NHRI Report-From Claims to Clarity: Deriving Actionable Healthcare Cost Benchmarks from Aggregated Commercial Claims Data

Over the past  three years Regional Health Improvement Collaboratives (RHICs), working collectively through the Network for Regional Healthcare Improvement’s (NRHI’s) Getting to Affordability Total Cost of Care initiative, have demonstrated the ability to assess and refine raw regional healthcare cost data, to standardize that data, and to use it in establishing meaningful, local practice level reports and comparisons within and between healthcare markets.

This effort demonstrates:
1. Commercial claims data can be refined and standardized to a level of quality sufficient to make meaningful, actionable healthcare cost comparisons.

2. Given access to sufficient and complete commercial claims data, access to which is typically withheld as being proprietary, it is possible to produce standardized data that would allow meaningful cost transparency. Participants have produced Total Cost Index (TCI), Resource Use Index (RUI) and Price Index (PI) comparisons locally, regionally and nationally—at levels of detail capable of informing provider-level insights into healthcare cost and quality. 

This work advances healthcare cost transparency, a necessity toward solving the healthcare cost crisis facing the US. We invite you to read the report in its entirety