A Primer for Managed Care Residents: How to Conduct Research Using Live Medical and Pharmacy Claims Data.

Journal Article (Journal Article)

Managed care organizations are growing more sophisticated in their ability to analyze data. There are increasing numbers of data analysts at managed care organizations, as well as more types of real-time, or "live," data available. These data range from pharmacy claims and enrollment files to medical claims, medical records, and linkages to external data. Moreover, the data are often curated in a way that allows for easier data analysis. Using these data, managed care residents are often required to perform a project to evaluate a utilization management policy or clinical program. Yet, there is a lack of guidance specific to managed care organizations on how to conduct such a research study using "live" claims data. This Viewpoint article provides a primer for managed care residents and other managed care professionals who are seeking to use data to help inform decisions on how to manage their beneficiaries' health and costs. DISCLOSURES: There was no funding source for this manuscript. Hung reports a grant from the Agency for Healthcare Research and Quality and personal fees from Blue Cross Blue Shield Association, outside the submitted work. Gedey, Groeneweg, and Jay have nothing to disclose.

Full Text

Duke Authors

Cited Authors

  • Hung, A; Gedey, R; Groeneweg, M; Jay, M

Published Date

  • May 2019

Published In

Volume / Issue

  • 25 / 5

Start / End Page

  • 538 - 543

PubMed ID

  • 31039066

Electronic International Standard Serial Number (EISSN)

  • 2376-1032

Digital Object Identifier (DOI)

  • 10.18553/jmcp.2019.25.5.538


  • eng

Conference Location

  • United States