Health Insurers Pool $1 Trillion in Medical Claims Data to Spot Trends

Major health insurers are pooling more than $1 trillion in claims data and creating an institute to cull the statistics and identify the drivers of higher health spending.

More than 5 billion medical claims from Aetna Inc. (AET), Humana Inc. (HUM), Kaiser Permanente and UnitedHealth Group Inc. (UNH) will be collected and combined with government health claims data by the newly formed Health Care Cost Institute. The nonprofit group, which will likely be housed in Washington, will begin publishing semi-annual scorecards beginning next year on spending and consumption of health-care services and products.

Policy makers and researchers have been frustrated by the limited availability of information from commercial insurers, who provide coverage for about two-thirds of Americans with insurance, said Martin Gaynor, a professor of economics and public policy at Carnegie Mellon University in Pittsburgh who will lead the institute. Much of the available data now comes from Medicare, the U.S. health program for the elderly and disabled.

“You literally can’t know too much as one of my colleagues likes to say,” Gaynor said in a telephone interview. “We have not been getting a very complete picture of what has been driving our health spending and utilization, and that restricts our ability to make policy.”

The insurers are providing an undisclosed amount of initial start-up money.

Soliciting Data

Gaynor said the organization will talk to other health insurers and the Centers for Medicare and Medicaid Services in Baltimore to solicit their participation and data. The institute is collecting data from 2000 to the present covering more than 5,000 hospitals and 1 million doctors and other health-care providers.

The information, which carries no individual identities, will be made available to researchers whose proposals are accepted by the institute. Insurance companies won’t be allowed to see information submitted by competitors, only aggregate numbers. Researchers will have to have grants or pay their own expenses. The participating insurers are providing initial start-up money and covering the cost of transferring their data to the institute, Gaynor said.

To contact the reporter on this story: Pat Wechsler in New York at pwechsler@bloomberg.net

To contact the editor responsible for this story: Reg Gale at rgale5@bloomberg.net

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