Unlocking the possibilities of closed and open claims data
HealthVerity was honored to have been chosen as the first partner in Inovalon’s newly established Preferred Data Partner Program. Having been a private source in HealthVerity Marketplace as Source 14 and Source 20 since Inovalon first came to market, many of our clients did not know that Inovalon was the company behind the data and sought to learn more about this newly announced partnership. In response, HealthVerity recently hosted a webinar to delve more deeply into its long-standing relationship with Inovalon. If you missed the webinar, now available for replay in HealthVerity Marketplace, here’s a recap:
Who is Inovalon and how do they source their data?
Inovalon is a leading provider of cloud-based software solutions empowering data-driven healthcare, powered by the Inovalon ONE Platform®. They offer deep analytics for payers to measure quality of care, risk adjustment and disease burden, de-identifying data that is used to drive outcomes.
For 25 years, Inovalon has worked with thousands of customers representing 23 of the top 25 U.S. health plans, all of the top 25 U.S. provider systems, seven of the top 10 specialty pharmacy companies and 17 of the top 25 pharmaceutical companies.
“That has enabled us to have the largest primary source, de-identified dataset with thousands of data access rights. That’s powering what was previously known as Source 14 and 20,” explained Kris Volrath, Inovalon senior vice president of product. “Our tagline is data has a story to tell, we give it a voice. We see the voice with HealthVerity... You provide an amplification in how we use data to tell a better story in healthcare and ultimately improve outcomes.”
What kind of data does Inovalon offer?
Inovalon is the largest closed claims data source in the nation offering a diversified mix of commercial, Medicaid and Medicare claims. They are also a significant open claims source, especially for Medicare fee-for-service. Specifically, Inovalon’s dataset offers:
Working across product lines (commercial, Medicare and Medicaid) allows you to study the longitudinal journeys of patients over the long term, including the impact of plan movements such as switching commercial insurance plans, bouncing between Medicaid and commercial, or aging into Medicare. The data is also geographically diversified with patients in all 50 states and Puerto Rico. Consistent with HIPAA, all data is de-identified and the closed payer data is refreshed on a monthly basis.
Inovalon provides a comprehensive and diversified dataset to address gaps in care and allow for groundbreaking research, especially when synchronized with other data sources in HealthVerity Marketplace. This includes other closed payer claims sources, such as BHI and Evernorth for a total of 165 million patients, and additional open claims sources representing three of the top four clearinghouses in the U.S. for a total of over 300 million patients. Additionally, HealthVerity Marketplace represents 65% of the outpatient lab market, including both Labcorp and Quest, hospital chargemaster data, and social determinants of health data sources.
What constitutes a closed claim and why is it important?
A closed claim is sourced from health insurance providers, also known as payers, and represents the payer’s adjudication and payment of a physician claim, generally three to six months in arrears of the date of service. Closed claims capture nearly all of a patient’s healthcare activities across settings while the patient is enrolled. If a patient changes health plans, you may no longer be able to access their data if the new payer’s data is not visible across the licensable data ecosystem.
“Closed claims are the gold standard when you think about health economics, outcomes, clinical, commercial research,” Volrath said. “They help us understand what actually happened with the patient, versus the prescription that was written but never filled. Closed claims identify what actually happened.”
What constitutes an open claim?
An open claim is sourced from clearinghouses that transmit data from the healthcare provider to the appropriate insurance provider, generally with a lag of one day to one week. Open claims offer a view of a patient’s relationship with a physician or pharmacy, but only for those providers in available clearinghouse or pharmacy feeds. Open claims are ideal for studying a patient’s interaction with a physician or pharmacy over a longer period of time, as clearinghouses don’t experience a lot of churn.
(For more information, see our blog post on open claims vs closed payer claims.)
What is the Inovalon Preferred Data Partner Program and what does HealthVerity being the first partner mean for me?
“The program formalizes our relationship with HealthVerity and we’re ecstatic to have HealthVerity as the first partner in the program,” Volrath said. “When we think about what the program does, it’s how we empower research, analysis and data-enabled solutions in a way that really wasn’t possible before. We looked across the industry and said who is best positioned to bring the value of the data asset to market the fastest and, more importantly, synchronize it with other data that’s not in our ecosystem and really make meaningful change. I think the partnership just unlocks opportunities for us to collectively advance research across the ecosystem of HealthVerity.”
What other opportunities are available?
As a Qualified Entity, Inovalon has access to the breadth of Medicare fee for service data from CMS. While this data cannot be licensed to clients, with the Preferred Data Partner Program, Inovalon can offer HealthVerity customers analysis and perform bespoke analytics projects using this data that they have been collecting for 14 years, which can be matched up with their other data assets. The Medicare fee for service data includes:
- 99.7 million unique beneficiaries
- 19.1 billion medical events
- 17.2 billion pharmacy events
- 1.1 million physicians
- 431,000 facilities
“This is data that’s interesting and I think it’s an opportunity for us to work together as two organizations to put our data scientists on top of this, combined with all the data information that HealthVerity has, to really bring new solutions and project work to your market customers,” Volrath said.
What else can you accomplish with open and closed claims?
Synchronizing open and closed claims in combination with other data types, HealthVerity has elevated the dataset to a masterset. With the breadth of data and the relationships that HealthVerity has with data providers, such as Inovalon, we have been able to secure permission from data owners to build syndicated products known as HealthVerity Mastersets. A Masterset is expertly curated by our team to build the most relevant journey for the therapeutic area that you’re studying.
Our newest Masterset is the Mortality Masterset, which is focused on cause of death. We developed the Mortality Masterset in partnership with Veritas Data Research whose Fact of Death dataset contains over 130 million death records going back to 1935 from more than 40,000 public and private sources. We synchronized this data with a syndicate of open and closed medical claims from the HealthVerity data ecosystem to determine the most likely cause of death using an advanced analytics engine to process the synchronized data, retracing each patient’s medical history back 36 months prior from the date of passing.
We developed this product because determining an accurate cause of death today is challenging. Oftentimes death certificates themselves are inaccurate. There is also a lag time of nine to 12 months to get death certificates from the CDC, who collects them. Access to death records is also restricted and not allowed for commercial applications. Additionally, death records are not de-identified and are not easily matched with other records.
The HealthVerity Mortality Masterset is pre-assembled, research-ready and can be seamlessly synchronized with other data sources. It includes:
- The fact of death, including the month and year of death
- Primary and secondary causes of death
- Confidence score, with 80% of patients having over a 90% confidence score
- Likelihood score that the reported indication is the primary cause of death
- Universal HealthVerity ID that allows each deceased patient to be synchronized across data sources
The Mortality Masterset joins a suite of HealthVerity Mastersets, including the:
- Chronic Kidney Disease (CKD) Masterset - Gain speed to insight with our expertly curated CKD Masterset that compiles all of the relevant clinical attributes into a research-ready dataset to help you better understand the CKD patient journey.
- Maternal Outcomes Masterset (MOM) - Generate reliable real-world evidence for your pregnancy studies with MOM, which synchronizes the de-identified healthcare records of more than 2 million pregnant women to their newborns.
- Provider Diversity and Diagnosis Index (PDI) Masterset - Enhance diversity in clinical trials by leveraging our PDI Masterset that assesses the demographic composition and diagnosis of 2 million healthcare providers’ patient populations.
1 Inovalon Insights Commercial, Medicaid and Medicare Advantage enrollment statistics are a 3-year rolling average of number of unique covered lives represented in our licensable dataset from the years 2019-2021. Medicare Advantage includes dual eligible.
2 KFF State Health Facts 2019-2021 rolling average Employer and Non-Group enrollment (not including military, Medicaid, Medicare or Uninsured) (https://www.kff.org/other/state-indicator/total-population/?dataView=1¤tTimeframe=1&selectedDistributions=employer--non-group&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D )
3 KFF State Health Facts 2019-2021 rolling average of Medicaid enrollment (https://www.kff.org/other/state-indicator/total-population/?dataView=1¤tTimeframe=1&selectedDistributions=employer--non-group&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D)
4 KFF State Health Facts 2021 Medicare Advantage enrollment (https://www.kff.org/medicare/issue-brief/medicare-advantage-2021-spotlight-first-look/ )
Total Insured Population 295.3M (323.1M less 27.9M uninsured from 2021 KFF State Health Facts); Inovalon Insights Closed Data total covered lives of about 80M over the 1-year period ending 12/31/2022.