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11/20/2018 14:58 EST
Application Amendment to #SE3 Advance-CTR multi-project license
11/20/2018 14:44 EST
Application for HealthFacts RI standard extracts
11/20/2018 14:43 EST
Application for HealthFacts RI standard extracts
08/20/2018 16:22 EDT
Application for HealthFacts RI standard extracts
08/20/2018 16:21 EDT
Application amendment

HealthFacts RI Database

Purpose

To identify healthcare cost savings, healthcare quality and health outcome improvement opportunities.

Key Information

Healthcare insurance payment information for people with health insurance living in Rhode Island. Includes data on demographics and health status, medical services, emergency room visits, pharmacy services, healthcare providers and member enrollment. The database does not include: information on individuals who do not have health insurance, healthcare services paid directly by an individual, free healthcare, dental services, claims by insurance companies with fewer than 3000 members, and some members who have insurance through a self-funded employer. The database includes information on over one million people, and most insured Rhode Island residents.

Collection Period

From 2011 to present for private health insurers and Medicaid. Medicare fee-for-service from 2011 to 2016.

How Data are Collected

Data are gathered from health insurance payment systems. The data does not have any names, addresses, or other personally identifying information. The information is anonymous, as it cannot be linked to particular people. Rhode Island residents have the opportunity to opt out of the database at any time.

How Data can be Used

Data can be used by healthcare consumers, researchers, providers, health insurers and others to examine data on healthcare use, quality, and spending, and identify opportunities for improvement. Examples of potential uses include measuring healthcare provider performance, tracking potentially preventable emergency room visits, and monitoring the growth of patient-centered medical homes.

How to Request Data

HealthFacts RI has different data products available for request. For questions about data requests, contact DOH.healthfactsri@health.ri.gov

There is a $100 application fee for applications submitted.

Summary Tables and Reports

Summary data tables and reports are available to the public free of charge online. These reports are highly summarized and can be used to:

  • Inform consumers on key healthcare issues;
  • Highlight issues to policymakers;
  • Provide statistics for grant applications;
  • Track healthcare spending and utilization trends overtime.

The State has published three reports: Potentially Preventable Emergency Room Visits, A Preliminary Look at Chronic Conditions in Rhode Island, and Potentially Preventable Readmissions Related to Behavioral Health. Requesters should review these reports before requesting additional data to determine if these reports and tables will meet their needs.

Standard Claims Extracts

Standard claims extracts contain de-identified, individual member-level detail that may be used for research purposes and statistical analyses. These extracts can be used to:

  • Evaluate interventions and policy changes;
  • Identify cost drivers and spending trends;
  • Compare healthcare quality across providers;
  • Evaluate effects of new treatment;
  • Compare payers’ or employers’ population health to statewide averages.

There are two types of standard extracts available for both medical claims and pharmacy claims. The Core Extract contains a lower level of detail in that only service month and year, and member state and 3-digit zip code are reported. The Extended Extract contains the full date of service and member city, state, and 5-digit zip code. The Data Elements Dictionary provides a full description of the data elements available in each standard extract. Standard extracts require a full application and review process.

There are three options for requesting Standard Claims Extracts:

Single Use, Single Agency

If you need standard extracts for a single project for your organization, follow the instructions on the Standard Claims Extract Online Application. Once submitted, the application will be posted to the HealthFacts RI webpage for public comment for 10 business days. The application is then reviewed by the Data Security Committee, Data Release Review Board and the Director of the Department of Health for approval.

A single use, single agency license costs $25,000 and includes all types (medical and pharmacy claims, enrollment and provider information) and all years of data (including new years of data when available).

Multi-Use, Single Agency

If you anticipate using standard extracts for multiple projects within your organization, we recommend applying for a multi-use, single agency license. To request a multi-use, single agency license, follow the same request process as for a single use, single agency license. Multi-project licenses require the requester to submit an initial application for review for the subscription, and a new application for each new project that will use the data.

This multi-use, single agency license costs $50,000 per year (licenses are renewed annually) and includes all types (medical and pharmacy claims, enrollment and provider information) and all years of data (including new years of data when available).

Multi-Use, Multiple Agencies

If you anticipate using standard extracts for multiple projects across multiple agencies (through a formal partnership or coalition), we recommend applying for a multi-use, multi-agency license. To request a multi-use, multi-agency license, follow the same request process as for a single use, single agency license. Multi-project licenses require the requester to submit an initial application for review for the subscription, and a new application for each new project that will use the data.

A multi-use, multi-agency license costs $87,500 per year (licenses are renewed annually) and includes all types (medical and pharmacy claims, enrollment and provider information) and all years of data (including new years of data when available). Multi-project, multi-agency licenses have a five-project maximum.

Custom Requests

Custom requests are for data that is not already available on the HealthFacts RI website, and for which standard claims extracts are not appropriate. This may include custom aggregated reports, or custom extracts. Requesters can apply for custom data by following the instructions on the Custom Request Online Application. Requests will require review by the Data Security Committee, Data Release Review Board, and approval by the Director of the Department of Health when:

  • Individual claims with member level detail are included (e.g. unique member ID, 5-digit zip code, etc.);
  • Results of cells based on fewer than 11 members are displayed.

Requests for custom aggregate data in which cells based on fewer than 11 members are not displayed do not require a full review and approval process. Prices for custom requests are determined on a case-by-case basis.