HCCI_SOW.docx

February 22, 2108

STATEMENT OF WORK

I. SCOPE

Private health insurance claims data are needed to support the development and analysis of projected health spending, the evaluation of the accuracy of historical health spending estimates, and the development of estimates of private health spending by age and gender and by state. It is vital for the National Health Statistics Group (NHSG) to be able to gain knowledge and insight into health care spending trends of the privately insured. The Health Care Cost Institute (HCCI) possesses a unique claims database that would allow for testing of a hypothesis to gain insight into the private health insurances population, which cannot be tested without this data.

A. Background

In the historical National Health Expenditure Accounts (NHEA), estimates of private spending for health care are calculated as a residual. As such, the accuracy of these estimates is largely dependent upon the accuracy of estimates of total health spending and publically financed health expenditures. This limits the use of NHEA data for testing hypotheses of private health insurance trends. HCCI possesses a unique data set that includes claims data from three (3) of the largest national health insurance companies, Aetna, Humana, and UnitedHealthcare. Gaining access to this claims database would allow the NHSG to learn more about the privately insured population.

B. Purpose

The purpose of this contract is to enable the NHSG to test approved hypotheses that will allow for the NHSG to gain greater insight into privately insured health spending trends.

C. Technical Considerations (Ranking in order of importance)

1. The vendor currently has a data collection system in place that produces a sufficiently large private health insurance claims database that allows for the evaluation and comparison of nationally representative estimates of private health insurance spending and fulfills the requirements listed in section II of this Statement of Work.

2. The vendor has data from numerous private health insurance plans.

3. The vendor currently has a system in place for ensuring the statistical reliability and consistency of the database.

4. The vendor has an ongoing quality assurance program that tests the accuracy of the data system.

II. REQUIREMENTS

Independently and not as an agent of the Government, the Contractor shall furnish all the necessary accesses to data as required in this Statement of Work.

A. Requirements/Tasks to be Performed.

These task orders are contingent upon having agreed to a hypothesis for the NHSG to test, as well as a master license agreement.

1. Grant access to HCCI database for users for the hypothesis testing.

2. Provide access to the expanded data set, which includes all years of data, rather than the 5 year data set.

3. Provide training for CMS users to be able to access the HCCI data through a data enclave.

4. Provide up to 30 hours of standard support.

5. Upload approved data sets to the CMS researcher’s workspace in the HCCI data enclave

B. Report Requirements

The Contractor shall provide access to the private claims database for 2 concurrent NHSG users. NHSG will be able to access the data through the HCCI data enclave.

The contractor will provide reasonably detailed and comprehensive support and materials (such as a data dictionary or glossary of terms/data variables) to NHSG including answering questions related to the database and providing adequate documentation that details the methods used to construct the database and the layout of the data and files.

See separate document for a complete listing of “Items to be Furnished and Deliverable Schedule”.

C. Period of Performance

The period of performance for this purchase is one year from gaining access, or until the completion of the research project, whichever is first.

D. Government Property

None.

E. Personnel Requirements

None.

III. QUALITY ASSURANCE

The Project Officer will review data described in section II.B. of this SOW and provide comment(s) to the Contractor.

IV. APPENDICES:

Section 508 Compliance:

The deliverables in this SOW, which are the software programs used by NHSG researchers to access HCCI data, shall comply with the standards, policies, and procedures below. NHSG verifies that the software programs by which researchers will access HCCI data under this SOW comply with the standards, policies, and procedures below. In the event of conflicts between the documents referred to below in this Section IV and this SOW, the SOW shall take precedence. Rehabilitation Act, Section 508 Accessibility Standards:

1. 29 U.S.C. 794d (Rehabilitation Act as amended)

1. 36 CFR 1194 (508 Standards)

1. www.access-board.gov/sec508/508standards.htm (508standards)

1. FAR 39.2 (Section 508)

1. CMS/HHS Standards, policies and procedures (Section 508)

V. REFERENCES

Please see website for additional information and background on the estimates in the National Health Expenditure Accounts (NHEA):

Definitions, Sources, and Methods document: http://www.cms.hhs.gov/NationalHealthExpendData/downloads/dsm-07.pdf

Additional references:

http://www.cms.hhs.gov/NationalHealthExpendData/01_Overview.asp#TopOfPage

Attachment J-

ITEMS TO BE FURNISHED AND DELIVERABLE SCHEDULE

The Contractor shall submit all required reports and deliverables in accordance with the following schedule. Reports and/or deliverables submitted under this contract shall be in accordance with the Statement of Work entitled

ITEM # DESCRIPTION QTY/RECIPIENT DELIVERY

Example: (Do NOT list what is to be in each report in this section. Descriptions of content and format for reports are contained in the SOW under Reporting Requirements.)

*Access will be granted within 45 days of either the signing of the master license agreement, or the approval of the research project, whichever happens later. Training is for new CMS users, or current users if there are changes to the enclave.

Recipient Addresses:

Joseph Benson Project Officer Centers for Medicare and Medicaid Services Office of the Actuary, N3-02-02 7500 Security Blvd.

Baltimore, MD 21244-1850