Re-imagining AHRQ’s Insight Platform

As COVID-19 has continued its unrelenting advance across the Nation, urgent questions have confronted an often overwhelmed healthcare system: How many hospital beds are available in different locations around the country? How many are currently occupied? What is the capacity of hospitals to provide intensive care unit (ICU) and ventilator care? What is the capacity of physician offices to provide telehealth services? What would be the financial impact of increased telehealth and fewer in-person visits on physician practices’ ability to remain open? And many more! Unfortunately, answers to many of these questions have not been available, even though the need for the information is acute.

In an AHRQ Views blog post last year, we talked about how AHRQ is using data and analytics to help policymakers and the public better understand today’s critical healthcare issues.  We return to this issue today to provide an update on how the Agency is using its data assets to enhance and expand its analytic capabilities into an “AHRQ insight platform”—a resource responsive to the needs of policymakers, healthcare systems and analysts, researchers, payers, and clinicians.  By platform we mean AHRQ’s publicly available data and analytic tools, supported by the Agency’s information technology infrastructure and in-house industry experts, who are able to provide information and obtain evidence-based answers to questions about the healthcare system.

Over the past year AHRQ has directed its data collection and analytic expansion efforts at building on its unique base of data-related resources, notably HCUP and the MEPS. Our goal has been to expand the Agency’s data and analytic capacity to fill critical gaps in the Federal government’s data inventory. 

Significant gaps persist in the availability of data to guide healthcare decision-making. To continue addressing those needs, we have focused our efforts on three areas in which current shortages of available information are preventing the development of analytic databases to address critical issues in today’s healthcare environment.

In particular, we concluded more data are needed about:

• Comprehensive medical claims.
• Physician supply data.
• Social determinants of health.  

By recognizing the needs of our customers going forward, our vision was clear. We sought to build on our current platform to provide unique new databases, ensure adequate data access (both within and outside the Federal government), enhance AHRQ’s reservoir of analytic tools, integrate innovative and novel data into our existing data streams, and develop rapid-cycle healthcare industry research capabilities.  In addition, these AHRQ databases will augment the surveillance data being collected elsewhere in the Department of Health and Human Services (HHS) to enhance our ability to respond to crises such as the COVID-19 pandemic.

To make detailed medical claims data more widely available for research, the issue of confidentiality posed a significant deterrent. That is, data with enough detail for analyses of the use and costs of specific treatments contain a very high risk of providing enough information to identify individuals.

To overcome this risk, AHRQ initiated a project to produce what is called a “synthetic database”—a resource that contains all the detail of claims data and comprehensive information on patients’ socioeconomic and demographic characteristics, but at the same time perturbs the information in a way that prevents connecting the data to individuals. In this way, analyses that require detailed information on care, as well as on individuals, can be done with little to no risk of identifying a specific person.  The beta version of this database, which includes information from both public and private insurance claims sources, is expected to be completed by the end of 2020. It will be the first of its kind implemented by HHS and in the healthcare marketplace.

Our second initiative is focused on overcoming the tremendous obstacles to understanding the supply side of the healthcare market.  While we do have some information on hospitals—from HCUP, the American Hospital Association, and the Centers for Medicare & Medicaid Services—we do not have very good information about other types of providers, perhaps most importantly, physicians and their practices. 

Our activities in this area involve collecting structural and financial characteristics data on physicians and physician practices for a selected set of States.  This effort builds on our experience with HCUP in partnering with State organizations to collect detailed State-level hospital billing data, and harmonizing those data to produce consistent, high quality, comprehensive analytic files.  This effort will be particularly helpful in responding to unexpected crises like the COVID-19 pandemic, where immediate information on provider capacities in specific locations and financial data for affected providers are critical to emergency preparedness and response.  Enhancing AHRQ’s prospective and predictive analytics capabilities to better address crises like the COIVID-19 pandemic are key elements of our 5 year strategic plan.

The third AHRQ initiative involves the creation of a consistent, well-documented social determinants of health (SDOH) database. This effort is intended to create a publicly available, easily linkable SDOH-focused database for research to inform addressing emerging health issues and, ultimately, help to improve health outcomes. 

Variables in this SDOH database correspond to five key domains: social context (e.g., age, race/ethnicity, veteran status); economic context (e.g., income, unemployment rate); education; physical infrastructure (e.g., housing, crime, transportation); and healthcare context (e.g., health insurance). The files are designed for linking to any external analytic database by county and zip code.  We expect the beta version of the SDOH database to be available by the end of this year.

Building a 21^st Century Healthcare System

These three data initiatives align with AHRQ’s efforts to create a comprehensive AHRQ Insights Platform, one that can provide a deeper, real-time understanding of today’s pressing healthcare challenges. Such a resource is fundamental to a true 21^st century healthcare system, one that can respond not only to a pandemic such as COVID-19, but to a wide range of public health emergencies.

Moving forward with additional resources, we will build on these pilot projects to leverage additional expansion opportunities, continue to improve the quality and utility of our data and research, and ensure our commitment to AHRQ’s customers. It is these stakeholders—healthcare analysts, researchers, payers, clinicians, and policymakers at the Federal, State and local levels—who require answers to the pressing questions in today’s rapidly changing healthcare ecosystem. Meeting these needs has become an imperative as we seek to deliver 21^st century care to the American people.

Gopal Khanna is director of AHRQ. Joel Cohen is director of the Agency’s Center for Financing, Access and Cost Trends.

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