Key considerations when using health insurance claims data in advanced data analyses: An experience report

Abstract

Health claims have become a popular source of data for healthcare analytics, with numerous applications ranging from disease burden estimation and policy evaluation to drug event detection and advanced predictive analytics. Independent of the application, a researcher utilizing claims information will likely encounter challenges in using the data, which include dealing with several coding systems and coding irregularities. We highlight some of these challenges and approaches for successful analysis that may reduce implementation time and help in avoiding common pitfalls. We describe the experiences of a group of academic researchers in using an extensive seven-year repository of US medical and pharmaceutical claims data in a research study, and it provides an overview of the challenges encountered with handling claims records for data analysis while sharing suggestions on how to address these challenges. To illustrate our experiences, we use the example of dening episodes of care for a bundled payment reimbursement system in the US context.