The Office of Personnel Management plans to create a health claims database from which it can analyze and track health trends and costs based on medical claims submitted by physicians and hospitals for federal employees and others covered by federal health plan options.
The health reform law called for the creation of the database, which OPM will start Nov. 15, the agency said in an announcement.
Analysis from the claims will enable OPM to develop statistical models, such as for methods to reduce risk in patients and improve outcomes, track pharmacy pricing, better prepare for health plan negotiations and make health care program changes, according to the notice Oct. 5 in the Federal Register.
The information will come from healthcare providers in the Federal Employee Health Benefit Program and the National Pre-existing Condition Insurance Program, a plan started in August under the health reform law, which offers coverage for high risk pools of individuals.
OPM will add data from the Multi-State Option Plan, another coverage plan that the health reform law authorized, when it begins in 2014.
OPM will collect and analyze health services data by establishing regular data feeds from each of the health insurance programs. The data may include personally identifying information, such as patient name, Social Security number, addresses, medical diagnosis, healthcare provider information and their reimbursement costs.
OPM said it will protect the information according to safeguards under the Privacy Act, which established a code of fair information practices on the collection, storage and disclosure of personally identifiable information in federal systems. Agencies are required to announce when they plan to collect personal data in a system of records that is covered by the Privacy Act.
In many instances, the data will be stripped of personally identifying information to allow researchers to query the data based on general demographics, risk-adjusted profiles and comparison of chronically ill patients, OPM said.
OPM will restrict access to the records on the database to employees who have the appropriate clearance and the need to know to perform their official duties. The database will run on a secured system, the agency said.
