This new dataset offers both benchmark charges and allowed costs, specific to 493 regions across the country, for procedures related to defined episodes. The benchmarks are based on market-level data from privately billed healthcare claims contributed to FAIR Health by insurers and claims administrators; they represent the claims experience of more than 150 million individuals nationwide.
Benchmarks are available for more than 40 common procedures and illnesses, ranging from hip replacement to diabetes care. For each episode, the product identifies the costs of treatment based on the total costs for all procedures and services that compose a patient's beginning-to-end treatment path for a specific condition or procedure. For example, in the case of a hip replacement, the episode might include the cost of physician and surgeon consultations, anesthesia, the surgery itself, medications, physical therapy and other required services.
The FH Episodes of Care Benchmarks product also allows users to adjust cost estimates based on a patient's specific profile—including up to five common comorbidities and five risk factors per episode—providing an exceptionally precise, real-world view of overall expenses. Thus, depending on the severity of patients' conditions and associated comorbidities, tailored, risk-adjusted cost estimates can be developed. FAIR Health's versatile product will be of particular utility to insurers, policy makers, government entitles, providers, healthcare systems and others seeking insight into value-based reimbursement and related pricing studies, provider budgeting, network building and more.
The FH Episodes of Care Benchmarks uses the PROMETHEUS Payment® model of Altarum Institute. Francois de Brantes, vice-president and director of Altarum's Center for Payment Innovation, stated, "Pricing transparency is a necessity for consumers to make informed decisions and to make the healthcare market work. FAIR Health's use of the PROMETHEUS episode definitions allows them to leverage an industry standard when exposing critically important pricing information to consumers."
"It is truly exciting to marry FAIR Health's massive claims data collection with this platform for defining episodes," noted FAIR Health President Robin Gelburd. "While the FH Episodes of Care Benchmarks product is especially suited to the needs of health plans, healthcare systems, consultants, researchers and others studying the healthcare sector, it also represents a major step forward in FAIR Health's mission of improving the general public's understanding of the true cost of healthcare through the dissemination of transparent, independent market-level data. Consumers, like other healthcare stakeholders, benefit from gaining a three-dimensional view of medical procedures and conditions."
About FAIR Health
FAIR Health is a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health oversees the nation's largest repository of private healthcare claims data, comprising over 23 billion billed medical and dental charges that reflect the claims experience of over 150 million privately insured Americans. FAIR Health licenses its data and data products—including data visualizations, custom analytics, episodes of care analytics and market indices—to commercial insurers and self-insurers, employers, hospitals and healthcare systems, government agencies, researchers and others. FAIR Health has been certified by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity, eligible to receive all Medicare Parts A, B and D claims data for use in nationwide transparency efforts. FAIR Health data are referenced in statutes and regulations around the country and have been designated as the official, neutral source of cost information for a variety of state health programs, including workers' compensation and personal injury protection (PIP) programs. Many states have approached FAIR Health with respect to proposed consumer protection laws governing balance billing for surprise out-of-network bills and emergency services, and two states have made FAIR Health a standard in their balance billing legislation. FAIR Health uses its database to power a free consumer website, available in English and Spanish and as an English/Spanish mobile app, that enables consumers to estimate and plan their healthcare expenditures. FAIR Health also offers a rich educational platform on health insurance on its website and app. The website has been honored by the White House Summit on Smart Disclosure, the Agency for Healthcare Research and Quality (AHRQ), URAC, the eHealthcare Leadership Awards, appPicker, Employee Benefit News and Kiplinger's Personal Finance. For more information on FAIR Health, visit fairhealth.org.
Executive Director of Communications and Public Relations
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SOURCE FAIR Health