We draw data from two sources to support Healthcare Benchmark Initiative data collection and analysis.
Cost Growth Benchmark Data
OHS collects Cost Growth Benchmark annually at the payer level by market, including commercial, Medicaid and Medicare, and at the Advanced Network level by market, as available. This includes:
• Aggregate TME data collected in broad claims service categories, such as hospital inpatient, and non-claims categories, such as performance incentive payments
• Insurer administrative costs and profit
The following markets are included in the data:
• Commercial fully and self-insured
• Student health plans
• State employees, retirees, and municipalities
• Medicare Advantage
• Medicare Fee-for-Service
• Medicaid
All-Payer Claims Database Data
OHS collects All-Payer Claims Database (APCD) data monthly and makes updates available for analysis each quarter. APCD includes:
• Medical claims
• Pharmacy claims
• Enrollment data
The APCD does not include non-claims payments, such as capitated payments or performance bonuses, drug rebates from manufacturers, or insurer administration costs and profit.
The following markets are included in the data:
• Commercial fully insured
• State employees and retirees, municipal employees in State Partnership 2.0 plan and some other but not all self-insured employers
• Medicaid
• Medicare Advantage
• Medicare Fee-For-Service
More detail is available in our Spending Data Collection and Analysis Table .