Posted by: David Morales, Commissioner, Division of Health Care Finance and Policy
Last month I described an important project we are spearheading at the Division of Health Care Finance and Policy–the creation of an all-payer claims database, which we refer to as the “APCD.” In brief, the APCD will facilitate objective analysis of the Massachusetts health care delivery system and promote public transparency in order to improve health care quality and mitigate the annual growth in health care costs. In line with this mission, the Division has proposed two regulations–to be heard on Monday, May 17–regarding the submission of health care claims data by all payers, such as health insurance plans, as well as the release of health care claims data to interested organizations.
In a previous blog post, “Toward Full Transparency of Health Care Costs”I described how the APCD will promote administrative simplification for both the government and payers, and provide similar benefits to providers and consumers of health care in the Commonwealth. Here’s how the APCD can help to achieve three key goals for health care in Massachusetts: transparency, integration, and wellness.
In order to develop effective public policies and programs, it is critically important to analyze and understand underlying trends in health care costs and medical utilization. By collecting comprehensive claims data from all payers, the Division will develop a database that will – for the first time ever – enable us to publicly answer questions such as:
• Do prices differ, and to what extent, for a particular medical service in the same geographic area?• How do health plan payments vary among providers and products offered in the same region?
• What are the trends in the use of medical services across the Commonwealth?
In addition, we hope that the APCD will facilitate consumers, employers, providers, payers, and government having the data necessary to make prudent health care purchasing decisions. While many large purchasers and providers may already have sufficient data to analyze variations in price and quality, making data more widely available will help to “democratize” such knowledge by giving small businesses and individuals access to this valuable information.
The APCD will also help to inform the development of integrated health care delivery systems. For the first time we will have complete data regarding the use of services across the continuum of sites where patients access and obtain their health care. This information will not only help us to develop and monitor better integration of health care services, but also will provide transparency regarding spending on specific health care services and the value produced for the patient.
Furthermore, data from the APCD can help us understand the cost of diagnosing, treating, and managing chronic conditions such as diabetes and asthma, as well as provide information on variation in the incidence of these conditions by geographic area, race, and ethnic group. This type of information also can be vital to Massachusetts public health officials in designing and targeting wellness programs to stem the increase in chronic diseases.
On Monday, May 17, you have the opportunity to provide testimony regarding this important initiative. The Division will hold public hearings relative to the creation of an all-payer claims database (under the adoption of regulation 114.5 CMR 21.00: Health Care Claims Data Submission) at 10:00 a.m. and on the release of this data (114.5 CMR 22.00 Health Care Claims Release) at 1:00 p.m. The hearings will be held at 2 Boylston St, 5th Floor, Boston, Massachusetts. Written testimony may be submitted through May 28.
I look forward to seeing you there.
By looking at it from the payers' perspective you are doing it backwards. And missing a large percentage of the expense. How do you capture the out of pocket costs and the insurance premiums paid--direct or via payroll (including by employer)--but not "used" (in the sense that the insured had no medical expenses in a given year)? Similarly how about taxes raised/appropriated for medical services but not "used?" Both federal and state. You need all of the above to get the true cost of healthcare services.
why do you go after the insurer and not the deliverer? Why not just have every physicians' practice, drugstore, nursing home, clinic, hospital, etc. send in every bill issued?
Posted by: Dennis Byron | May 12, 2010 at 07:25 AM