Why Transparency in Healthcare is Important: FAIR Health Methodology
Michele Hibbert
SVP of Regulatory Compliance Management
Having access to a database with a transparent methodology for deriving provider market rates and insurance information serves as a valuable asset in the P&C industry for organizations largely involved in the healthcare market. Healthcare claims data is integral in helping identify and monitor trends in the healthcare market. This is where FAIR Health comes into play. FAIR Health is a national, independent, nonprofit organization whose mission is to bring transparency to healthcare costs and health insurance information.1 They strive to develop robust, unbiased data products and solutions to meet the needs of those they serve. FAIR Health is widely recognized as a reliable, objective source of data, frequently cited in media reports and honored for its leadership in promoting and modeling transparency in the healthcare field. 
Consumers and payors have limited choices when it comes to choosing a reliable database as comprehensive as FAIR Health and would provide a wide coverage of the United States. The vast databank from FAIR Health is accessible to anyone who wants to use it and because of the size of the underlying data, it has become one of the largest in the world. FAIR Health licenses its provider charge modules separately. The modules are updated twice a year and the data included in the modules fall within a 12-month moving window. For example, the May 2016 release included data from the preceding year, trended forward using the consumer price index. FAIR Health’s methodology can be found on their website for each module they provide. This year, FAIR Health has plans to update and make methodology changes to the Medical/Surgical Module payors use which will include a delineation of actual and derived benchmarks. This new database will be the unification of two differing products and create unified benchmarks for all. The FAIR Health website will match the data used by payors after deployment.
This year, FAIR Health has plans to update and make methodology changes to the Medical/Surgical Module payors use which will include a delineation of actual and derived benchmarks.
The majority of charges we will see in relation to the industry will be actual charge data as the top codes used represent approximately 150 of the approximate 10,000 Current Procedural Terminology (CPT) codes used today. Mitchell will keep customers apprised when deployment is ready in our products with the new unified database. There will be educational materials and information provided for a clear understanding prior to usage.
