Payer_plan_period - new fields to allow standardized health economic analysis
gowthamrao opened this issue · 5 comments
Use case:
- Allows for standardized health economic analysis about contractual relationship between a person and their health care experience
- Using the constructs of payer, plan and sponsor allows the use of standard OHDSI tools like Atlas and R-packages for cohort-build and cohort charcterization.
- Addresses a key concern among OHDSI community around limited representation from health-plan, health-economics and actuarial science.
- Address forum discussions: here and here
Proposal overview
Introduces, clarifies and standardizes the representation of four new constructs using _source_concept_id, _type_concept_id and _concept_id
sponsor: who finances the transaction
payer: who administers the transaction
plan: the actual contract being administered by the payer and agreed by the sponsor
stop reason: reason for termination of the contract
Changes are only additions of fields. Additions are in bold
Backward compatibility = Yes
Proposed table
Field | Required | Type | Description |
---|---|---|---|
payer_plan_period_id | Yes | integer | A identifier for each unique combination of payer, plan, family code and time span. |
person_id | Yes | integer | A foreign key identifier to the Person covered by the payer. The demographic details of that Person are stored in the PERSON table. |
payer_plan_period_start_date | Yes | date | The start date of the payer plan period. |
payer_plan_period_end_date | Yes | date | The end date of the payer plan period. |
payer_concept_id | No | integer | A foreign key that refers to a Standard Payer concept identifiers in the Standardized Vocabularies |
payer_source_value | No | varchar(50) | The source code for the payer as it appears in the source data. |
payer_source_concept_id | No | integer | A foreign key to a payer concept that refers to the code used in the source. |
plan_concept_id | No | integer | A foreign key that refers to a Standard plan that represents the health benefit plan in the Standardized Vocabularies |
plan_source_value | No | varchar(50) | The source code for the Person's health benefit plan as it appears in the source data. |
plan_source_concept_id | No | integer | A foreign key to a plan concept that refers to the code used in the source. |
sponsor_concept_id | No | integer | A foreign key that refers to a Standard plan that represents the sponsor in the Standardized Vocabularies |
sponsor_source_value | No | varchar(50) | The source code for the Person's sponsor of the health plan as it appears in the source data. |
sponsor_source_concept_id | No | integer | A foreign key to a sponsor concept that refers to the code used in the source. |
family_source_value | No | varchar(50) | The source code for the Person's family as it appears in the source data. |
stop_reason_concept_id | No | integer | A foreign key that refers to a Standard termination reason that represents the reason for the termination in the Standardized Vocabularies. |
stop_reason_source_value | No | varchar(50) | The reason for stop-coverage of the record. |
stop_reason_source_concept_id | No | integer | A foreign key to a stop-coverage concept that refers to the code used in the source. |
Proposed vocabulary
To help with standardized analysis, we will need to introduce into the OMOP CDM vocabulary, new concepts. Only omop standard concepts may be used in plan_concept_id, payer_concept_id, sponsor_concept_id and stop_reason_concept_id.
plan_concept_id
- Bronze
- Silver
- Gold
- Platinum
- Catastrophic
Reference: - Individual health plan metal level
plan_source_concept_id
- depends on the vocabulary used by source data, not designed/useful for standardized analysis
sponsor_concept_id
-
self-insured
-
fully-insured
-
individual
-
small group
-
large group
sponsor_source_concept_id
- depends on the vocabulary used by source data, not designed/useful for standardized analysis
payer_concept_id
http://www.phdsc.org/standards/pdfs/SourceofPaymentTypologyVersion7FINALJune27_2016.pdf
Reference: payer types
payer_source_concept_id
- depends on the vocabulary used by source data, not designed/useful for standardized analysis. One option for non-standard vocabulary is [payer list] (https://www.officeally.com/payerList.aspx)
stop_reason_concept_id
- Termination of the employee's employment for any reason other than gross misconduct;
- Reduction in the number of hours of employment.
- Termination of the covered employee's employment for any reason other than gross misconduct;
- Reduction in the hours worked by the covered employee;
- Covered employee becomes entitled to Medicare;
- Divorce or legal separation of the spouse from the covered employee; or
- Death of the covered employee.
Reference: group coverage termination vocabulary - Termination of all group health plans by sponsor
- Failure to pay premiums
- Coverage under another plan
- Loss of Social Security disability status
- Entitlement to Medicare
Reference: opm - termed by person
- termed by subscriber
- termed by payer
- termed by sponsor
Related proposal
The proposal is related to but not dependent on #107 .
This is a good start. But I think we need to bring it to the Forum to do a couple things:
- Generally get folks' feedback, including use cases
- Ask the international folks what they think, and how we can create a nomenclature that is generally applicable. "Platinum" as a concept is not very interoperable.
Thoughts?
@gowthamrao have these concepts been added to the vocabulary?
I don't think so. @cgreich wanted to bring this up for more community feedback
We should bring it back up, there are THEMIS questions coming up about them
added in v6.0