FAIR Health database of claims opens to researchers
■ The access could aid the study of regional health spending and treatment protocol patterns as well as determine how public health initiatives affect utilization.
By Emily Berry — Posted Aug. 8, 2012
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The health insurance claims database created as part of settlements between the New York State Attorney General’s Office and major health insurers in 2009 now is accessible to academic researchers, opening a new window into the way privately insured people use health care.
FAIR Health Inc., a nonprofit entity created as part of an agreement between the largest health insurance companies and the office of then-Attorney General Andrew Cuomo, opened up its database for academic research with a new set of research-friendly tools announced July 17.
“Health care reform has really brought health insurance and the health care reimbursement system as a whole into the spotlight,” said Robin Gelburd, president of FAIR Health. “We’re so happy people are asking the right questions. We can show them ‘what’; it’s for them to ask ‘why’ and ‘how.’ ”
The database was formed in part to ensure that health plans would not use proprietary databases to artificially drive down the fees they pay out-of-network physicians. Making the database accessible to researchers could help physicians and patients by offering insight into how, where and by whom health care is consumed, Gelburd said.
With national health system reform under way, public health researchers and health economists are going to be busy examining spending and utilization, and some of their questions can be answered with access to a large claims database, said Paul Fronstin, PhD, director of the health research and education program at the Employee Benefits Research Institute.
“Researchers are really digging into why health care costs are increasing, what we might be able to do to change that, and the movement to consumerism, not only with consumer-directed plans, but health risk assessments, biometric screenings — getting at what people react to,” Fronstin said. He said there are limits to how much claims data can reveal, but the information does provide a start to answering those questions.
Gelburd said FAIR Health’s data are particularly helpful for several reasons. Public health research is based either on public payer claims data or claims from a single insurer. Usually those claims are a few years old, so their usefulness is limited, she said. The FAIR Health database, by contrast, offers claims data from more than 70 private insurers, and most recent data at any given time will be just three months old.
The claims date back to 2002 and cover an estimated 125 million enrollees in every part of the U.S. Interested researchers will have to apply for and pay for access to the data, and fees will depend on the type and quantity of the data requested, and the type of institution or research entity requesting it.
Researchers and businesses also can pay for access to claims databases maintained by Optum, formerly Ingenix, or by Truven Health Analytics, formerly Thomson Reuters Healthcare. But FAIR Health’s nonprofit status means researchers can feel confident that the data are truly impartial, Gelburd said.
The research tool is the third part of FAIR Health’s charter to come to fruition. Its first objective was to build a database to replace two that were maintained by UnitedHealth Group and used by many health insurers to determine rates for out-of-network physicians. The FAIR Health database replaced those run by Ingenix, which were shut down under the terms of the settlement. FAIR Health also has set up a searchable consumer site to help patients estimate what they might pay for out-of-network care.