One Step Forward Toward Full Transparency

Posted by: David Morales, Commissioner, Division of Health Care Finance and Policy

Question: Why are we one step forward toward greater transparency in the Massachusetts health care delivery system? 

Answer: Today, the Division of Health Care Finance and Policy adopted regulations for the All-Payer Claims Database (APCD). 

As I have mentioned in previous blog posts, the APCD will include virtually all health care claims data in Massachusetts. Not only will it support valuable analysis of the health care system, it will also offer consumers and employers a clearer picture and better understanding of the true cost of health care. 

An added benefit of the APCD is that it will help to lower administrative costs for both government and health plans because it will serve as a central repository for health care claims. Today, multiple agencies make routine requests of such data and drive up unnecessary administrative costs.

Here's a quick overview of the two APCD-related regulations: 

114.5 CMR 21.00 establishes data submission requirements for health care payers. Essentially, the APCD will serve as a clearinghouse for comprehensive quality and cost information that will help consumers, employers, insurers, and government have the necessary data to make prudent health care purchasing decisions. 

114.5 CMR 22.00 governs the disclosure of all member eligibility and claims data. This will make health care claims data available for health care policy analysis that serves the public interest and safeguards the privacy rights of members. 

Over the next several months, we will continue to update you on the progress of the APCD. Stay tuned to learn more. 

Comments

[Dennis Byron]

How come the quarterly Key Indicators Report is two months late? Its delay does not speak well for transparency.

[Scott Plantier]

Hi Mr. Morales,

Thanks for all your work on behalf of the public. I'd like to know what your thoughts are on the informative site found here: http://masshealthlawtruth.org/mass_health_mandate_truth_vs_spin_1.htm

Data here appears quite opposite to much of what has been printed in the media.

Regards,
Scott Plantier

[Cindy Small]

This is good news a step in the right direction!

[dianne]

Your so-called transparency is merely another invasion of our privacy and leaves people open to denial of care and much more.

The mandated health insurance law in MA is not working and has been harming individuals, families and small businesses from the get-go. Look at the enrollment figures, in particular, the number of disenrollments on an average monthly basis vs the number of enrollments. That tells the entire story in a nutshell.

I believe Brian Rosman, who heads up one of the cheerleading squadroons for this nightmare, has stated that without further revenue, this system is not sustainable.

But that's not a problem for Beacon Hill. Just cut benefits, raise copays, slash important programs for seniors, cut budgets at Boston Medical Center, dump people from Commonwealth Care, etc.

Want to know the truth that all of you tried to censor during the national debate? If so, the link to a terrific website is below. Be sure not to miss the series on the MA plan by Trudy Lieberman from Columbia Journalism Review and the article that appeared on the Huffington Post written by the AMSA students - Health Reform Lessons from Massachusetts. I found these at the Other Resources button on the truth site in the list of Articles and Facts.

http://www.masshealthlawtruth.org

P.S. What'd you think about Obamacare which dumps a certain segment of the population into expanded Medicaid against their will or without their knowledge, or, if enrollment is not auto, nails them with a tax penalty b/c there is no other choice if they don't want to be in this lousy plan.

Interesting that when they revised Medicaid regs to increase the income and age limitations as well as to allow childless adults to be eligible and DROPPED THE ASSET TEST, they did not, to my knowledge, get rid of the federally-required estate recovery program that will affect millions of Americans who receive Medicaid benefits at age 55 and up.

The national plan is supposed to be mandated health insurance, not a mandated collateral loan.

No choice for expanded Medicaid-eligible Americans is discrimination, and estate recovery under a mandate is exploitation of this segment of the population.

That said, both schemes - the MA and national plans - are discriminatory in general b/c both are based on ability to pay and treat various income brackets differently.