A joint investigation by NPR and ProPublica examines how the health insurance industry aggregates and utilizes individuals' "lifestyle" data to inform how much they should be charged for health insurance.
ProPublica's Marshall Allen published the second report in a series examining how the health insurance industry uses various tactics to maximize its profits. Mr. Allen spoke with several insurance companies that took part in America's Health Insurance Plans' recent conference in San Diego. There, he asked officials about insurers' tendency to use "lifestyle" data to spot patients' potential or existing health issues.
The "lifestyle data" insurers reportedly collect comprises an array of personal details, including an individual's social media posts, the things they buy, the foods they eat, time spent in front of the television and more. For example, if an individual purchases plus-size clothing, insurers could infer that individual may be at risk for depression; a woman who just changed her name may have a costly pregnancy on the way.
While insurers claim they use such lifestyle and socioeconomic data to connect patients with health services they may need, patient advocates claim companies may also use the data to make false medical assumptions and lead insurers to improperly price plans or discriminate against anyone tagged as high cost, Mr. Allen notes.
Cathryn Donaldson, a spokesperson for AHIP, told Becker's Hospital Review July 19 insurers do not use social determinants of health data to set rates.
"Health plans do not use data on social determinants of health to set premiums ... Plans use this data to create new programs designed to help people in their communities become more healthy. This is to help bring healthcare costs and premiums down for consumers — not up. Programs may include tobacco cessation programs, education on healthy foods, care management programs, programs to help members get transportation to a doctor or pharmacy," she said, adding, "premium rate requests are submitted to state insurance commissioners, who have strong oversight of plans offered to citizens in their states. These rate filings request a lot of detail about why premium rates may be changing. There is a lot of transparency in this process."
Mr. Allen also notes the use of such data and algorithms to assess a person's potential health raises issues concerning patients' medical privacy. HIPAA, the only federal health privacy law, deals with patients' medical information, not lifestyle data. While the ACA prohibits insurers from denying people coverage based on pre-existing conditions, experts contend insurers can legally use patients' personal information for marketing, to assess risks and to determine the prices of certain plans, he said.
Mr. Allen expressed curiosity regarding insurance companies' use of his own personal information to score his potential health costs. During the conference in San Diego, he filled out a request for LexisNexis to send him some of the personal information it had obtained about him. LexisNexis reportedly sent him 182 pages of data containing personal phone numbers and prior addresses dating back 25 years, with information noting whether the residences were in high-risk areas.
"My report was boring, which isn't a surprise. I've lived a middle-class life and grown up in good neighborhoods. But it made me wonder: What if I had lived in 'high risk' neighborhoods? Could that ever be used by insurers to jack up my rates — or to avoid me altogether?" he wrote.
Ms. Donaldson told Becker's the ProPublica story envisions a system vastly different from the insurance industry's current business model.
"The entire approach that the ProPublica story envisions fundamentally misunderstands our industry's business model. Health insurance providers grow when they are able get everyone covered with affordable coverage that helps them get healthier faster and stay healthier longer — when they offer a highly value product that people want to invest in," she said.
To access the full report, click here.
Editor's note: This story was updated at 11:30 a.m. July 19 to include a statement from America's Health Insurance Plans.