July 8, 2014: The Health Care Cost Institute (HCCI) announced today that the Centers for Medicare & Medicaid Services (CMS) has certified HCCI as the first national “Qualified Entity”

Jemma Weymouth, 301-280-5706

Health Care Cost Institute’s National Cost and Quality Reporting Effort Gains Momentum With CMS Granting HCCI Access to Medicare Data

CMS’ “Qualified Entity” Certification Gives HCCI Opportunity to Track and Report on Medicare Provider Care Costs and Quality in All 50 States

Washington, DC —AThe Health Care Cost Institute (HCCI) announced today that the Centers for Medicare & Medicaid Services (CMS) has certified HCCI as the first national “Qualified Entity” (QE), making it the first organization to have full access to national Medicare claims data for reporting on the costs and quality of health care services. Having access to the national CMS cost data set will enable HCCI to build on its robust commercial health plan data set and offer the most comprehensive information available about the price and quality of health care services.

Created as part of the Affordable Care Act, the Qualified Entity Program permits select organizations to combine Medicare Parts A, B, and D claims data from CMS with other payer data to evaluate the performance of providers, services, and suppliers in the health care sector, among other things. As a Qualified Entity, HCCI will have access to 100 percent of the nation’s traditional Medicare claims data and about 40 percent of Medicare Part D prescription drug claims data. HCCI also currently holds data on roughly 40 percent of the Medicare Part C (managed care) population.

HCCI currently holds one of the largest private health insurance claims databases available for public reporting and academic research purposes. The addition of comprehensive Medicare claims data will now afford HCCI a unique and unprecedented opportunity to track and publicly report on health care trends using both public and commercial data. Moreover, HCCI intends to convert its access to the Medicare data to a research license to pursue a broad research agenda using the combined dataset containing information on more than 100 million individuals.

“The national Medicare cost data set will be a powerful addition to the HCCI transparency initiative, providing essential information to help us better understand what is needed to improve the quality and performance of the U.S. health system,” said David Newman, executive director of HCCI. “Public reporting, as permitted with these data, when combined with cost and quality data from commercial health plans and state Medicaid data will represent the most credible information source for consumers, regulators and employers on health care cost and quality variation.”

Health care costs have been rising more than three times as fast as wages. Official estimates project that U.S. health spending will reach $4.7 trillion by the end of the decade – an 80 percent increase from $2.6 trillion in 2010 – underlining the need to better understand the prices of health care services to help make decisions and choices about purchasing care.

The independent, not for profit HCCI announced in May that it will create and administer an information portal that will provide consumers, employers and regulators free access to consistent, comprehensive information about the price and quality of health care. Aetna, Humana, and UnitedHealthcare have agreed to provide information on health care costs to HCCI, which will maintain and manage access to the information in a highly secure, protected environment. Other participating commercial insurers will be announced soon. The new online tool is expected to be available in early 2015.

Other major commercial carriers have expressed interest and HCCI expects additional carriers to participate in the near future and be part of the initial release in early 2015. The cost data will be supplemented with quality and other information to provide consumers a transparent and comprehensive destination to make more informed decisions about health care.


About the Health Care Cost Institute
The Health Care Cost Institute promotes independent, nonpartisan research and analysis on US health care spending. HCCI believes a better understanding of the forces driving health care cost growth will help policy makers, researchers, and the public make decisions that will lead to more accessible and affordable care. HCCI is governed by an independent board that includes distinguished economists, actuaries and health care experts. For more information, visit www.healthcostinstitute.org or follow us on Twitter @healthcostinst

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