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Vocabulary for Payer Plan Period table

Vocabulary Users
#21

Is there a source we could start with, @Gowtham_Rao?

#22

Yes. Remember we started going back and forth on this

Memories from almost three years ago!

#23

But we have these in the vocabularies. @divakhnenko canā€™t find what she needs in there. Is there a better more comprehensive ontology of this stuff somewhere you know?

#24

No. There is no single authoritative source that is international.

In USA, regulation of licensed health insurance companies is at State level. So maybe a big state may have a more standardized vocabulary.

I suggest, this be solved domain by domain. What are we trying to solve

  • capture the identifier or type of administrator of benefitsā€¦i.e. payor
  • capture the identifier or type of sponsor, who is at risk
  • capture the type of benefit design i.e. plan
  • capture reason for stopping coverage?

Note: we also have to differentiate between trying to capture a name of a payor company, vs type of company. We donā€™t need to capture the name of the company e.g humana, but we do need to know if itā€™s employer sponsored private health insurance (type).

The spreadsheet has those

#25

We partially populated the payer_plan period in the Stanford OMOP (primarily the payer_concept_id and effective start/end date). We had a significant number of benefit plans mapped to the SOPT vocabulary as our institution(Stanford) was using them in QRDA reports. They have since stopped generating the reports and that mapping is no longer being updated. Some questions I had (similar in theme to those above)

  1. In California we have MEDI-CAL which could straddle MEDICAID and MEDICARE. Do you have any advice on how to map that?
  2. Is there a standardized/recommended way to map the plan to payer type?
  3. Same question for sponsor type and plan type?

@Gowtham_Rao @Christian_Reich @mik
Thanks!
Priya

#26

Also typically our users want to know who is in on:

  1. MEDICARE
  2. MEDICAID
  3. MEDI-CAL
  4. Managed Care(Private)
  5. Self Pay
#27

Are you using the cdm table payer_plan_period in version 6? Note: OMOP is still in version 5.x

#28

no -we are using OMOP5.3. For now, have only mapped payers to their SOPT so only populated payer_concept_id. What we noticed is that Medi-Cal often straddles Medicare and Medicaid so SOPT mapping could be 1** or 2**.

#29

@PriyaDesai:

You either create your own local concept with an ID>2Billion, or we add that.

No. Benefit analysis has not yet been a use case. Do you want to do that?

t