Health Claims Data Warehouse

The Federal Employees Health Benefits (FEHB) Program provides employee health benefits are provided to civilian government employees.  In 2012, federal employees had a choice of 206 health plans. These plans include:

  • 14 fee for service plans (10 available to all eligible federal employees and retirees and 4 open to employees in certain agencies);
  • 164 HMO choices.
  • 15 high deductible plans
  • 13 are for consumer driven choices.

Researchers dream of having access to the administrative claims data for FEHB beneficiaries.  All these data provide a rich source for healthcare researchers to answer a variety of questions regarding drug safety, cost-effectiveness and other topics.  Further, FEHB plans already report a number of quality measures including Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Healthcare Effectiveness Data and Information Sets (HEDIS) measures.


Is the dream a reality?

Researchers dreams may be coming true.

The Office of Personnel Management (OPM) is organizing a research database of insurance claims filed by the 8 million workers and dependents enrolled in the Federal Employees Health Benefits Program, as well as participants in two other federally administered programs.

In October 2010,  OPM announced its plans to create a database – called the Health Claims Data Warehouse – containing copies of detailed electronic health records of millions of Americans. According to the October 2010 notice, the Warehouse would include enrollees’ Social Security Number (SSN), information on spouses, children, and employment, as well as health care coverage, procedures, diagnoses, and payments. OPM would collect this data by setting up data feeds with plans participating in three major insurance programs: the Federal Employee Health Benefit Program, the National Pre-Existing Condition Insurance Program, and the Multi-State Option Plan.

The National Pre-Existing Condition Insurance Program is made up of enrollees in the high-risk pools set up by the Department of Health and Human Services for people who cannot get insurance because of medical problems. The Multi-State Option Plans are plans to be included in the ACA’s State Health Insurance Exchanges (HIE) (a minimum of two per state) health eother involves private “multi-state plan options” for individuals and small businesses. These plans, overseen by OPM, will be subject to the same requirements as other qualified plans offered in the exchange, including the consumer protection laws of the purchaser’s state, and the secretary has to be assured that the policy will not weaken enforcement of state consumer protection laws.



Not everyone is happy.  Critics such as the the American Civil Liberties Union, Consumers Union and the American Federation of Government Employees worry that the health claims data warehouse would be susceptible to privacy breaches.  The Center for Democracy and Technology gives OPM an alternative mechanism to distribute healthcare claims data more effectively:

…it is unclear why OPM couldn’t use a one-way hash function to scramble the identifiers in the health information (a hash function is essentially a cryptographic technique that can conceal messages but still allow for comparison of similar messages). Both limited data sets and a hash function should enable OPM to create statistically viable longitudinal records while preserving the relative anonymity of individual enrollees.

However, some precedent does exist.

Tricare, the military’s health-care program, has data on its participants, and the federal Centers for Medicare and Medicaid Services keeps information on Medicare beneficiaries. But Tricare, Medicare and Medicaid are public health programs; OPM’s database will be collecting health information from private plans. The California Public Employees’ Retirement System maintains a database on the private health plans it manages. The OPM’s project would be similar.

It will be interesting to see if the Health Claims Data Warehouse is ever built and–if so–what protections will be put in place to safeguard enrollee privacy.

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