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03/17/2017 11:32 EDT
Custom Request Application for HealthFacts RI Data
03/09/2017 13:56 EST
Custom Request Application for HealthFacts RI Data

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

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 VisitsA 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: more

One-time request

For a one-time request for standard claims extracts, 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 Release Review Board and the Director of the Department of Health for approval.

The State charges the following fees for one-time requests for standard extracts:

  • Academic researchers, government agencies, and data submitters: $7,000 per extract per year of data requested;
  • Others: $21,000 per extract per year of data requested.

Single-project subscription

This is an annual subscription for standard claims extracts to be used for a single project. The subscription includes:

  • Initial delivery of requested standard claims extracts;
  • Quarterly or annual data refreshes of the two most recent years of data requested, plus extracts for any new year of data available.

To request a single-project subscription, follow the same request process as for a one-time request.

The State charges the following fees for single-project subscriptions for standard extracts:

  • Academic researchers, government agencies, and data submitters: $7,000 per extract per year of data requested for initial delivery; $7,000 for each refresh (refresh price includes all extracts and years of data);
  • Others: $21,000 per extract per year of data requested; $21,000 for each refresh (refresh price includes all extracts and years of data).

Multi-project institutional subscription

This is an annual subscription license for research and other institutions to use standard claims extracts for multiple projects. The subscription includes:

  • Initial delivery of requested standard claims extracts;
  • Quarterly or annual data refreshes of the two most recent years of data requested, plus extracts for any new year of data available.

Multi-project subscriptions 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. Price is determined on a case-by-case basis, depending on the number of extracts and refreshes needed, and the number of individual projects using the data. If you are interested in applying for a multi-project institutional subscription, please contact the HealthFacts RI team at DOH.healthfactsri@health.ri.gov.

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 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. more