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HEALTHCARE CLAIMS DATABASE AND DATA PRODUCTS

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Background

FAIR Health Founded 2009Emerged from NYS Attorney General Investigation

into OON Reimbursement/$95 million settlement Independent Not-For-Profit OrganizationNew Database and Enhanced Data ProductsFree Consumer Website Promoting Cost

TransparencyData Available for Research and Innovation: FAIR

Health Research Support Program featuring the FH National Private Insurance Claims (FH NPIC ) Database ℠

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Data Assets

Charge data from 2002 to PresentNational in scope – 491 geozips Over 70 data contributors – health plans, insurance carriers, third

party administrators126 million covered livesCurrently over 14 billion billed

medical and dental proceduresRobust auditing and validation

programLargest independent private claims

collection in the country

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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

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FH NPIC Data Products 2 - FH NPIC SAF

FH NPIC Standard Analytic File (SAF)Underlying claims data, de-identifiedAvailable by year and geographic region Research Support Program launching July 1Streamlined application processLicense fees scaled based on data

volume, length of license and nature of use

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FH Consumer Cost Lookup

www.fairhealthconsumer.orgFree on-line resource for consumers to estimate medical and

dental fees in their areaIncludes Medicare-based reimbursement comparisonIncludes 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

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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

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Connecting

Facebook: www.facebook.com/fairhealthTwitter: @fairhealthUpcoming 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, ragostinelli@fairhealth.org Linda Stelmach, Director of BD, lstelmach@fairhealth.org Ben Casado, CTO, bcasado@fairhealth.org 212-370-0704