Insurers open up claims data

  • Article by: JACKIE CROSBY , Star Tribune
  • Updated: September 20, 2011 - 9:25 PM

A nonprofit group will give researchers access to national data for people with private insurance.

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Getting access to private insurance data, which covers most Americans, could be a researcher’s gold mine, offering a “granular level of detail” on every aspect of care.

Photo: Glen Stubbe, Star Tribune

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Four of the nation's biggest health insurance companies are opening up their claims data to researchers in hopes that better insight into the massive U.S. health system could improve care and put the brakes on rising costs.

Minnetonka-based UnitedHealthcare, Aetna, Humana and Kaiser Permanente said Tuesday they will form a nonprofit group, the Health Care Cost Institute, that for the first time will provide economists, researchers and other experts a look at nationwide medical data for all ages and health issues for people covered by private insurance.

The data, which will be stripped of identifying information on patients and medical providers, will include more than 5 billion medical claim records. It will come from more than 5,000 hospitals and 1 million service providers dating back to 2000 and represent more than $1 trillion of health care activity, the companies said.

"No one has seen anything like this before," said Steve Parente, a health economist at the University of Minnesota's Carlson School of Management who was named to the seven-member governing board. "This is something we always thought would be great to do, but to get the plans to agree to do it was a challenge."

In the past decade, health care costs have risen three times faster than wages. Rising costs are burdening state and federal governments as well as businesses and consumers, who are paying an ever larger share of the costs. Without significant changes, U.S. health spending could rise from $2.5 trillion to $4.6 trillion by the end of the decade, according to industry estimates.

Researchers have been able to gain restricted access to public data from Medicare and Medicaid, but Parente said it doesn't show the complete picture. Getting access to private insurance data, which covers the majority of Americans, could be a researcher's gold mine, offering a "granular level of detail" on every aspect of care.

For instance, the data might identify areas where people spend less time in the hospital or states where medical technologies make it to market faster. It might identify best practices that can be shared across systems or show where needs aren't being met.

"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 Inc.

The institute plans to apply to the federal government to add Medicare and Medicaid information to its database, and would welcome participation from other plans.

Parente said security protocols could be established fairly quickly, and researchers could start applying for access in 2012.

Researchers say the data should help them 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 the Massachusetts Institute of Technology who is also a board member, health care "is the biggest and fastest-growing sector of the economy. We can't know too much."

The New York Times contributed to this report. Jackie Crosby • 612-673-7335

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