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Healthcare Claims Database and Data Products

Healthcare Claims Database and Data Products. Background. FAIR Health Founded 2009 Emerged from NYS Attorney General Investigation into OON Reimbursement/$95 million settlement Independent Not-For-Profit Organization New Database and Enhanced Data Products

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Healthcare Claims Database and Data Products

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  1. Healthcare Claims Database and Data Products

  2. Background • FAIR Health Founded 2009 • Emerged from NYS Attorney General Investigation into OON Reimbursement/$95 million settlement • Independent Not-For-Profit Organization • New Database and Enhanced Data Products • Free Consumer Website Promoting Cost Transparency • Data Available for Research and Innovation: FAIR Health Research Support Program featuring the FH National Private Insurance Claims (FH NPIC℠) Database

  3. Data Assets • Charge data from 2002 to Present • National in scope – 491 geozips • Over 70 data contributors – health plans, insurance carriers, third party administrators • 126 million covered lives • Currently over 14 billion billed medical and dental procedures • Robust auditing and validation program • Largest independent private claims collection in the country

  4. FH NPIC Data Products 1 - FH Benchmarks • Provider charges arrayed by percentile, by geozip (approximately 500 geozips nationwide) • Modules: Medical/Surgical, Allowed Medical, Dental, Anesthesia, HCPCS, Outpatient Facility, Inpatient Facility • Used by commercial payors and state programs to help inform Usual and Customary (UCR) rates • In early stage of use by commercial entrepreneurs to add healthcare cost information to tools for consumers and providers

  5. FH NPIC Data Products 2 - FH NPIC SAF • FH NPIC Standard Analytic File (SAF) • Underlying claims data, de-identified • Available by year and geographic region • Research Support Program launching July 1 • Streamlined application process • License fees scaled based on data volume, length of license and nature of use

  6. FH Consumer Cost Lookup • www.fairhealthconsumer.org • Free on-line resource for consumers to estimate medical and dental fees in their area • Includes Medicare-based reimbursement comparison • Includes educational content, resources and videos – available for use in other systems • APIs in progress; mobile app in progress • Website recently honored at White House Summit on Smart Disclosure

  7. FH Data In Action • NPIC Data for Research • Healthcare policy; market and behavioral economics • Development of clinical care protocols • Public health and epidemiological trends/utilization • Identification of disparities in care • Medical school curricula • FH Benchmarks Data • Module data and API access • Geo-specific tools for cost transparency/ cost variation • ACO and bundled payment calculations • Strategic planning analytics

  8. Connecting • Facebook: www.facebook.com/fairhealth • Twitter: @fairhealth • Upcoming Conferences • American Society of Healthcare Economists (6/10) • AcademyHealth (6/24-6/25) – panel discussion and Innovation Station • For more information, contact • Ray Agostinelli, CIO, ragostinelli@fairhealth.org • Linda Stelmach, Director of BD, lstelmach@fairhealth.org • Ben Casado, CTO, bcasado@fairhealth.org • 212-370-0704

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