Data represents $1 trillion in spending since 2000 and contains clinical laboratory and pathology data
In what may turn out to be a positive development for clinical laboratories and pathology group practices, four of the nation’s five biggest health insurance companies will collaborate and put their medical claims data for billions of transactions into a single data base. Researchers say this database will give them an unprecedented ability to assess utilization trends and the clinical care delivered to patients covered by private health insurance.
The four health insurance companies that will provide data are:
The data provided by each of these health insurers will be submitted to the newly-created Health Care Cost Institute (HCCI). This data will consist of more than five billion medical claims dating back to 2000. These claims represent more than $1 trillion in spending. The health insurers are also providing the financing required to launch HCCI.
Clinical Laboratory Test Information Likely to Be Included
In its coverage of this story, The New York Times reported that access to such a rich source of medical claims data will help researchers identify certain trends and better understand the utilization of healthcare services where prices seem abnormally high. “This is the first time that the claims data paid by carriers will be available to produce public reports and for researchers,” said Roy Goldman, Vice President and Chief Actuary at Humana, in the NYT article.
This huge data dump is designed to fix the “black hole” of American healthcare. That black hole is the knowledge void about how patients with private health insurance are treated by the nation’s physicians and hospitals. Until now, Medicare data has been the only regular source of detailed information about the delivery of healthcare in the United States.
But Medicare only serves about 30% of Americans with health insurance and none of its beneficiaries are less than 65 years old. “It’s the same doctors, it’s the same hospitals, but we only have the half the information,” noted Katherine Baicker, a health economist at the Harvard School of Public Health. By design, the new HCCI database fills that vacuum.
The New York Times noted that the data will be anonymized as to patients, physicians, and hospitals. It will be updated at least twice every year and will include price, volume and intensity of care data.
What makes this a big deal is that, although Medicare information has been available; private insurer information largely has not—except piecemeal. The lack of private market data has been a source of “frustration for researchers,” added Martin Gaynor, E.J. Barone Professor of Economics and Health Policy, Carnegie Mellon University (and Chairman of the new HCCI governing board).
The aggregated data from private health insurance plans could explain differing costs. Medicare data will be used to compare cost information against private health plans, including variation in pricing. “There’s huge variation across geographic markets,” Mark Duggan, Ph.D., Professor of Business and Public Policy, Wharton School, University of Pennsylvania, acknowledged in the Times article. “It does not line up with Medicare.”
Neither insurers or the public will have access to the aggregated data because officials do not want insurers to use the data to negotiate with providers. Qualified researchers will have access to the aggregated data, however, summaries will be made public twice every year. The summaries will identify changes in prices and use of medical services.
Real Time Monitoring of Healthcare Cost Drivers
The Times article pointed out that the data will better equip researchers to monitor and detect cost-triggers in real time, as well as to determine their impact. Researchers expect the data to help in answering fundamental questions about healthcare costs.
For the clinical laboratory testing industry, the ramifications of researchers having access to such a huge database of health insurance claims for beneficiaries in private health plans could turn out to be significant. Until now, utilization data, cost of service information, and patient outcomes data across a large population of under-65 patients has been unavailable.
Going forward, researchers will be regularly trolling this pool of healthcare data that is made up of five billion claims and represents $1 trillion in spending. Pathologists and clinical laboratory managers know all too well that medical laboratory test claims make up a large proportion of all claims submitted. As well, the test results from these clinical laboratory tests can allow case reviewers to understand whether the physician properly diagnosed and treated the patient.
For these two reasons, Dark Daily believes that the odds are high that it won’t take researchers using the HCCI medical claims database long to produce and publish relevant findings on how clinicians are utilizing medical laboratory tests. In turn, these findings may be then used by private payers to revise coverage guidelines and reimbursement with goal of helping health providers treat their beneficiaries with care that is consistent with evidence-based medicine principles.
—Pamela Scherer McLeod