To identify healthcare cost savings, healthcare quality and health outcome improvement opportunities.
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.
More than twenty public facing, interactive reports have been developed using HealthFacts RI data, Rhode Island’ All-Payer Claims Databased (APCD). Reports include those related to COVID, rates on firearms injuries, behavioral health, preventive services, and more. HealthFacts RI Interactive Public Reports
From 2011 to 2019 for private heath insurers and Medicaid. For Rhode Island state agencies and requesters working on behalf of the state, Medicare Fee-for-Services data is available from 2011-2018 (Medical) and 2011-2017 (Pharmacy).
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.
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.
HealthFacts RI has different data products available for request. For questions about data requests, contact DOH.email@example.com
There is a $100 application fee for applications submitted.
Summary data tables and reports are available to the public free of charge online. These reports are highly summarized and can be used to:
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 contain de-identified, individual member-level detail that may be used for research purposes and statistical analyses. These extracts can be used to:
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:
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).
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).
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 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:
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.
Although the Rhode Island APCD contains no information that could directly identify a person (e.g. name, address, SSN) requesters can receive de-identified medical and pharmacy claims for a specific group of individuals. This can be achieved using the APCD’s “lockbox” capabilities. Using the file specifications found here, requesters can submit identifiable member information to the lockbox vendor (e.g. names, date of birth, address, etc.) and receive back from the APCD, deidentified, member-level claims information for those individuals only (i.e. without knowing who is who). Please email DOH.HealthFactsRI@health.ri.gov for more information on the request process and product offerings.