Report: FAIR Health most 'reliable' database for benchmarking out-of-network physician rates

A new study found FAIR Health outperformed other national databases as a reliable source for out-of-network physician rate benchmarking.

Physicians for Fair Coverage, an alliance of multispecialty groups promoting cost transparency, commissioned the study to address balance billing issues related to insurers' increasingly narrow physician networks. The alliance tapped independent researchers from NORC at the University of Chicago — a social research organization — to analyze four national and 15 state databases.

The researchers evaluated the databases on comprehensiveness, validity and availability, among other characteristics. The researchers also considered how independent the databases were and how much it cost to access their data.

Study authors found FAIR Health met the most criteria when compared with other sources — Health Care Cost Institute, Blue Health Intelligence, Truven Health Analytics and 15 state all payer claims databases. The researchers recommended the use of FAIR Health based on the database's rank as the largest and most geographically spanning source, covering more than 150 million insured lives.

Researchers also noted its inclusion of both Medicare and commercial claims, accessibility and transparency. Researchers added an important differentiator is that FAIR Health licenses its data for benchmarking.

"For the purposes of identifying a standard benchmark that draws on comprehensive data, NORC recommends the use of a vendor with national data coverage over state APCDs," the authors concluded. "APCD data and access processes are not uniform across, rendering a nationwide standard and process for analysis of claims and costs associated with the establishment and maintenance of the databases very difficult." 

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