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(From RESEARCH HORIZONS Magazine, Fall 2016)

Individual states have significant independence in setting health care priorities and determining how those goals will be met through specific service offerings. But how do policymakers evaluate those decisions?

That’s a question Nicoleta Serban and Julie Swann are addressing by studying billions of transaction records from the nation’s Medicaid program. Medicaid largely addresses the needs of children, whose issues differ dramatically from those of private-sector workers and older Americans. The Georgia Tech researchers have access to eight years of complete records from 50 million patients, 38 million of them children.

“People want to make informed decisions, and we can help them make decisions based on data,” said Serban, an associate professor in Georgia Tech’s Stewart School of Industrial and Systems Engineering. “Health care policies have often been set by clinicians or public health agents who are making decisions based on their experience. We can add a layer of data and health analytics to that.”

For example, in a project supported by Children’s Healthcare of Atlanta, Serban looked at how states in the Southeast were managing asthma in children — a condition identified by the CDC as a priority. With proper diagnosis and management, acute asthma attacks can be minimized.

Based on the Medicaid data, however, she found significant differences among the states in the degree to which the disease was being managed in accordance with guidelines. In the best-performing state, 80 percent of children studied received the recommended care, while in the worst-performing state, only 30 percent of the children studied did.

The implications of care quality are significant and can be measured in costs of emergency treatment, chronic diseases carried into adulthood, time away from work for parents, and the quality of life for affected children. “If we can provide the best care now for these children, we can rely on them as adults to be healthier and more productive,” Serban said.

The findings could spur underperforming states to re-examine their policies, perhaps by looking at states that have done a better job. In some states, care for children with asthma is limited by a shortage of medical providers and practices that accept Medicaid. “We cannot charge either patients or clinicians for lack of adherence,” Serban said. “We are simply looking at compliance within the system and how to intervene.”

Serban and Swann — also a professor in the Stewart School of Industrial and Systems Engineering — have also looked at access to mental and oral health care, access to primary care, the cost-effectiveness of telemedicine, and at the potential return on investment for expanding Medicaid services to cover more preventive care for children. The Medicaid data includes personal information about patients, so Georgia Tech has an extensive protocol for securing it. For instance, the data is maintained on networks not connected to the internet, and can be accessed only in secure data review rooms from which cellphones and other electronic devices are excluded. Only Georgia Tech employees can see the information, and then only for research permitted by the agreement with the U.S. Department of Health and Human Services.

Working out the security infrastructure and agreements for using the data took nearly two years, including the construction of secure data rooms housed at the Institute for People and Technology, a Georgia Tech interdisciplinary research institute.

“When we started, I was a bit naïve about the level of security that would be required to protect these data,” Serban said. “Now that we have established the infrastructure for this database, it is a proof-of-concept for how Georgia Tech can deal with that level of data security and data complexity.”