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Written by: Bob Habasevich, PT on Saturday, December 17, 2011 Posted in: Inpatient Rehab

The war on rising health care costs was provided new ammunition with the agreement to open the books on claims paid by commercial insurance companies.  Policymakers and researcher have been limited to looking at cost and utilization practices through the Medicare sets which are biased with health care provided to the elderly. On September 20, a panel of distinguished health care economists and researchers announced the launch of the Health Care Cost Institute. This unprecedented health research initiative will allow researchers and policymakers access to a comprehensive collection of health plan and government payor data offering new insights into health care costs, utilization, and intensity. The data represents more than $1 trillion in spending from 2000 to present and is expected to be updated twice a year and will no doubt be the richest source of cost and utilization data ever assembled.  Researchers hope to improve understanding of health care costs and utilization in the US, and help policymakers develop effective solutions to the long-term problems facing the health care system.

Several major health insurers have agreed to provide their claims data to academic researchers; in an unusual agreement that they say will open a window onto the rising costs of health care. Researchers have struggled to perform such studies on the commercially insured population. They often turn to Medicare data, which reflect a mostly elderly patient base as well as the federal government’s unique payment model. The Health Care Cost Institute will start with claims from UnitedHealth Group Inc., Aetna Inc., Humana Inc. and the nonprofit Kaiser Permanente; these carriers are also providing initial funding to set it up.

The initiative has been five years in the making; it’s overcome the many bureaucratic, privacy and technical obstacles of creating a single claims data base. While it has been acknowledged for these achievements, its bounty of information is just now being tapped, affording analysis of provider performance and cost without a filter of the over 65-year-old patient view.

Although claims data lacks the detailed information contained in an electronic medical record it provides a broader look at health care utilization across a wider spectrum of patients, providers, and geographical communities.

Amassing these data in one place doesn’t solve the problems of content and coding differences between the original applications. Managing the interoperability problems within a single data warehouse presents a requirement and challenge of formidable magnitude. Solutions will require another approach to bring information and meaningful use closer to the point of care.

The next steps involve the development of a universal exchange language to enable providers to integrate patient information without the requirement to transfer the data to a national database. This approach requires a common infrastructure for locating and assembling individual elements of a patient’s records, via secure “data element access services” (DEAS).  Records will remain in their original locations. Distinct DEAS could be operated by care delivery networks, by states or voluntary grouping of states, or possibly with a national DEAS for use by providers. All DEAS will be interoperable and intercommunicating, so that a single authorized query can locate a patient’s records across multiple DEAS.

Another five years or more will be required before providers grant real time access to clinical records to evaluate the cost and delivery effectiveness, incentives lack sufficient compensation to offset the provider’s perceived risks.  But maybe that is what accountable care is all about.