Analysis of Data From Four Health Plans, Medicaid to Shed Light on Costs

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Health care claims information—representing more than $1 trillion in treatment and services rendered over the past 11 years—will be submitted by four major health plans and Medicare to the newly formed Health Care Cost Institute for researcher analysis of the primary drivers of costs and utilization.

Aetna, Humana, Kaiser Permanente, and United Healthcare will regularly furnish to the institute access plan data that has been “scrubbed” of its identification properties. The newly created non-profit will then conduct health research with the claims information.

For the first time, comprehensive data on privately insured patients will also be available in addition to claims data from the Centers for Medicare and Medicaid Services (CMS), The data will include 5 billion medical claim records from 5,000 hospitals and one million service providers.

“Unfortunately, the existing public data aren’t enough to form a complete, up-to-date picture of national cost drivers and trends,” says Martin Gaynor, chair of the institute's governing board.
Gaynor says current data from Medicare covers only seniors, and the federal government pays a stated rate for healthcare services. On the other hand, the private payer data will cover all ages and health issues. The information will highlight the variations in costs for the same service among private and public payers.

In 2012, the institute will start to publish its own scorecards and analysis of overall trends in health care cost and resource utilization. It aims to attract more health plans to participate in the claims data collection and more data from government payors.

Gaynor says better data and deeper analysis can result in more effective policy decisions. He emphasizes that the institute will use data that has been de-identified according to the Health Insurance Portability and Accountability Act (HIPAA) and create a data integrity committee to focus on the privacy and security of information, including data contribution agreements with payors.