All-Payer, All-Claims Shows Clear Figures for Medicaid

But the database as presented by Oregon Health Authority shows very little value in regard to the private insurance market. Many health plans don’t give enrollment numbers; data for individual hospitals is not collected; and data identifying health insurers is kept secret.

The public got a peek into the Oregon Health Authority’s all-payer, all-claims database on Tuesday, and it confirmed in detail much of what was already known -- the growth in the Oregon Health Plan has been huge, and the Medicaid expansion has gone a long way in reducing the state’s number of uninsured.

Oregon had 550,000 people going without health insurance in 2013. The database can’t track directly how many people have insurance, but the Oregon Health Plan -- designed to cover the state’s neediest residents as well as about half of all children -- grew by 330,000 and now stands just shy of 1 million people.

The director of the office of health analytics, Gretchen Morley, gave a rough but educated guess that 5 percent of those people had some form of private insurance before the expansion.

The data also revealed that the  individual insurance market grew by 52,000 people since the onset of Obamacare. A fair number of these people were likely among the uninsured, although some may have simply lost employer-supported insurance. The small business market shrank by 5,000 members.

In its June report, the analytics office also shared a survey of medical debt -- which showed considerable racial inequity. About 28 percent of the sampled Oregonians reported medical debt, but that number ballooned to 35 percent for American Indians and 38 percent for Latinos. Latinos, blacks and American Indians were also more likely than the state average to report being in poor health.

Morley’s presentation did show that the state lacks some information that would make the database more useful. Businesses that are self-insured are governed by federal law and not the Oregon Insurance Division. They therefore report their enrollment data only voluntarily, and many aren't sharing this information. 

Morley later added in response to questions from The Lund Report that third-party administrators for self-insured plans are required to submit claims data, even if they neglect to submit their enrollment data to the Insurance Division.

The database doesn’t include most Medicare claims, although it does include Medicare Advantage managed care plans, which cover 44 percent of Oregon’s seniors 65 and older. The analytics office has asked the federal government to provide the remaining Medicare data, but is still waiting on approval.

“The Medicaid data is very useful. The Medicare data is somewhat useful,” said Dr. Joe Robertson, the president of the Oregon Health & Science University. “The remainder of the data is barely useful. … As long as there are serious holes, I don’t think we will ever be able to use this data in a way that is useful.”

But within the data that was reported, the list of the most frequently reported procedures did show different health needs between Medicaid, Medicare Advantage and regular private health insurance.

The public has had little access to the all-payer, all-claims database since the Legislature created it several years ago. And it contains reams of data that isn’t easily digestible to the public.

The Oregon Office of Health Analytics is preparing a contract proposal to create a public dashboard to make it more available, which will likely go out to bid at the end of June.

How much any of this data will be valuable to consumers is suspect at best. The data shows basic trend lines of spending on certain procedures over time, but most of the graphs compared Medicare and Medicaid along with private insurers -- which is kind of like comparing apples, oranges and pears.

Medicaid rates, to no one’s surprise, had the lowest costs per member per month. Medicare typically had the highest monthly expenses but only because utilization rates were much higher than private insurance.

The health analytics office did not reveal the identities of the insurers in their presentation Tuesday, giving no inkling as to whether some insurers were negotiating better rates or adopting good coordinated care strategies. It’s uncertain if that information will be in the public dashboard, either.

The all-payer, all-claims database also does not let consumers compare the cost for certain procedures performed at different hospitals. Insurers must only provide the state with records of the services and the procedures they paid for.

“The APAC doesn’t track where the claim took place,” explained Felisa Hagins, a policy board member and representative from Service Employees International Union Local 49. She had asked for such information only to discover the state isn’t tracking it, further reducing the usefulness of the all-payer, all-claims database.

Oregon Health Authority spokeswoman Alissa Robbins said that the Seattle company Milliman was working on a hospital index for the database that could solve this probem. But without that data, a lack of transparency in pricing makes it easy for high-cost health systems to gouge consumers and charge wildly different rates to health insurers compared to  competing health systems.

Last week, Sen. Larry George, R-Sherwood, asked Insurance Commissioner Laura Cali if information about rates charged by providers could be made part of the insurance rate review process for the individual and small group market. However, such a move would be unlikely if only because such data, like the all-payer, all-claims database, would be incomplete and only apply to one small part of the overall health market, as consumer health advocate Jesse O’Brien of the Oregon State Public Interest Research Group explained.

Editor's Note: This article was corrected to show what data the state receives from self-insured health plans. The state receives claims data but not all enrollment data.

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