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A Call For Clarity In Health Care: The FAIR Health NPIC Database



November 28th, 2012

By all accounts, health care in America has been ailing for several decades. Americans have struggled with acquiring and maintaining adequate health insurance as costs have steadily increased. While the increased insurance coverage provided under the Affordable Care Act (ACA) will help individuals access and pay for health care services, the ACA’s impact on cost, which will be shifted but not eliminated, seems likely to be less substantial. Developing new approaches to rein in spending and improve the value of care delivery remains a critical challenge for all of the diverse players in the health care arena.

We know that there are a number of drivers of health care costs. New, more expensive medicines and technology — and particularly technology that brings with it only incremental benefits — are obvious factors.  A related issue is the overuse and misuse of certain procedures and tests. Finally, the burden of treating a population with high rates of chronic illness brings with it significant costs and presents an increasing challenge as rates of chronic illness grow.

Putting clarity into the health care system. To truly bend the cost curve, we need to take a holistic approach. While the call for transparency in the health care system is a common one, we need to also be thinking about how we can move beyond transparency to insist on clarity across the health care system. Clarity is achieved by giving people information that they will find useful to their decision-making process and empowering them to act on that information. Such clarity must take place on two different levels: macro and micro.

At the macro level, encompassing payers, providers, policymakers and plan sponsors, we need to identify new tools for understanding the real drivers of health care costs in this nation and actively addressing them. We need to identify common data and information sources that offer the opportunity for new discussions around the value of the care that is being provided.  At the micro level, consumers also need to do their part.  For too long consumers have lacked cost information in advance of seeking health care services. Now, they need to consider both the cost information that has recently become available, as well as the quality data that is offered through a variety of sources to make sure that they are clear about the value they are getting out of the system.

Through changes in health insurance plan designs and reimbursement models (e.g., high deductible plans, increased cost sharing in more traditional plans, etc.), consumers are being asked to use the data available to them to understand the relative costs of different treatments and procedures and to act accordingly. They are being asked to research different treatments being offered to them just as they might research the features of a new car or new house.

A new resource: the nation’s largest collection of private claims data. An important new resource is now available to improve the clarity of our health care system at both the macro and micro level. The FAIR Health National Private Insurance Claims (FH NPIC) Database offers a common dataset to all players — consumers, insurers, providers, employers, policymakers, and researchers — that will advance the nation’s conversation about health care costs and the value of our care system.

The FH NPIC Database, the nation’s largest collection of private claims data, includes over 15 billion billed charges for medical and dental procedures performed nationwide between 2002 and the present.  The Database continuously grows as new claims data are submitted from over 70 data contributors on a regular basis. The FH NPIC data include claims data for every CPT and CDT code and for all 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands.

The FH NPIC Database is the foundation for data products that are used by a wide range of health care industry customers including providers, insurance companies, self-insured plans, third-party administrators, and state and federal government agencies.  FAIR Health also maintains a free consumer website that allows patients to estimate the cost of specific medical and dental expenditures in 491 distinct geographic areas. With these data tools, consumers, insurers and providers have a common source of cost data from which to work together to improve understanding about the cost of health care services, and to improve the clarity of the care system overall.

Beginning in July 2012, claims data from the FH NPIC Database became available to researchers and policymakers seeking to study patterns, trends, and geographic disparities in service utilization and private health care spending. Researchers can license underlying claims data from the FH NPIC repository to study such relevant questions as how health care technology is being utilized across the country, how various policies adopted at the state level are impacting service delivery, and how treatment of different health conditions vary across the country.

Ultimately, everyone wins when we focus on building clarity and a common base of knowledge for participants in the health care system. Consumers are armed with actionable information. Insurers and providers have more meaningful dialogues. And insurers, providers, plan sponsors, and policymakers can come together to develop new, innovative models of health care delivery and payment.

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