OHDSI Home | Forums | Wiki | Github

Vocabulary for Payer Plan Period table


(Gowtham Rao) #1

Good morning OHDSI!

Payer plan period table needs your guidance for adding concept_id’s! This topic has been discussed before in the CDM work group, and in the forums.

GitHub https://github.com/OHDSI/CommonDataModel/issues/120 (approved by CDM WG).
Related discussions here and here thread.

We would like to begin adding vocabulary, but before adding wanted to get community opinion one more time

Question for discussion - Could we start by adding one vocabulary for the field payer_concept_id as the first vocabulary? i.e. can we add concept_ids for concepts in this external vocabulary pdf version and its corresponding csv versions are here for your review. Additional reading

@jenniferduryea


(Don Torok) #2

Will the top hierarchy concepts be standard concepts? We are usually lucky
if we can distinguish commercial and medicare let alone what type of
Medicare.


(Gowtham Rao) #3

The proposed vocabulary from PHDSC can definitely support hierarchy.

In this case Medicare (1) is the parent, while 11 Medicare (Managed Care) is child. etc. All levels may be standard-concepts I think - like in SNOMED or RxNorm.


(Christian Reich) #4

@Gowtham_Rao:

“Medicare Non-managed Care Other” - Ouch!!! Let’s list out. Who cares if the list is a little longer. Or leave out, and then the next Concept up will be used (“Medicare (Non-managed Care”).


(Gregory Klebanov) #5

@Gowtham_Rao need your expert help. I am still struggling a bit to understand how we can use our existing Payer and Plan vocabulary domains to sufficiently map Medicare part A, B, C and D. In my mind, it should be working like this: Medicare - mapped to payer, and we have a concept or that. For Part A (inpatient / hospital), B (medical) and D (drugs) - and setting C aside for a minute - these should be mapped to the corresponding plan. However, this is what we have today

there is no corresponding term for Part A, but there are for Part B and Part D?

Then, there is whole different thing called “Medicare Part C” (Medicare Advantage). According to Medicare, this is - “Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are an “all in one” alternative to Original Medicare . They are offered by private companies approved by Medicare”. So, in this cases - who should be the payer and what should be the plan type? Apparently, being in Medicare Part C does not necessarily mean it would cover hospital, medical and drugs.

Then I am also confused that we seems to be mixing actually Payers and Management Type (HMO, PPO etc…) in our Payer domain.

Any thoughts?


(Gowtham Rao) #6

I think the various types of medicare are non standard (source) concepts.

We created standard concepts to capture plan, sponsor, payor, benefit domains that should go to corresponding standard concept field


(Gowtham Rao) #7

Yes. We created the concepts, but not the mapping.

Exactly. We felt that precordinating the mapping in the vocabulary would be a big lift. Plus, we may not have consensus and how do we support international use cases.

We felt it would be best to do the mapping decisions during ETL.


(Gregory Klebanov) #8

so, which concept would we use to map Part A too since there seems to be no individual concept representing Hospital only plan type?


(Gowtham Rao) #9

I would consider creating a non standard concept


(Christian Reich) #10

Gents:

Are we good with this? Or do we need a powow returning to the choice of concepts we have?


t