Four major health plans will supply claims information, along with some from Medicare, representing more than $1 trillion of healthcare treatment and services over the past 11 years to a database so researchers can analyze it and root out what the primary drivers of costs and utilization are.
Aetna, Humana, Kaiser Permanente and United Healthcare will furnish access on a regular basis to the Health Care Cost Institute to the plans' data, which has been scrubbed of its identification properties. The institute, a newly created non-profit, will conduct health research with the claims information.
For the first time, comprehensive data on those who are privately insured will also be available in addition to the claims data from the Centers for Medicare & Medicaid Services, providing a much more accurate analysis, according to Martin Gaynor, economics and health policy professor at Carnegie Mellon University. The majority of individuals who are insured receive their coverage from private health plans.
The data will include 5 billion medical claim records from 5,000 hospitals and 1 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,” Gaynor said in a Sept. 20 announcement of institute.
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.
The institute will start in 2012 to publish its own scorecards and analysis of overall trends in healthcare cost and resource utilization.
The organization seeks more health plans to participate in the claims data collection and more data from government payers. Better data and deeper analysis can result in more effective policy decisions, Gaynor said. He is also the chairman of the institute’s governing board.
Over the past decade, healthcare costs have soared three times faster than wages, straining the budgets of families, employers and private and public payers. If unchecked, U.S. health spending may rocket from $2.5 trillion to $4.6 trillion by the end of the decade, “an unsustainable path,” said Donald Segal, president of the Society of Actuaries.
“The need to study the underlying drivers of costs is more important than ever,” he said.
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 privacy and security of information, including data contribution agreements with payers.