HealthFacts RI Reports

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To submit a public comment related to any of the posted applications, please email DOH.healthfactsri.@healthri.gov.

HealthFacts RI Database

Background

HealthFacts RI is Rhode Island’s All-Payer Claims Database (RI APCD), a large-scale database that systematically collects healthcare claims data from a variety of payer sources, including Medicare, Medicaid, and RI’s largest commercial payers. In 2008, RI passed legislation to enable a healthcare database to collect healthcare claims data from payers. In 2013, the Regulations were issued to provide data collection guidelines and data release policies and procedures.

Purpose

The purpose of HealthFacts RI is (1) to identify areas for improvement, growth, and success across the healthcare system; (2) to understand and quantify health system performance and healthcare transformation; and (3) to provide meaningful comparison and actionable data and reports to help inform policy and consumer decisions.

Data Collected

HealthFacts RI includes data from commercial, Medicare, and Medicaid payers who have more than 3,000 covered lives in Rhode Island. Data collection has been ongoing since 2014. Payers are required to regularly submit six types of files to the database. 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 can opt out of the database at any time.

Opt-Out Portal Accessible here: Opt-Out Portal

File Type File Description
Eligibility Includes medical, dental, and pharmacy enrollment information for the members covered by each payer during the reporting period. Files include member demographic information and information regarding an individual’s plan and coverage type.
Medical Claims Includes information on the medical services rendered to covered individuals during the reporting period. This file contains a wealth of useful cost and utilization data, such as diagnosis and procedure codes, charge amount, paid amount, copay amount, deductible amount, type of setting, and rendering/billing provider information, etc.
Dental Claims Includes information on the dental services rendered to covered individuals during the reporting period. Among the data elements submitted in this file are procedure code, charge amount, paid amount, copay amount, deductible amount, rendering/billing provider information, dental quadrant, and tooth surface codes, among other data.
Pharmacy Claims Includes information on pharmacy services rendered to covered individuals during the reporting period. Among the data elements submitted in this file are National Drug Code, national pharmacy ID, prescribing provider information, generic/brand drug indicator, plan paid amount, copay amount, and deductible amount.
Provider Includes information on the providers associated with the medical, dental and pharmacy services submitted during the reporting period. These files contain data related to healthcare providers themselves, including elements such as National Provider Identifier, provider name, provider specialty, and provider geographic information (e.g., city, ZIP code, etc.)
Alternative Payment Model (APM) Includes non-fee-for-service (non-claims) payments. APM data supplements claims payment data to provide a full picture of healthcare payments. Types, amounts, and covered services under APMs vary across contracts and payers. Examples of APM (non-claims) payments are care management fees, incentive payments, infrastructure and operations payments, shared savings payments and risk settlements, and population-based payments.
CurrentCare Includes supplemental Race and Ethnicity data provided by the state’s HIE.

Data Available

A snapshot summary of all of the data available in the APCD is updated quarterly as new data is collected. The summary provides an overview of the number of unique payers, members, and claims available in the database. Drill-down detail is available by both claim type and date range for the 10 payers with the highest volume of unique members.

Accessible here: APCD Data Availability Dashboard

Data Use Cases

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.

APCD Data Requests

HealthFacts RI offers a variety of data products including Summary Tables and Reports, Standard Claims Extracts, and Custom Requests. Data Requests and general inquiries can be emailed to: DOH.healthfactsri@health.ri.gov

Published HealthFacts RI Reports

More than twenty interactive reports have been developed using HealthFacts RI data. Reports include those related to COVID, rates on firearms injuries, behavioral health, preventive services, and more.

Accessible here: HEALTHFACTS RI INTERACTIVE PUBLIC REPORTS

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, and compare payers’ or employers’ population health to statewide averages.

Two types of standard extracts are 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.

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.

There are three options for requesting Standard Claims Extracts:

1. Single Use, Single Agency

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).

2. 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).

3. 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 or when 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.

Requesting Claims for Specific APCD Members

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.