Medicare Claims Data Analytics, Medicaid Claims Analytics & Market Intelligence

Data assets

Our analyses draw on 100% traditional Medicare claims (Parts A and B), Medicare Advantage encounter data, the beneficiary enrollment file, Medicare Part D, and Medicaid claims. We supplement claims with beneficiary-level HEDIS files, CAHPS survey data, NCPDP pharmacy data, and a range of proprietary crosswalks.

Data history extends back to 2012. Traditional Medicare claims, Part D, and the enrollment file are current to within roughly the past month. Medicare Advantage data typically lags about 2.5 years, and Medicaid data about 1.5 years.

Why FastHSR for claims analytics

FastHSR is built for teams that need answers from Medicare and Medicaid claims data, not just access to a data product. We turn raw utilization, enrollment, provider, plan, pharmacy, and quality data into decision-ready market intelligence, analytic files, dashboards, and reproducible methods.

• Medicare and Medicaid coverage, including medical claims, pharmacy claims, enrollment, and supplemental quality data.
• Custom analyses for strategy, diligence, market access, provider performance, value-based care, and clinical operations.
• Rapid analytic execution for teams that need useful answers without building an internal claims data pipeline first.
• Transparent methods suitable for publication-quality evidence, board materials, payer conversations, and operating decisions.

Market and competitive intelligence

Build market overviews and market share analyses, assess the competitive landscape, and track the long-term performance and growth of healthcare market participants, closing knowledge gaps to support corporate strategy.

Patient journey analysis

Map patient journeys across care settings and segment markets by diagnosis group, procedure, or other clinical and patient factors.

Provider prescribing and diagnosing patterns

Analyze provider prescribing and diagnosing behavior across specialties, markets, and patient populations.

Pharmacy and medication analytics

Examine pharmacy dispensing and medication patterns across PBMs, pharmacies, formularies, plans, and prescribers, including drug spend, out-of-pocket cost, and medication adherence. Monitor treatment patterns, adherence, and therapy switching rates.

Quality, utilization, and value-based care analysis

Evaluate quality, utilization, referral patterns, provider performance, and plan comparisons, with support for both plan-level and market-level views. Conduct ACO-level analyses, apply NCQA quality metrics at the provider level, and produce specialized measures including PQI preventable hospitalizations and frailty indices.

Common claims analytics questions

• How large is the Medicare or Medicaid market for a disease, procedure, drug, device, site of care, or service line?
• Which providers, groups, facilities, plans, PBMs, pharmacies, or ACOs drive utilization and spending in a market?
• Where do patients go before and after diagnosis, prescribing, procedure, hospitalization, discharge, or therapy switch?
• Which providers diagnose, prescribe, refer, admit, discharge, or manage specific patient populations?
• How do quality, utilization, avoidable hospitalizations, frailty, adherence, and total cost vary by provider or plan?

Medicare, Medicaid, and Part D analytics coverage

• Traditional Medicare claims: inpatient, outpatient, professional, post-acute, and other Parts A and B utilization.
• Medicare Advantage encounter data: plan and market analysis where MA encounter data supports the use case.
• Medicare Part D: drug utilization, prescriber behavior, pharmacy patterns, adherence, switching, and out-of-pocket cost.
• Medicaid claims: state Medicaid utilization, spending, diagnoses, procedures, pharmacy, and patient journey analytics.
• Supplemental files: enrollment, HEDIS, CAHPS, NCPDP pharmacy data, and proprietary crosswalks.

Claims analysis case studies

See examples of FastHSR claims analytics work across Medicare claims, Medicaid claims, Medicare Advantage encounter data, Part D, HEDIS, pharmacy analytics, and value-based care performance.

Access case studies

Frequently asked questions

What Medicare and Medicaid claims data can FastHSR analyze?

FastHSR analyzes traditional Medicare Parts A and B claims, Medicare Advantage encounter data, Medicare Part D, beneficiary enrollment data, Medicaid claims, and supplemental quality, pharmacy, survey, and proprietary crosswalk data.

How current are the Medicare and Medicaid claims data assets?

Traditional Medicare claims, Medicare Part D, and enrollment data are current to within roughly the past month. Medicare Advantage data typically lags about 2.5 years, and Medicaid data about 1.5 years.

What analyses can FastHSR run with Medicare and Medicaid claims?

FastHSR supports market sizing, market share analysis, patient journey analysis, provider prescribing and diagnosing behavior, pharmacy and medication analytics, quality and utilization measurement, ACO analysis, and value-based care performance evaluation.

Is FastHSR a raw claims data vendor or an analytics partner?

FastHSR focuses on analysis and healthcare market intelligence. Clients use FastHSR when they need claims data translated into decision-ready evidence, market views, provider patterns, quality measures, and value-based care insights.

For Medicare claims analytics, Medicaid claims analytics, market intelligence, or value-based care analysis, please email us.