Health Plan Research Networks

A key factor in realizing PCORnet’s full potential to drive meaningful, patient-centered research is access to complete, longitudinal data on populations receiving health care within PCORnet Partner Networks, including both Clinical Data Research Networks (CDRNs) and Patient Powered Research Networks (PPRNs).  CDRNs are continuously capturing electronic health record (EHR) data from both ambulatory and in-patient care, as well as claims information or other records representing care received outside participating delivery systems. However, to reduce gaps in existing data, PCORI has embarked on a supplemental approach: an initiative to directly fund two major U.S. health plans that cover significant numbers of patients in one or more of the PCORnet CDRNs.

These health plans form the Health Plan Research Networks (HPRNs) and partner with PCORnet CDRNs and PPRNs, engaging in data linkage governance and technical activities in a comprehensive, stepwise approach toward successful linkages of claims and EHR data for use in conducting comparative clinical effectiveness research (CER). The two initial health plans awarded in 2016 are:

HealthCore-Anthem Research Network

Visit the HealthCore Website

Principal Investigator:  Kevin Haynes, PHARMD, MSCE (scroll to bottom of linked page for PI profile)

Contact: [email protected]

HealthCore is the research subsidiary of Anthem, Inc. with clinical and scientific research expertise, and exclusive access to a robust, integrated research environment containing information on nearly 60 million individuals from Anthem health plans across the U.S. Though Anthem has membership in all 50 states, membership is primarily concentrated in the 14 states with geographic distribution in the Northeast (Connecticut, Maine, New Hampshire, and New York), Midwest (Indiana, Missouri, Ohio, and Wisconsin), South (Georgia, Kentucky, Virginia), and West (California, Colorado, and Nevada).

The HealthCore Anthem Research Network (HCARN) will advance the PCORnet mission to improve the nation’s capacity to conduct clinical research by creating a large, highly representative, national patient-centered network that supports more efficient clinical trials and observational studies. We will achieve these aims by closing the gaps in data to support a Learning Health System (LHS) to address both gaps in evidence and gaps in care. This LHS will advance the quality of care Anthem delivers to its members and provide real-world evidence to patient-centered research.

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HUMnet: Humana

Visit the Humana Website

Principal Investigator:  Vinit P. Nair

Contact:  [email protected]

Humana’s Comprehensive Health Insights Inc. has created “HUMnet”, a research and data infrastructure system linking Humana’s administrative claims database with PCORnet Clinical Data Research Networks(CDRNs) and Patient Powered Research Networks (PPRNs). The collaboration will add longitudinal tracking capability to PCORI studies and will increase coverage outside of existing PCORnet networks through linkage with Humana’s membership. The research team at HUMnet has extensive experience with distributed research networks while Humana has one of the largest Medicare Advantage populations in the United States. This allows for robust samples of older Americans with multiple chronic conditions, particularly in Florida, Texas, and the Midwest. 

Year one of the initiative will focus on data linkage to support the research aims of PCORnet’s Demonstration Studies, and years two and three will focus on helping to craft appropriate governance alongside linkages with CDRNs and PPRNs for additional research projects and the development of multipurpose linked data sets.

By bringing health plans into the conversations around research focus, PCORI and PCORnet are trailblazing a new frontier of patient-centered care and enabling quicker patient treatment decisions based on the output of CER studies. As health plans are often closely connected to outcomes research, the path to supporting reimbursement for the favorable treatment path is simplified. Thus, collaboration between researchers and health plans can inform the direction of research to increase the likelihood of improving health care for patients.

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Last updated on August 24, 2017