HEALTHCARE CLAIMS DATABASE AND DATA PRODUCTS 1. Background FAIR Health Founded 2009 Emerged from NYS Attorney General Investigation into OON Reimbursement/$95.

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Presentation transcript:

HEALTHCARE CLAIMS DATABASE AND DATA PRODUCTS 1

Background FAIR Health Founded 2009 Emerged from NYS Attorney General Investigation into OON Reimbursement/$95 million settlement Independent Not-For-Profit Organization New Database and Enhanced Data Products Free Consumer Website Promoting Cost Transparency Data Available for Research and Innovation: FAIR Health Research Support Program featuring the FH National Private Insurance Claims (FH NPIC ℠ ) Database 2

Data Assets Charge data from 2002 to Present National in scope – 491 geozips Over 70 data contributors – health plans, insurance carriers, third party administrators 126 million covered lives Currently over 14 billion billed medical and dental procedures Robust auditing and validation program Largest independent private claims collection in the country 3

FH NPIC Data Products 1 - FH Benchmarks Provider charges arrayed by percentile, by geozip (approximately 500 geozips nationwide) Modules: Medical/Surgical, Allowed Medical, Dental, Anesthesia, HCPCS, Outpatient Facility, Inpatient Facility Used by commercial payors and state programs to help inform Usual and Customary (UCR) rates In early stage of use by commercial entrepreneurs to add healthcare cost information to tools for consumers and providers 4

FH NPIC Data Products 2 - FH NPIC SAF FH NPIC Standard Analytic File (SAF) Underlying claims data, de-identified Available by year and geographic region Research Support Program launching July 1 Streamlined application process License fees scaled based on data volume, length of license and nature of use 5

FH Consumer Cost Lookup Free on-line resource for consumers to estimate medical and dental fees in their area Includes Medicare-based reimbursement comparison Includes educational content, resources and videos – available for use in other systems APIs in progress; mobile app in progress Website recently honored at White House Summit on Smart Disclosure 6

FH Data In Action NPIC Data for Research  Healthcare policy; market and behavioral economics  Development of clinical care protocols  Public health and epidemiological trends/utilization  Identification of disparities in care  Medical school curricula FH Benchmarks Data  Module data and API access  Geo-specific tools for cost transparency/ cost variation  ACO and bundled payment calculations  Strategic planning analytics 7

Connecting Facebook: Upcoming Conferences  American Society of Healthcare Economists (6/10)  AcademyHealth (6/24-6/25) – panel discussion and Innovation Station For more information, contact  Ray Agostinelli, CIO,  Linda Stelmach, Director of BD,  Ben Casado, CTO, 