The Vermont Health Care Uniform Reporting and Evaluation System (VHCURES) is the State’s all-payer claims database. The VHCURES database includes eligibility information and medical and pharmacy claims provided by commercial health insurers as well as Medicaid and Medicare beginning in January 2007. Through data use agreements, VHCURES data is utilized by state agencies, state and federal contractors, and academic researchers to support analysis of health care access, spending, utilization, and quality.
There are two types of files that can be requested: Public Use File and Limited Use Data Set. Vermont state agencies requesting VHCURES data should email email@example.com and review the State Agency DUA Application Process.
You will also find currently active and pending VHCURES Data Use Agreements.
Understand VHCURES Data to determine if this data source meets your research needs.
- VHCURES APCD Snapshot - Want to learn more about VHCURES? Not sure if VHCURES has the data you are looking for? Check out the APCD Snapshot for metadata about VHCURES such as how much and the types of data that are available (interactive dashboard).
- VHCURES Capabilities - table describing the types of information available in VHCURES and the kinds of analyses that can be conducted using the VHCURES dataset (2 pages).
- VHCURES Overview - a guide for data users (15 pages).
- VHCURES Data Use and Disclosure Manual - this specifies the procedures for the submission and review of applications for data from the VHCURES data set, limitations on the availability of such data, and requirements that persons seeking or receiving such data must comply with to ensure that the privacy and security of the data is maintained (19 pages).
- See how the data is used. GMCB produces a variety of public reports that provide statistics describing the Vermont health care system. VHCURES is the primary source for these analyses, and therefore only data submitted to VHCURES is included.
What is the VHCURES PUF?
The VHCURES PUF offers summarized information related to health care claims for high-level demographic stratifications. Specifically, the PUF includes information related to the following populations:
- Vermont residents under the age of 65 years
- Members whose primary insurance coverage was provided by commercial or Medicaid insurance (i.e., members with Medicare are excluded)
- Members who had insurance coverage and any reported services during the included reporting period(s)
- Orphaned claims. Orphaned claims are adjustments to original claims that were never reported to the APCD – a scenario that results in outlier negative paid amounts that deflate total expenditures and inflate utilization counts.
- Denied claims. Denied claims are claims for which all plan and member payment amounts (e.g., paid, copay, coinsurance, deductible) were reported as zero, indicating that the service should not be included in analytics.
- Medicare claims. The PUF uses only claims covered by commercial and Medicaid insurance plans. Medicare Fee-for-Service coverage provided by the U.S. Centers for Medicare & Medicaid Services (CMS) and Medicare Advantage coverage provided by commercial insurers have been excluded.
- Members aged 65 years and older. Similar to the exclusion of Medicare data, members aged 65 years and older also have been excluded to avoid distortion in the reporting given their low numbers in the commercial and Medicaid populations.
- Out-of-state residents. Only Vermont residents have been included based on their reported ZIP code of residence in the eligibility data. Members with a non-Vermont ZIP code of residence are excluded even if their service was provided in Vermont. (Note that members with a missing or invalid ZIP code also have been excluded.)
- Uninsured individuals. Data reported to VHCURES is provided by insurers and therefore includes only individuals who have medical, pharmacy, or dental insurance coverage. Information regarding the demographics and health care services provided to uninsured individuals is not available in the VHCURES data.
- Members reported with an unknown, missing, invalid, or non-binary sex. Members reported to VHCURES with a gender code of ‘U’ (Unknown) and those reported with a missing or invalid gender code have been excluded. Members reported with the nonbinary gender code (‘I’) recently adopted for VHCURES also have been excluded due to low numbers.
For more detailed information refer to the PUF User Guide.
Who Can Request the VHCURES PUF:
Researchers, students, and others who want use the data in the VHCURES-PUFs for statistical analysis and reporting to aid in evidence-based decision-making to plan and improve health service delivery, evaluate health care interventions and systems, and inform health policy decisions.
The data should not be requested to:
- Attempt to identify an individual patient or provider in the VHCURES-PUF;
- Disclose the identity of any individual(s) discovered inadvertently;
- Allow anyone other than the Requestor identified in this Agreement to access the VHCURES-PUF or the data contained therein;
- Use the data in the VHCURES-PUF for any purpose other than the purpose I identified in my request;
- Use the VHCURES-PUF for any purposes that are inconsistent with the intended uses set forth in introductory paragraph of this Agreement;
- Make any effort to determine identifying information about any reported case in the VHCURES-PUF;
- Link the VHCURES-PUF with any other data sets or databases;
- Use the VHCURES-PUF at any other location than that specified in the Organization Name and Address field in this agreement;
- Rent, lease, lend, sell, transmit, or otherwise distribute or dispose of the VHCURES-PUF temporarily or permanently without written consent of GMCB;
- Create or permit third parties to create derivative works based on the VHCURES-PUF; or
- Sell derivative works based on the VHCURES-PUF.
- Fill out the request form.
- GMCB will review the request within 10 business days of receipt. We may ask the requester clarifying questions.
- If approved, the GMCB will send the data to download via a secure Globalscape Workspace or secure email.
Who Can Request the VHCURES PUF:
Researchers, students, and others who want require a more detailed data set compared to the PUF for statistical analysis and reporting to aid in evidence-based decision-making to plan and improve health service delivery, evaluate health care interventions and systems, and inform health policy decisions.
All entities requesting VHCURES data that are not a Vermont State Government Agency are considered non-State entities.
The following steps describe the process for a non-State entity requesting access to VHCURES.
- Complete and File an Initial Data Request
The first step in the process is to complete and file a VHCURES Data Request Form to firstname.lastname@example.org. GMCB will review the request, and if the request is deemed an appropriate use of VHCURES data, the requestor will be sent a full DUA application. Note: Entities other than Vermont State Government agencies shall not receive access to Medicare data under any circumstances.
Applicants are strongly encouraged to review all documents associated with data release to become more familiar with the GMCB release protocols and to be sure the applicant can agree to the requirements and limitations as described in GMCB’s Data Use Agreements. These resources can be found in the Resource library at gmcboard.vermont.gov/data-forms-library.
Questions related to the VHCURES data release process can be sent to GMCB’s data team at email@example.com.
- File an Application with All Necessary Supporting Documentation (as listed in the application).
If invited to complete a full DUA application, the applicant will complete and file a DUA application to firstname.lastname@example.org. The GMCB data stewardship program staff will review the application materials to determine whether the application is complete, meets the necessary requirements, and includes all required attachments and signatures. Staff may communicate with applicants to ensure that applications are complete and that responses are clearly stated. The length of this review depends on the complexity of the request and the sensitivity of the data sought. All filings pertaining to a DUA application are considered part of the public record.
- Agency Review
If the application is deemed complete and approved through initial review it will advance with a recommendation as to whether the data requested are the minimum necessary to achieve the proposed objectives and whether the risk of re-identification of individual patients has been minimized and appropriately balanced with project needs. The application will be routed through a DUA review and approval process that may involve the Department of Vermont Health Access (DVHA) if Medicaid data is requested. Medicaid requests may also require IRB review through the Vermont Agency of Human Services. DUA applications may also be reviewed by the GMCB Data Governance Council at a public meeting and routed through the Vermont Agency for Digital Services for their approval.
- Execute a Data Use Agreement
Once approval is given, the Data Use Agreement (DUA) with the GMCB is prepared and routed for signatures including GMCB, other Vermont State agencies involved in contracting, and the applicant’s principal investigator and authorized user, as listed on the application. The GMCB does not accept comments or revisions to its data use agreements. The DUA start date is the date the final signature on the DUA is obtained.
- Data Released
Upon execution of the DUA, GMCB staff will notify its data aggregation vendor to request transmission of the authorized data or to activate access to the data enclave. Notice will be sent to the Principal Investigator and/or the data transmission representative as listed on the DUA application.
DUA Application Process for a Non-State Entity (flow chart visual)
Cost: The cost of receiving a raw data extract consolidated file with up to 5 years of eligibility and paid claims data for medical and prescription drug services is $5,250.00, plus $550 for file transfer set-up, that is paid directly to the GMCB’s data aggregation vendor, Onpoint Health Data. This pricing is subject to change.
- University of Vermont College of Medicine: Health Services Analysis Using VHCURES
- Vermont Department of Health: Public Health Analyses of Medical Claims Database
- Department of Vermont Health Access: Analysis and Evaluation of Programs, Procedures, Benefits, and Payment Structures
- NORC: Evaluation of the Vermont All-Payer ACO Model
- Archway Health Advisors
- HSI - Berkeley Sky Deck