Managed Care


Researchers to Obtain Private Insurers’ Data

MANAGED CARE October 2011. © MediMedia USA
News and Commentary

Researchers to Obtain Private Insurers’ Data

MANAGED CARE October 2011. ©MediMedia USA

Through the years, academic researchers have collected, studied, sliced, and diced data from Medicare and Medicaid claims, but have often wished for greater access to private insurers’ treasure trove of data. Now a new initiative will give researchers and policymakers access to a comprehensive collection of health plan and government payer data that, one hopes, will offer insights into health care costs, utilization, and intensity.

Aetna, Humana, Kaiser Permanente, and UnitedHealth Group will provide information from more than five million claims that represent over $1 trillion in spending to the newly formed Health Care Cost Institute (HCCI). In addition to data from private insurers, HCCI will receive government data from the Medicare fee-for-service program and from Medicare Advantage. Importantly, to ensure usefulness, the data will be updated regularly.

Martin Gaynor, PhD, will head up HCCI, and says, “Unfortunately, the existing public data derived from Medicare and Medicaid activity aren’t enough to form a complete, up-to-date picture of national cost drivers and trends. For the first time there will be comprehensive data on the privately insured who make up the majority of health consumers in the United States.”

Gaynor says that Medicare represents only a third of people with insurance and that the program offers little information about the care being delivered to people under age 65 who are not covered.

HCCI says that identifiers will be stripped from the data in accordance with HIPAA regulations. The institute will establish a Data Integrity Committee whose primary focus will be on all matters related to data privacy, security, and integrity. Insurers will not have access to the aggregated pool of private data and the data will not be accessible to the public.

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. The institute will provide claims data to qualified researchers seeking to analyze the data. Summaries that identify changes in health care prices and use of medical services will be made public twice a year, however.


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