Health Care Cost Institute
Health Care Spending in North Carolina
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Introduction
Visualizing How Health Care Costs Vary Across North Carolina
We partnered with the Health Care Cost Institute (HCCI) to help North Carolinians explore how health care spending differs across the state — by county, by service, and by payer.
Health Care Cost Institute (HCCI) is a non-profit research group based in Washington D.C. that studies the U.S. health care market. We’ve worked with HCCI before, most notably on their Healthy Marketplace Index series in 2019 and 2020.
For this collaboration, HCCI teamed up with researchers from Duke University’s Margolis Center for Health Policy and Blue Cross Blue Shield of North Carolina. The goal was to pool data from all three organizations to create a comprehensive view of health care spending in the state of North Carolina. We were brought in to design and develop a data visualization experience to promote the research.
The work was generously supported by the Commonwealth Fund and Arnold Ventures.
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The Challenge
Health care costs can vary dramatically depending on where you live — but for most patients, those differences are invisible.
The Health Care Cost Institute wanted to change that in North Carolina by releasing localized data on insurance claims for services like primary care, maternity care, and emergency room visits. They needed a clear, approachable platform to help policymakers, researchers, and the general public navigate complex cost data — and ultimately make more informed decisions.
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The Research
Behind the scenes, a team of researchers from HCCI, Blue Cross NC, and Duke worked to harmonize millions of claims across four major payer types.
Data Sources
The dataset powering this project consists of de-identified health care claims from individuals with Employer-Sponsored Insurance (ESI), Medicare Advantage, Medicare Fee-For-Service, and Medicaid. Together, these sources represent about 12.6 million member years across 2016 and 2017 — roughly 6.3 million people annually.
Analysis
To make costs comparable across regions and services, the research team had to make dozens of technical decisions: aligning categories, adjusting for demographic differences like age and gender, and ensuring consistency across payers. Their goal was to standardize the data in a way that preserved nuance while enabling meaningful apples-to-apples comparisons.
The result was a detailed and rigorous foundation that made localized health care cost comparisons possible — and trustworthy.
See the methodology document for more information on things like sample selection and claims categorization.
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Our Approach
Our work on this project began in earnest in March 2020, before the research was actually complete. In the absence of real data, we had to design visualizations that were flexible enough to accommodate a variety of possible insights and conclusions.
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Designing for Exploration at Multiple Levels
We developed an interactive map and data table that allowed users to explore costs across counties, services, and payers. The interface makes it easy to:
Compare health care prices across different regions of the state
Filter by service type (e.g., maternity care, diagnostic imaging)
Break down costs by payer (Medicaid, Medicare Advantage, Commercial)
By designing flexible navigation and layered filtering, we ensured that users could explore the data from whichever angle was most relevant to them.
Making the Data Accessible and Trustworthy
To help users interpret the numbers accurately, we included clear definitions, service category explanations, and data sourcing notes throughout the platform. From color choices to labeling conventions, every design decision reinforced a sense of transparency and trust.
The Design Process
We went through three rounds of formal mockups with HCCI and Duke. The mockups outlined the complete experience in higher fidelity, including the functionality for every data viz.
The interactive dot plot, in particular, took some careful consideration. The goal was to show the distribution of per-person spending across counties for different payer populations. HCCI also wanted a way of determining which dots mapped to which counties. We achieved this through some clever interactivity, highlighting and linking dots from the same county on hover.
The default view of the dashboard gives readers a sense of the geospatial distribution of per-person health care spending. They can also drill down by payer type or service category.
Then, by zooming in on a particular county, the reader has access to more granular data like:
The payer type population breakdown
Per-person spending by payer type
The percentage of spending derived from inpatient, outpatient, and professional care.
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The Results
The North Carolina Health Care Spending dashboard launched in 2020, providing a first-of-its-kind view into how insurance claims costs vary across the state.
It has become a resource not only for policymakers and researchers, but also for journalists and advocacy groups working to increase price transparency and drive reform efforts. The project demonstrates how data visualization can bridge the gap between complex research and public understanding — helping North Carolinians see and question the hidden costs of care.
Testimonial
Shout out to @TheDataFace for dashboard and visual design elements - we love working with them on projects like this and the Healthy Marketplace Index!!
Niall Brennen
CEO, Health Care Cost Institute
Tools used
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HTML
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Javascript
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CSS
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D3
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Handlebars
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Archie ML
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Github
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Figma
By the numbers
Recognitions and press moments