February 26, 2024

4 Insurers to Provide Researchers With Claims Data

Aetna, Humana, Kaiser Permanente and the UnitedHealth Group plan to supply information on more than five billion medical claims, representing more than $1 trillion in spending, to a newly created nonprofit group, the Health Care Cost Institute.

About $2.6 trillion is spent each year in the United States on health care, an amount that is expected to increase by about 80 percent in the next decade.

While Medicare has made its data available to researchers, with certain confidentiality restrictions like prohibiting identification of individual doctors, information from private insurers has been largely piecemeal.

“Our perspective is that the nation needs greater transparency about what is driving health care costs,” said Simon Stevens, an executive vice president for the UnitedHealth Group.

The insurers say they will not have access to the aggregated pool of private data and the data will not be accessible to the public. The new institute will provide claims information to qualified researchers seeking to analyze the data, and it will make public twice-a-year summaries that identify changes in health care prices and use of medical services. These summaries might examine specific areas like maternity care or orthopedic claims, according to Martin Gaynor, a health economist at Carnegie Mellon University who will be chairman of the new institute’s governing board.

Highlighting certain trends could also serve to put pressure on individual fields where prices seem abnormally high, or expose areas where demands for services have not been met. The insurers are providing start-up financing for the group.

“This is the first time that the claims data paid by carriers will be available to produce public reports and for researchers to be able to use the data,” said Roy Goldman, a vice president and chief actuary for Humana.

The claims data, which will not include any identifying information about patients and will not specify the doctor or hospital providing care, represents health care spending since 2000 and will be updated at least twice a year, according to the institute. The claims will not be made available for commercial use, partly because officials want to prevent their use by any insurer negotiating with hospitals and doctors.

Still, researchers say the new information will allow them to get a better sense of how the nation’s health system operates. “It’s the same doctors, it’s the same hospitals, but we only have the half the information,” said Katherine Baicker, a health economist at the Harvard School of Public Health, who is not involved in the project.

The data could provide answers about the differing cost of hip replacements, or how commercial prices affect insurance premiums. The claims data will include the price, volume and intensity of care being delivered to people with private coverage from one of the four insurers. Medicare data will be used to compare cost information with private health plans.

The lack of private market data has been “a source of frustration for researchers,” said Mr. Gaynor, who noted that Medicare represented only a third of people with insurance and offered little information about the care being delivered to people under age 65 who were not covered by the program. He says he hopes to persuade additional insurers to contribute their information to offer an even more complete view of the private market.

One of the critical differences between Medicare and private health plans is the variation in price that the commercial insurers pay to different hospitals and doctors for the same medical services. While Medicare generally pays a fixed price, with some adjustments for where a hospital or doctor is located and the like, private insurers may pay very different rates, depending on the characteristics of the individual market and hospital or doctor. “There’s huge variation across geographic markets,” said Mark Duggan, an economist at the Wharton School at the University of Pennsylvania. “It does not line up with Medicare.”

Researchers are also hoping that the institute analyzes the data relatively quickly. Some note that the release of Medicare data is often a year or more behind an emerging trend.

For example, looming Medicare cuts are expected to have an effect on the prices being paid by commercial insurers, an uptick in costs that would most likely be detected early on by the institute if the data were being monitored in real time.

While the data does not allow researchers the ability to focus in on a single hospital system or physician, it should enable them to draw important comparisons between different types of programs and between care provided under Medicare or commercial insurers, said Alan Garber, a health economist at Harvard who is also a member of the institute’s board. “You can’t answer every question well, but this is a great start,” he said.

Researchers say the data should help them to begin to answer fundamental questions about why health care is so expensive and to help determine whether the main culprits are higher prices, high use of services or some combination of factors. “At the end of the day,” said Jonathan Gruber, a health economist at M.I.T. who is also a board member, health care “is the biggest and fastest-growing sector of the economy. We can’t know too much.”

Article source: http://feeds.nytimes.com/click.phdo?i=420a15d2b542557f960ff3d288308ce3

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