New Report Examines the Use of Claims Data in Rate Setting for New Health Insurance Marketplace

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The latest report in Atlantic Information Services’s Management Insight Series, Data Sources for Rate-Setting in ACOs, Exchanges and Narrow Networks, provides a comprehensive review of how FAIR Health® and other data sources can be used to determine rates for health insurance products sold via accountable care organizations, public and private insurance exchanges, and narrow networks.

Greater cost transparency and consumer engagement are front-and-center in the health insurance revolution that is underway, and the use of data is driving these monumental changes. In addition to helping support the adjudication of out-of-network claims, claims data can provide the building blocks for ACO development, as well as the foundation for pursuing a narrow-network strategy, developing consumer-oriented tools to promote effective plan selection and plan management, and building internal dashboards for strategic decision making. Atlantic Information Services – industry-leading publishers of Health Plan Week and AIS’s Health Reform Week – is pleased to announce the publication of Data Sources for Rate-Setting in ACOs, Exchanges and Narrow Networks. The latest addition to AIS’s Management Insight Series, the report examines the various ways claims data can be used in the new health insurance marketplace.

Featuring a review of FAIR Health’s origins and mission as a repository of claims data, as well as the auditing and validation processes in place to ensure data integrity, this comprehensive report also addresses issues such as:

  • Why do health plans need a sound and defensible source of benchmark data?
  • How can benchmark data be repurposed to help build consumer education, and cost and transparency tools?
  • Why are benchmark data important for exchange products?
  • What models exist today for setting out-of-network rates? What are the relative advantages and disadvantages of each?
  • How can chronic disease and treatment cost profiles be used to promote enrollment and informed use of benefits on the exchange?
  • How should benchmarking data be used to determine charges under value-based payment mechanisms such as ACOs?

For more information on Data Sources for Rate-Setting in ACOs, Exchanges and Narrow Networks, including a full table of contents, visit

AIS’s Management Insight Series is designed to provide practical solutions to complex business challenges with the help of the industry’s most insightful advisors and managers. See a full list of titles in this series at

About AIS
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at

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Jill Brown, Executive Editor
Atlantic Information Services
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