PCORI created PCORnet®, The National Patient-Centered Clinical Research Network for conducting clinical comparative effectiveness research (CER) across a large population using data from many sources including electronic health records, registries, and health insurance data enabled through the use of a common data model. Creating a rapid research capacity to identify and evaluate important questions about healthcare treatments requires engagement of all stakeholders including health insurance plans. America’s Health Insurance Plans (AHIP) is the lead organization representing the health insurance industry, and it is uniquely positioned to convene health plan leaders to facilitate engagement with PCORnet as partners in research. The focus of this effort by AHIP will be to:
- Facilitate the engagement of health plans with the PCORnet Clinical Data Research Networks (CDRNs) as essential partners in research.
- Identify important gaps in availability of health insurance administrative data, such as claims to support critical public health surveillance and safety efforts as well as the CER efforts of PCORnet.
- In conjunction with PCORI, identify a standard baseline and required capabilities for health plans participating and providing data to such a network. This encompasses the use of a common data model for ease of interoperability and capacity to link data across systems.
- Identify key purposes for the network such as: expanded collaboration with PCORnet and similar networks, response to public health emergencies and/or needed surveillance, and other potential uses that may benefit the public or the health plans in their operations.
- Identify specific benefits for health plans beyond public health, such as ability to use their existing operation’s infrastructure to be part of research.
- Create an infrastructure that integrates data collection and analysis as part of the health plans’ existing workflow.
- Identify any barriers to implementation and needs for support, structure, and sustainability.
The projected outputs from this project include expanded participation by health insurance plans in distributed data networks such as PCORnet and other similar systems; creation of an interest group to collaborate on the development of increased distributed data capacity; linking plans with opportunities to engage and develop their participation; and development of a summary of findings on feasibility and scenarios for implementation.
Project collaborators include PCORnet leadership; Harvard Pilgrim Health Care Institute; Group Health Research Institute; and representatives from AHIP’s member health plans.
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Project Resource: White Paper Final Report