The Supreme Court on Monday announced it will hear a case next term regarding whether Vermont can require self-funded health insurers to submit information on the prices they pay for medical care to a state all-payer claims database.
The high court likely will hear the case in November or December, and a decision is expected by June 2016.
Eighty percent of patients want their physicians to talk about price
Background on case
The case—Gobeille v. Liberty Mutual Insurance –centers on the legality of a requirement under Vermont law for self-funded insurers to submit certain information upon request to the state's database, including:
- Claims data;
- Enrollee eligibility; and
- Other information.
At least 11 other states have similar databases.
Who is actually using hospital price, quality data?
Liberty Mutual argues that the company and its third-party administrator are exempt from submitting the data under the federal Employee Retirement Income Security Act (ERISA). Meanwhile, Vermont argues that the state needs the data to help reduce health care costs and improve quality of care.
According to Vermont Assistant Attorney General Bridget Asay, the state uses payers' data to:
- Analyze cost and outcome differences of similar medical procedures;
- Conduct research on care quality; and
- Track differences in care utilization by geographic area;
- Identify the health care needs of its population; and
- Provide health care data to state residents.
Using claims to analyze physician performance? First, check your data.
The 2nd U.S. Circuit Court of Appeals ruled in favor of Liberty Mutual. Vermont then appealed the decision to the Supreme Court.
Decision could have national implications
The Office of the Solicitor General argues in a brief that the questions presented in the case are of "national importance." The brief states, "If States are unable to acquire such data from self-insured ERISA health care plans, their databases will be significantly less comprehensive and thus not as useful in developing health policy at both the state and national levels."
According to Steve Wojcik, vice president of public policy at the National Business Group on Health, the case has major implications for the question of whether employers have ownership and control over health data (Wille, Bloomberg BNA, 6/29; Schencker, Modern Healthcare, 6/29 [subscription required]; Gullo, MyChamplainValley, 6/29; Leonard, Courthouse News Service, 6/29; Bagley, The Incidental Economist, 6/29; Schencker, Modern Healthcare, 12/18/14 [subscription required).
Your guide to price transparency
As the number of high-deductible health care plans increase—and more patients consider cost when choosing providers—organizations need to get up to speed on price transparency. This guide outlines objectives for:
- Maximizing your patient financial counseling department;
- Preparing your department for the increased volume of patients asking about out-of-pocket medical costs and pricing for scheduled procedures;
- Creating collateral that explains out-of-pocket financial responsibility for a medical service to patients; and
- Developing online portals and third-party avenues to help create a culture of price transparency.
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