Insurers to pool claims data for study on health care costs

Four of the country's largest private health insurers -- in what is believed to be the first collaboration of its kind -- have agreed to offer their claims data for use in health research projects in the hopes of adding to the understanding of what is driving health care costs.

The project, unveiled Sept. 20, is called the Health Care Cost Institute. It will rely on data from Aetna, Humana, Kaiser Permanente and UnitedHealth Group. Organizers said they hope to persuade other insurers to join as well.

The four companies agreed to share claims information dating from 2000 to the present and update the claims database twice a year. The data will not identify individual patients or physicians.

Arthur Kellermann, MD, MPH, director of RAND Health, called the HCCI announcement significant. "It is a huge development in that it does offer the opportunity or the potential to give a window into the private insurance industry, and how private insurance and health care utilization play out," he said

Until now, unlike government plan data, the cost and utilization patterns of the commercially insured population has been a kind of "black box" that was accessible only through the small, narrow window of a single plan, if at all.

Although it offers the potential of major new insights, the project's reliance on claims data limits what researchers can learn, said Belinda Ireland, MD, an independent medical epidemiologist in St. Louis.

"Claims data should be a good indicator of cost," she said. "But because of the way health care is delivered in the U.S., we know it isn't an accurate metric. What's charged for the delivery of care is so dependent on contracts between providers and payers, charges don't reflect what we think of as costs."

What HCCI will do

HCCI aims include:

• Fostering a better understanding of the true drivers of increasing health care costs among thought leaders, policymakers, other health care decision-makers and ultimately the public.
• Creating and maintaining a first-of-its-kind database of up-to-date information about public- and private-sector health care costs and utilization.
• Conducting cutting-edge research on health care costs and their drivers.
• Providing fact-based, nonpartisan insights on health care policy issues.

HCCI leaders said some Medicare Advantage and Medicare fee-for-service data will be included in their database, and that they would work eventually to include claims information from Medicaid.

Martin Gaynor, PhD, the E.J. Barone Professor of Economics and Health Policy at the Heinz College at Carnegie Mellon University, will serve as chair of the HCCI Governing Board.

"Researchers and experts are clamoring for better data and deeper analysis to better understand the factors driving costs and to inform effective policy decisions," he said in a news release announcing the project.

"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," Gaynor added.

The insurers involved deferred any comments to representatives of HCCI. The project grew out of several researchers' shared desire to use commercial claims databases in their work, according to HCCI.

"The commercial costs might be more representative of what's happening throughout the country," said Susan Levine, PhD, senior vice president of health technology research and consulting for Hayes Inc., a Philadelphia-based corporation that conducts comparative effectiveness research and medical technologyassessments.

Beginning in 2012, HCCI plans to produce a twice-yearly health care cost tracker reports, which it calls "scorecards," to demonstrate "the primary drivers behind increasing health care costs."

The reports will provide aggregate data broken down by region, with more detailed information available for download.

But the greater part of HCCI's work depends on what independent researchers decide to do with the information.

A committee of HCCI leaders will review proposals from researchers who want access to the database, and the topics are limited only by the proposals received.

No strings attached

The project leaders have taken pains to assure its independence from any commercial interests.

According to HCCI, the organization "will ensure that all projects and research are only conducted and used by governmental, nonprofit and academic researchers and not for commercial or competitive reasons, or for the direct or indirect benefit of commercial organizations."

Dr. Ireland said HCCI will have to work hard to maintain that clear line of separation from the health plans contributing data.

"I think it's very important to separate, in terms of the public trust and trust from the provider side, to show that [HCCI] is not under the control of those providing the data," she said.

Dr. Kellermann said he wants to make sure there are no strings attached to the data by the contributing health plans.

"What if the insights are not to the advantage of sponsors? That's the ultimate acid test," he said.

The genesis of HCCI may be seen as part of a wave of discussions of the role physicians and hospitals play in health care costs, including a Sept. 9 hearing by the House Ways and Means health subcommittee.

"You can't dodge the cost issue," Dr. Kellermann said. "We can deal with that cost issue in a harsh and clumsy manner, and do rationing, or by setting prices, which is kind of a nonstarter ... or we can focus on making sure people get the care they need and not a lot of wasteful, ineffective or inappropriate care."

Levine said although the HCCI holds potential, the results will be limited if researchers and policymakers don't act on what they learn.