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12/08/2016 14:46 EST
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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. The database includes information on four out of five Rhode Islanders (824,537 residents in 2014, or 78% of the population).

Collection Period

From 2011 to present for private health insurers and Medicaid. Medicare fee-for-service from 2011 to 2013.

How Data are Collected

Data are gathered from health insurance payment systems and de-identified. Names, addresses, and other personal information is removed. 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 levels of data available for request. For questions about requesting data, contact DOH.healthfactsri@health.ri.gov

Level 1 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 by 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 reiew these reports before requesting additional data to determine if these reports and tables will meet their needs.

Level 2 Aggregate Data Sets

Level 2 data are summary data sets that are not publicly available on the Department of Health website. The State plans to make Level 2 data products available for request in 2017. Pricing for Level 2 products is to be determined.

Level 3 Claims Extracts

Level 3 data refers to pre-built, claims-line level extracts with de-identified, individual member-level detail that may be used for research purposes and statistical analyses. Examples of how these extracts can be used include:

  • 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 pre-made 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 Level 3 Data Elements Dictionary provides a full description of the data elements available in each extract.

The State charges the following fees for Level 3 extracts:

  • Academic researchers, government agencies, and data submitters: $7,000 per extract per year of data requested;
  • Others: $20,000 per extract per year of data requested.

These fees are intended to recover the costs associated with developing the data products and making them available for request. Level 3 extracts require a full application and review process.

Requesters can apply for the data by following the instructions on the online application. Before beginning the online application, requesters should review the Copy of the HealthFacts RI Level 3 Application to determine what information they will need in order to complete the application.

HealthFacts RI anticipates making additional levels of data available in the future.