OPM's Healthcare Claims Data Warehouse

The Politico offers an article today on OPM's Healthcare Claims Data Warehouse, a project that began in 2010.  OPM has been planning to use this warehouse to hold longitudinal health histories of federal and postal employees.  FEHB plan carriers are covered entities for HIPAA Privacy and Security purposes and must accept the financial risk of coverage. As the article explains, carriers are willing to contribute claims data that is de-identified for HIPAA purposes and protects proprietary information. De-identified means that the contributed data cannot be linked back to any particular federal/postal employee, annuitant, or family member.

The article quotes the former OPM policy and planning director Jonathan Foley. The warehouse is his baby.  He gets the last word in the article as follows:

Foley called that [/the FEHBlog's] argument a "smokescreen" because the data is not governed by HIPAA in the same way as health plans. The warehouse's security is extremely stringent and it is federally authorized to handle sensitive health data, he said.

Section 8910(b) of the FEHB Act reads in pertinent part as follows

(b) Each contract entered into under section 8902 of this title shall contain provisions requiring carriers to-
(1) furnish such reasonable reports as the Office determines to be necessary to enable it to carry out its functions under this chapter; and
(2) permit the Office and representatives of the Government Accountability Office to examine records of the carriers as may be necessary to carry out the purposes of this chapter.

In short, the FEHBA authorizes OPM to collect, not receive copies of, carrier records. The 1959 FEHBA does not contemplate this data warehouse. If OPM wants the full-blown warehouse, then the agency should have asked Congress to amend the FEHB Act.

In any event, as the article explains, and the FEHBlog confirms, carriers cooperatively are working with OPM to create a warehouse that serves the agency's purposes and protects the interests of carriers and FEHBP members. As the article explains,

An OPM spokesperson said the agency and its carriers were still negotiating release of the data, in de-identified form to ensure protection from breaches. In fact, OPM has convened a meeting with insurers next month on the topic, the spokesperson said. The agency did not explain how it could use de-identified data to create files with long-term information about patients, which is a key benefit of data warehousing to data analysts.

Believe the FEHBlog, carriers and OPM are working on creating a secure approach that will address the data analysts' concern.