Virginia Health Sector Embraces Big Data

Michael Lundberg, head of Virginia Health Information, oversees the all-payer claims database. The database represents the culmination of years of work using data to create transparency and accountability to Virginia's health care sector.

Michael Lundberg, head of Virginia Health Information, oversees the all-payer claims database. Photo credit: Virginia Business.

At long last Virginia has a consolidated medical claims database that insurers and employers can access to help improve health outcomes. The state’s All-Payer Claims Database consolidates “hundreds of millions” of paid claims from 2011 to 2015 into a single database. As Bob Burke writes in Virginia Business magazine:

Self-insured businesses can study the outcome of the health care their employees are getting and figure out what works and what doesn’t work. Accountable care organizations — which can be groups of doctors, hospitals or other health-care providers — can measure the health outcomes for the population they are treating.

Hospital departments at the regional and state level can evaluate the needs of specific population groups, and insurers can evaluate the effectiveness of treatments and the costs.

Other potential uses of the database: Finding out how many name-brand drugs are being prescribed versus generic drugs; revealing how often physicians are prescribing opioid pain killers and which parts of the state have higher rates of opioid abuse.

The creation of a unified database of medical claims has been years in the making. It hasn’t been easy getting buy-in from all the state’s major insurers as well as the state agency that administers Medicaid. (Apparently missing from the database is Medicare.) All-payer databases began catching on about a dozen years ago, according to Burke. About 30 states either have established the databases or have expressed a “strong interest” in doing so.

There aren’t many positive stories coming out of the health care policy arena, but this is one of them. Virginia insurers, hospitals, physicians and public health administrators have an opportunity to utilize big data to improve health outcomes in the state… and just in the nick of time, as I’ll get to in my next post.

— JAB

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4 responses to “Virginia Health Sector Embraces Big Data

  1. I would hope this also lends itself to catching more Medicare and other insurance fraud.

  2. a couple of things –

    – we KNOW about fraud in Medicare precisely because the govt collects the statistics and makes them public while private insurance often does not.

    then opponents of Medicare USE it to argue against Medicare itself!

    second – the single most important thing that Medicare could do to tamp down fraud would be to restore the 20% co-pay provision so that all consumers of Medicare have some skin in the costs.

    Medicare Advantage (known as Part C) and to a lesser extend Medicare Part D – both heavily subsidized by taxpayers – totally encourage an “all you can eat” mentality among those who use Medicare for things that are discretionary.

    Then if you REALLY want to address reform – you charge more than 105.00 a month for insurance for people who can make up to 85K a year in retirement income and hold a million dollars in assets.

    Finally – WHY do we pay for nursing homes with MedicAid for folks who own their own homes and have a million or more in assets – then in Virginia – cry about the “crushing” costs of MedicAid and actually use it as an excuse for not expanding MedicAid to truly destitute folks?

    so the biggest fraud the way we ourselves have allowed Medicare AND MedicAid to be corrupted and abused beyond their original purpose and intent.

    Again I remind folks – this is coming from the guy that Bacon, and Don and others here routinely label as a “liberal” – “progressive”

  3. It would be useful if private insurers could publish aggregate statistics on fraud and prevented fraud. Maybe some do, but I’ve not seen them.

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