data Initiative and what she called “virtually limitless” potential for distilling insights into the challenges facing New Yorkers — such as the potentially deleterious roar of ascending planes — and the policies needed to make life a little, or even a lot, easier.
How did Wagner gain full access to Medicaid’s massive claims file?
There is a story to this. Professor Billings had been working with Medicaid data for a very long time when he won – with the support of New York State Health Commissioner Nirav Shaw – a grant from the State Health Foundation to encourage wider access looking at state Medicaid claims. – meeting data. A data use agreement with the state health department gave Billings direct access to the Medicaid data warehouse, and an array of possible research projects was identified. Then, in 2016, Billings joined James Knickman, a former professor of population health at NYU Langone, to launch the Health Evaluation and Analytics Lab, or HEAL, to push the effort forward.
How are strict state confidentiality requirements met?
HEAL has designed its procedures so that very few people actually touch this data – a very small team of extremely skilled analysts. The computers are not only digitally protected, not connected to the web, but they are even locked behind cages. The researchers who collaborated with us on the research do not have direct access to the data, but rather receive the relevant summary tables. The very limited number of analysts with practical access have to sign releases, sign their lives. However, in all honesty, if anyone else tried to figure out how to use this database, it would take them forever. In comparison, the analyst team can change things quickly.
Can you discuss some of the research results so far?
One of the earliest studies looked at the 2014 rollout of Universal Pre-Kindergarten across New York City. We looked at the health care utilization of children born before and after the program start date and found an interesting result that no one had seen before: children who entered pre-K were significantly more likely to to be diagnosed and treated for vision problems. These children were receiving glasses much earlier, which had a lasting effect on their academic performance.
Working with professor of urban policy and planning Ingrid Gould Ellen and the NYU Furman Center’s highly accurate geographic data for New York City, we also found that while low-income children moved all the time, gentrification was not a predictor of this. Surprisingly, this study found a limited effect of such frequent child moves or on the health of children born in neighborhoods that later experienced gentrification.
Have you researched the health effects of an eviction?
We were doing. Many people lose Medicaid during their deportation. When they reappeared in data sent back to Medicaid listings, we found a variety of negative health effects. However, in another study, we found that among those who lived in buildings where owners had made renovations – better lighting or windows, for example – their disease burden was lower overall.
Can the state’s Medicaid database tell us anything about the health of inmates?
We actually did an in-depth project with the mayor’s office of criminal justice that compared inmates released from Rikers Island to Medicaid data to see what kind of health conditions ex-inmates have and whether they sought any health services for them. We found that people who are frequently in prison are often in hospital when they are not in prison. But one of the things that surprised us was that they often have very high rates of alcohol consumption. The consumption of alcohol, of course, is not illegal, unlike the consumption of drugs.
What are some of the upcoming studies?
We examine whether extending Medicaid for longer periods between mandatory renewal dates would help reduce recidivism in prison. This study is based in Westchester.
We also assess the impact of the COVID outbreak on the health of Native Americans residing in upstate New York, a neglected and disadvantaged population. While they are eligible for public health services, what happens when these services run out of money before the end of the year, which they often do? What happens to those who also drop out of Medicaid and fall through the cracks?
Another article, which is pending publication, revolves around a federal policy that makes babies born under 1,250 grams, or about 2.75 pounds, automatically eligible for Supplemental Security Income, or SSI, if their families are poor. Data shows that these children do so much better than babies born with higher weights, who are not eligible for SSI. Additionally, the savings to the Medicaid program resulting from their reduced health care utilization far outweigh the costs of SSI. Thus, babies who benefited from it were much less likely to contract urinary tract infections, for example. Why? Their parents could afford more diapers, in part.
It shows the potential for impact of even small adjustments to rules and policies.
An example of this is what data has revealed on paid sick leave, which is that the benefit leads to regular doctor visits and better health outcomes for recipients, preventing people from going to emergency room. The United States is one of only two Western countries that does not mandate paid sick leave. We hope to compare our results from the introduction of the New York City warrant to those of more recently introduced warrants in other cities in New York State. Overall, however, the Medicaid Data Project promises an endless number of potential projects. We expect many of them to have important implications for policy makers.