Tracking spending among commercially insured beneficiaries using a distributed data model

Am J Manag Care. 2014 Aug;20(8):650-7.


Objectives: To explore the feasibility of using a distributed data model for ongoing reporting of local healthcare spending, specifically to investigate the contribution of utilization and pricing to geographic variation and trends in reimbursements for commercially insured beneficiaries younger than 65 years.

Study design: Retrospective descriptive analysis.

Methods: Commercial claims were obtained for beneficiaries in 5 states for the years 2008 to 2010 using a distributed data model. Claims were aggregated to the hospital service area (HSA) level and healthcare utilization was quantified using a novel, National Quality Forum-endorsed measure that is independent of price and allows for the calculation of resource use across all services in standardized units. We examined trends in utilization, prices, and reimbursements over time. To examine geographic variation, we mapped resource use by HSA in the 3 states from which we had data from multiple insurers. We calculated the correlation between commercial and Medicare reimbursements and utilization. Medicare claims were obtained from the Dartmouth Atlas.

Results: We found that much of the recent growth in reimbursements for the commercially insured from 2008 to 2010 was due to increases in prices, particularly for outpatient services. As in the Medicare population, resource use by this population varied by HSA. While overall resource use patterns in the commercially insured did not mirror those among Medicare beneficiaries, we observed a strong correlation in inpatient hospital use.

Conclusions: This research demonstrates the feasibility and value of public reporting of standardized area-level utilization and price data using a distributed data model to understand variation and trends in reimbursements.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Health Expenditures / statistics & numerical data*
  • Humans
  • Insurance Claim Review
  • Insurance, Health / economics*
  • Insurance, Health / statistics & numerical data
  • Male
  • Medicare / economics
  • Medicare / statistics & numerical data
  • Middle Aged
  • Models, Statistical
  • Retrospective Studies
  • United States
  • Young Adult