FAIR Health is a national, independent, not-for-profit corporation whose mission is to bring transparency to healthcare costs and health insurance information. We strive to develop robust, unbiased data products and solutions to meet the needs of those we serve, which includes all stakeholders in the healthcare sector: consumers, health plans, policymakers, insurers, government officials, bill reviewers and administrators, healthcare systems, hospitals and other facilities, healthcare providers, pharmaceutical companies, researchers and consultants. We accomplish this by dedicating all of our resources and expertise to making the nation’s largest collection of private medical and dental claims data available to all users in the formats that are most helpful to them.
A Unique History and a Defining Mandate
FAIR Health, Inc. was established in October 2009 as part of the settlement of an investigation by New York State into certain health insurance industry reimbursement practices which had been based on data compiled and controlled by a major insurer. FAIR Health was formed to create a conflict-free, robust, trusted and transparent source of data to support the adjudication of healthcare claims and to promote sound decision-making by all participants in the healthcare industry.
FAIR Health’s mission is to fulfill the mandate incorporated in the 2009 settlement which is to provide --
With the guidance of our teams of advisors, including some of the nation’s leading experts in healthcare policy, medicine, health economics and statistics, FAIR Health delivers on its commitment to provide the objective and reliable data, educational materials and tools to support the best industry practices and to inform decision-making by consumers and others participating in the healthcare sector. FAIR Health is widely recognized as a reliable, objective source of data, frequently cited in media reports and honored for its leadership in promoting and modeling transparency in the healthcare field.
Patients can estimate medical and dental costs and learn about the healthcare reimbursement system on our consumer website at www.fairhealthconsumer.org or www.consumidor.fairhealth.org
The FAIR Health Board of Directors is comprised of recognized leaders in the fields of medicine, healthcare policy, law, consumer advocacy, technology, education, medical research and business. The Board serves without compensation and holds regular quarterly meetings. Members of the FAIR Health Board of Directors include:
Stephen Warnke, Esq. (Chair)
"What drew me to the healthcare bar was that it’s an area of private practice in which I, as a lawyer, can be intimately involved in matters of pressing policy significance, representing private clients but doing so in a way that advances the public good. The healthcare industry is in a state of perpetual flux and perpetual crisis, so there is never a moment when you can profess to have complete command of all the technical details. The challenge for lawyers who represent healthcare clients is therefore constantly evolving, and of course, always fascinating."
"Access to health coverage is the most serious issue that I’ve worked on. I’ve heard many heartbreaking stories about people unable to get health coverage, particularly people who have chronic illnesses and disabilities. I’m also very interested in issues that affect low-income and vulnerable populations. It’s very expensive to be poor in America, and the poor pay more for virtually every service and product that they get. Those issues are particularly challenging, but also really rewarding to work on."
"I have always believed that the best consumer is the educated consumer. Access to cost information that’s transparent, reliable and accurate is such an effective tool in helping consumers make better healthcare choices and decisions. When consumers are armed with the right information, we can make better choices. We’re able to demand high quality service from our providers and we become active participants in our own healthcare. And that’s especially important because we really are the best ones to advocate for ourselves."
Sherry Glied, PhD
"I’m actually one of the few people who think that employer-sponsored coverage is a strong institution and is not likely to disappear any time soon. It offers many advantages even compared with the health insurance exchanges. There is a good reason, especially in very large companies, to retain employer-sponsored health insurance, but I can see it fading out among the smaller firms over time. Employers are pretty innovative so we will continue to see changes in the way employer-sponsored coverage operates. We don’t entirely know what those trends are going to be yet and I am not enthusiastic about predicting, so we’ll see."
Peter J. Millock, Esq.
"What surprises me most is that the issues have not changed. The three primary issues in healthcare – quality of healthcare, access to healthcare and cost of healthcare – have been the same issues for the last 30 years. The challenges today involve longstanding problems that have not been addressed through law, policy or private initiative. The Affordable Care Act (ACA) is an effort to address access, but says very little about quality and cost. The ACA is the greatest achievement in healthcare policy in 30 years, but it is far from a panacea."
Dr. Nancy Nielsen
"Nothing has been more rewarding than taking care of patients and sharing their lives—that was a real privilege and I feel very fortunate to have had that opportunity. The greatest privilege in terms of my professional career, though, was leading the AMA at a time when there was clearly an opportunity to move toward health insurance for all Americans."
Sara Rosenbaum, JD
"Those who specialize in civil rights have been extremely active around passage and implementation of the ACA because it is self-evident that gains for low-income Americans are, in effect, gains for minority Americans in the US. The ACA of course makes a seminal contribution to the problem. The Kaiser Family Foundation just published a study showing the disproportionately large impact of the Act on minority Americans, who are much more likely to be uninsured. To the extent that a central purpose of the Act is to create more equal access, its benefits for minority Americans should be seen as a one of the greatest civil rights achievements of our time."
Dr. John W. Rowe
"I came to gerontology and geriatrics not through an initial focus on older people but from a science-based interest in the biology of aging. I developed a substantive, broad-based research program in aging and developed a clinical interest in geriatric medicine as a secondary focus. There are a lot of people interested in aging who tell you a story about their grandfather, but that was not me. I was initially interested in the molecules."
"The trouble with the marketplace model, in which patients are assumed to choose the best quality and the lowest cost care options, is that consumers are not very informed when making decisions about healthcare, especially when they are sick. The standard marketplace model of supply and demand assumes that consumers make rational choices about a purchase but they are often unable to do that. The other issue is that the healthcare profession itself controls the supply of services — the number of primary care physicians, specialists, hospital beds and, in many ways though not completely, the demand for services. If there are buyers and sellers in a market, and one side controls both supply and demand, it isn’t a real market. On the other hand, there is a real yearning on the part of consumers to control their own healthcare experience. We are a consumer-based culture, and other industries have been completely reformed based on consumer need. When that happens, the consumer becomes more empowered."
Christopher F. Koller
“As a society, we need to consider the role of price transparency as opposed to charge transparency, and the role of public organizations, trusted community-wide efforts, national nonprofit resources like FAIR Health and private initiatives in making that price information more readily accessible to different stakeholders-consumers, providers, researchers and others.”
FAIR Health’s management team offers broad knowledge and extensive experience in healthcare, information technology, data management, insurance, finance and law. They are dedicated to their primary goals: to bring fairness and transparency to healthcare cost information and to apply their collective talents and expertise to make that information as accessible and useful to as many stakeholders as possible by providing innovative data products, consumer resources and research tools.
Prior to being recruited as President of FAIR Health, Robin Gelburd served for eight years as General Counsel of a medical research foundation comprising approximately 30 premier academic medical centers, hospitals and research institutions in New York State. During her tenure at this consortium, Robin was also appointed Chairperson of the New Yorkers for the Advancement of Medical Research, a statewide coalition of over 40 organizations that she helped found in 2003 and whose mission was the promotion of state funding and support for stem cell research. Previously, Robin was a health law partner at the New York City law firm Kalkines, Arky, Zall & Bernstein (now Manatt, Phelps & Phillips). During her 10 years at that firm, she represented an array of healthcare-based clients—including hospitals, provider groups and organizations, payors, skilled nursing facilities, special needs plans and ambulatory care centers—on a variety of strategic, regulatory, policy, governance, business and contractual matters. Earlier, Robin worked as a litigation and corporate associate at the international law firm Morrison & Foerster. She began her legal career as a federal appellate law clerk to the Honorable Francis D. Murnaghan, Jr. from the Court of Appeals, 4th Circuit. She received a BA with honors from the State University of New York at Binghamton and a JD from Cardozo School of Law, Yeshiva University.
Chief Operating Officer
Prior to joining FAIR Health, Bart Bronfman had over 15 years of experience as Chief Financial Officer for two not-for-profit organizations, St. Mary's Healthcare System for Children, a pediatric healthcare system providing subacute and long-term care in facilities and at home, and Pathways to Housing, a social services agency. In these positions he provided financial and strategic direction to the organizations. Previously, he served as Corporate Controller for American NuKEM Corporation, a national environmental consulting and services company, and managed the worldwide planning and analysis function for Avis, an international vehicle rental and leasing company. He received a BA from Syracuse University and an MBA from Rutgers Business School.
Chief Financial Officer
Mr.Sheit Dhaon is an accomplished finance executive with over 25 years of experience in improving the financial performance of organizations. Mr. Dhaon joins FAIR Health after serving over 8 years with Truven Health Analytics, former Healthcare division of Thomson Reuters, where he served in various leadership roles and most recently as VP & Head of Finance for $0.5 billion Commercial division. At Thomson Reuters, he focused on numerous acquisitions and the $1.2 billion divestiture of the Healthcare division. Prior to Truven, he held various positions with United Health Group. Mr. Dhaon earned his bachelor’s degree in Chemical Engineering from HBTI, India and Masters of Business Administration in Finance from University of Connecticut.
Chief Technology Officer
Ben Casado García has over 25 years of progressive information technology experience in global organizations. He joined FAIR Health after serving for the previous three years as the Chief Technology Officer for a multi-million-dollar global consulting firm based in Madrid, Spain. Ben made the transition to the healthcare industry from the financial markets, where he was a key designer and architect at JP Morgan Chase, Citigroup, Salomon Smith Barney and Prudential Financial. He also founded a software development company, later purchased by the Carlyle Group, and served as a member of the Board until 2008. Ben received a BS in Electrical Engineering from Rutgers University, an MS in Computer Science from Monmouth University and an Advanced Project Management certification from Stanford University.
Chief Information Security Officer
Jim Wilson leads FAIR Health’s Information Security Program and will oversee the expansion of the organization’s Health Insurance Portability and Accountability Act (HIPAA)-compliancy initiatives to include Health Information Trust Alliance (HITRUST) and National Institute of Standards and Technology (NIST) certification. Jim has over 20 years of professional technology security experience, with an extensive background in information technology security governance, compliance and operations. He has over 12 years of HIPAA-regulated industry experience, most recently as Director of IT Security at Interpace Diagnostics, the molecular diagnostics subsidiary of PDI, and, prior to that, as Global IT Manager at the cardiac medical device manufacturer Datascope Corp., where he directed an international team of 12 individuals covering both the United States and the European Union. Jim also served nine years as Director of IT Operations & Security at American Friends of The Hebrew University (AFHU), where his responsibilities included managing organizational security functions across their six US offices and Israel. He is a long-standing member of the Society for Information Management (SIM) and also has served as technology representative to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), now known as the Joint Commission. Jim attended Rutgers University and has Certified Information Systems Security Professional (CISSP) certification from the International Information System Security Certification Consortium ((ISC)2)
Chief Information Officer
Chris Goggin has over 25 years of experience in management and information technology leadership within the healthcare information technologies, health insurance, leisure travel and manufacturing industries. He was previously with Emdeon, where he was responsible for setting the overall direction of technology utilization and development for the Payer Services organization ($520MM annual revenues). He maintained a stable of enterprise-wide databases for use across Emdeon, lead support and development for the Payment Services division, developed and enabled Emdeon’s Payment Integrity business and managed the relationships with internal and external technology and service providers. Mr. Goggin has also previously held senior leadership positions at UnitedHealth Group, Trisept Solutions, UnitedHealthcare of WI, Humana and the Eaton Corporation.
Prior to joining FAIR Health, Michelle Scott was Vice President, General Counsel and Assistant Secretary of the National Audubon Society, the national conservation organization. She also served as Vice President, General Counsel and Secretary of the East-West Management Institute (EWMI), a non-governmental organization that conducts civil society, rule of law and economic development programs in Eastern Europe, Asia, Africa and South America. After leaving EWMI, she was elected to its Board of Directors and in 2010 became the Board’s Chairman, a position that she continues to hold. For over 18 years, Michelle was Vice President and Corporate Counsel for Prudential Financial, responsible for significant investment transactions and tax planning, and served as General Counsel of The Prudential Foundation. Earlier in her career, she was legislation counsel for the Joint Committee on Taxation of the United States Congress and was in private practice with law firms in New York City and Washington, DC. Michelle has spoken and written extensively on tax and nonprofit law. A long-term member of the Executive Committee of the New York State Bar Association Tax Section, she was Co-Chair of its Committee on Tax-Exempt Organizations for several terms and was appointed to the Commissioner of Internal Revenue’s Advisory Committee on Tax-Exempt Organizations. Michelle is a member of the National Steering Committee for the Women’s Studies in Religion Program at Harvard Divinity School and has served on the Boards of Directors of The Transition Network and The Associated Blind. She earned an AB from Bryn Mawr College and a JD from Harvard Law School.
Executive Director of Grant Programs
Ashley Smyth joined the FAIR Health team with over 15 years of experience in healthcare communications, health policy and program development. She has held senior management positions at organizations throughout the healthcare sector, including an academic medical center (Mount Sinai Hospital), government (the New York City Mayor's Office and New York City Health and Hospitals Corporation) and a private foundation (AMDeC Foundation). Most recently, Ashley served as the Administrative Director for Mount Sinai Hospital’s Office for Excellence in Patient Care and Mount Sinai School of Medicine's Department of Health Policy. Ashley was awarded her BA summa cum laude from Bowdoin College. She received master’s degrees in public health and public policy from Columbia University.
Executive Director of Business Development
As Executive Sponsor for FAIR Health’s large client base, Donna Smith maintains an effort to bring value to the various stakeholders that cross multiple market segments in the healthcare ecosystem. Donna has over 25 years of experience in the healthcare industry, concentrating on benefits administration, managed care, payor and claims solutions. Prior to joining FAIR Health, she was an independent consultant to a variety of entities in the healthcare and benefits sector, including health plans, third-party administrators and other companies serving the health insurance payor and self-funded employer markets. For these entities, her consulting services concentrated on marketing, sales and organizational strategic planning. In addition, Donna also served the provider community, working with small physician group practices to evaluate electronic medical record (EMR) solutions, based on meaningful use evaluations. Earlier in her career, Donna served as Senior Vice President of Sales and Marketing for a technology company, SBPA Systems, a role she retained when the company was acquired by SunGard, a leading technology and services provider of employee benefits, healthcare claims adjudication, business process automation and reporting solutions for the health and benefits insurance industry. In addition to focusing on business development, sales and marketing, Donna developed customer service, implementation and account management teams as well as executive and customer advisory groups. Donna has participated in several key industry associations—including Self-Insurance Institute of America (SIIA), Health Care Administrators Association, America's Health Insurance Plans (AHIP), Institute for Healthcare Consumerism (IHC) and Institute of Medicine (IOM)—by serving in many capacities, such as focused panels, workshops, task groups and committees, including a Board of Directors appointment with SIIA. Donna continues to participate and speak at various industry forums representing the many sectors FAIR Health serves. She holds a BS in Business Management and Marketing from Louisiana Tech University.
Chief Information Officer
Ali Russo has over 20 years of experience in various aspects of information technology, including more than 15 years in healthcare data, analytics and product development. Prior to joining FAIR Health, Ali was with McKesson, where she had many roles, including, most recently, responsibility for the Analytics Services team under the Health Solutions division. As Director of Analytics Services, her focus was to bring actionable analytic information to the healthcare sector based on allocated claims data. Ali received her BS in Biology from the State University of New York at Albany.
Deputy General Counsel
Tom Swift is responsible for licensing negotiations and contracts, data privacy and security and general corporate legal issues. Prior to joining FAIR Health, Tom was a Director and Counsel at Credit Suisse, a global integrated bank, advising on technology, intellectual property, privacy and general contract issues for 15 years. He has spoken and written on privacy and technology issues, and actively participated in a securities industry association addressing a variety of market data issues. Prior to that, he was a litigation attorney at Shearman & Sterling in New York, working on an array of commercial litigation matters, including antitrust, bankruptcy, securities and commercial lending cases. He received a BA in Government from Pomona College and his JD from New York University School of Law.
Chief Financial Officer
Roger Adler leads the Finance team in fiscal management and strategic planning as well as supporting the organization’s operations. Before joining FAIR Health, Roger served in several roles in technology, market research, finance and strategic planning over 25 years at Time Inc. As Finance Director of Time Inc.’s Corporate Services, from 2011 to 2015, Roger managed the finances and supported operations of corporate cost centers, including worldwide real estate and facilities, human resources, legal, central finance and corporate communications. In earlier roles, Roger managed consolidations, budgets and forecasts along with supporting the operations for media brands such as Time, LIFE, Sports Illustrated, Fortune and Money. Prior to these positions, Roger worked in Time Inc.’s corporate strategic planning, where he performed corporate financial planning and analysis, acquisitions, dispositions and new business development, including the relaunch of LIFE magazine. Before joining Time Inc., Roger spent five years at Erisco, an employee benefit system company, designing systems and analyzing medical claim information. Roger holds a BS in Mathematics from Union College and an MBA from Columbia University.
Executive Director of Customer Experience
Chris O’Donnell has over 25 years of experience in marketing, operations and customer experience. She is responsible for the overall customer experience for the multiple stakeholder groups that FAIR Health serves. Her role encompasses managing the client services team, the consumer help line and product management for a segment of the company’s product offerings. Prior to joining FAIR Health, Chris ran her own consulting practice, helping financial services organizations develop user-friendly products and processes. Earlier in her career, Chris was the Vice President of Marketing and Product Development for the voluntary benefits division at Prudential Financial and managed individual retirement accounts for Wells Fargo Bank. Chris is a graduate of Middlebury College with a BA in Economics.
Chief Medical Officer
Russ Robbins provides clinical oversight to clients regarding healthcare data, improves healthcare literacy and consumer engagement, uses episodes of care software to create bundled payment solutions and works with state workers compensation programs. Prior to joining FAIR Health, he was the Chief Medical Officer at Cambridge Advisory Group. For six years, he served as a Principal and Senior Clinical Consultant at Mercer, where he led the Total Health Management Clinical Team in addition to his work as a consultant. Before that, he was a Medical Director at iHealth Technologies and served as a Vice President and the Chief Medical Officer at Ingenix for the Symmetry product line, in which capacity he developed and maintained the industry-leading grouper, Episode Treatment Groups (ETG). He was the Medical Director at Health Market, one of the first consumer-directed health plans, and a Consultant at Novalis, part of the TriZetto Group, helping health plans create physician performance programs. He was in practice as a urologist with Schenectady Urological Associates. Russ received a BA in Biology from Swarthmore College, an MD from New York University (NYU) School of Medicine and an MBA in Health Sciences from Union College. He completed his surgical and urologic residencies at NYU Medical Center, Bellevue Hospital, Manhattan Veterans Affairs, Memorial Sloan Kettering Cancer Center and Cabrini Medical Center.
Deputy Director of Operations
Rachael McKeon oversees communications activities, develops and manages enhancements to consumer-facing portals and leads planning, development and maintenance of FAIR Health’s web environment. Prior to her current position, Rachael served as Director of Web Services, and was responsible for FAIR Health‘s web portal development. She brought knowledge of operations from Sandell Asset Management, where she provided research support to analysts before joining FAIR Health. Earlier experience included positions at Red Light Management and Force One Entertainment. Rachael graduated from Indiana University with a BA in Music and Business.
Executive Director of Information Technology
Bert Cliche oversees development efforts for externally and internally facing websites and applications, as well as working to coordinate infrastructure releases. He joined FAIR Health with over 25 years of technology experience, more than 15 of which were with Wall Street firms. Previous roles included Director at Merrill Lynch, where he ran the engineering team for Investment Banking, Research, Human Resources, Legal/ Compliance and Corporate Technology. Prior to that, Bert was Senior Vice President and Chief Architect for Equity and Fixed Income Prime Brokerage, Equity/Fixed Income Sales and Futures technology areas at Citigroup. Bert graduated with a BA from Hampshire College, majoring in Modern Algebra and minoring in Sculpture.
FAIR Health Advisors Help Ensure Process Integrity
FAIR Health advisors provide invaluable expertise and guidance to the FAIR Health professional staff. Their experience, knowledge and judgment contribute substantially to the development and evaluation of FAIR Health’s methodologies, product development, outreach and marketing efforts. Select a link below for more information about these essential advisory bodies.
The FAIR Health Scientific Advisory Board (SAB) is comprised of leading researchers from around the country. They are experts in a variety of fields relevant to FAIR Health's mission and activities: behavioral and market economics, geo-coding and market definitions in healthcare, analysis of claims data and its use in examining quality of care and disparities in care, HCPCS codes and CPT® codes, insurance plan design, RVUs, and large datasets such as Medicare inpatient data and all-payer data sources. SAB activities include review of UHRN research and recommendations for improving the database and products, data use and access policies for the FAIR Health Research Support Program and the design and strategic deployment of FAIR Health consumer survey instruments.
The FAIR Health Consumer Advisory Board (CAB) plays an important rolein the consumer education mission of FAIR Health. Specific activities of the CAB include providing guidance on the design and enhancement of the free tools on the FAIR Health consumer website-the FH Consumer Cost Lookup tools and other consumer offerings. Members of the CAB also guide the development of FAIR Health's educational curriculum on the FAIR Health consumer website as well as the development of outreach strategies to increase consumer awareness of the free tools and services available on the website.
The Customer Advisory group advises FAIR Health on issues related to new data product development, enhancements to existing products, business policy and the system implications of these changes.
The FAIR Health Dental Actuarial Group provides guidance on the statistical profile of dental charge data, and considers new product development and enhancement initiatives. The Group addresses such issues as frequency of data delivery, the schedule for product releases, the impact of methodological changes on data outputs, the use of relative values versus actual charge data in products and the design of the data contribution program.
The Dental Advisory Board (DAB) provides advice that reflects the unique perspective of the dental community. DAB members' areas of focus include the dental content of the FAIR Health database and products, research and product development, clinical and coding issues, and the FH Consumer Cost Lookup website.
The Physician Advisory Group (PAG) provides FAIR Health the important perspective of physicians who represent a range of clinical specialities. The PAG's focus includes data research and product development/enhancement, clinical and coding issues and the introduction of new tools and content to the FH Consumer Cost Lookup.
Read FAIR Health Access Q&A here.
Representing the Full Range of Healthcare Industry Stakeholders
Our diverse client base—from government agencies to consumer advocates, health policy researchers, corporate decision-makers and individual consumers—represents the full spectrum of healthcare stakeholders. Each one has a distinct need and specific use for our data, and an appreciation that the information we provide is comprehensive, unbiased and reliable.
Here are just some of our categories of clients:
Contact us for more information about the range of stakeholders we serve.
Health insurers nationwide use FAIR Health’s data to help them develop usual, customary and reasonable (UCR) fees for out-of-network reimbursement, to inform negotiations with providers, to design provider networks and to assist with benefit design decisions. Insurers and other industry customers also use the data to:
FAIR Health data and educational tools and resources are being used nationwide to support state health programs, assist government officials in understanding local healthcare markets and facilitate consumer engagement under the Affordable Care Act. For example:
The FH Consumer Cost Lookup tools and related educational materials are being licensed by state health exchanges, brokers and navigators as well as health plans operating on public and private exchanges. Connecting exchange participants, and organizations advising them, to FAIR Health’s cost data and other consumer resources allows them to:
FAIR Health data are supporting health services research to study population health and understand trends and disparities in care utilization and cost. For example, one researcher used FAIR Health data to examine how medical malpractice damage caps impact physician charges and care utilization. Another research team is using the data to examine the impact of licensing regulations on practice patterns. Other research topics include the overuse and underuse of certain procedures, studying geographic variation in the use of various treatments and assessing the diffusion of technologies.
Physicians licensing FAIR Health’s FH Fee Estimator are using the data to assist in the development of fee schedules and to evaluate participation in payor networks and accountable care organizations (ACOs). The data also support business planning for practices expanding to new geographic areas and/or adding new specialties or equipment. In addition, practices nationwide are using FAIR Health’s consumer education materials to offer their patients independent, unbiased information on health insurance, reimbursement and healthcare cost management.
Unions are licensing FAIR Health data to support claims adjudication, out-of-network fee schedules and member advocacy related to balance billing. The FH Benchmark® modules provide union customers with estimates of typical prices for medical and dental services in 491 different geographic regions. Union customers are also using FAIR Health data to better understand how their members’ healthcare utilization patterns compare to the broader commercial population.
FAIR Health’s consumer cost lookup tools are being used by consumers nationwide to estimate costs for medical and dental services in their geographic areas. These cost estimates help patients decide whether to go out-of-network for care, pursue reimbursement appeals and choose among different health plan options. FAIR Health consumer tools have been honored at numerous national forums including the White House Summit on Smart Disclosure, the URAC 2013 Quality Summit and the 2012 eHealthcare Leadership Awards