Regence BlueCross BlueShield Objects to Making Healthcare Costs More Transparent
October 7, 2013 -- The Oregon Health Policy Board laid out five straw proposals last week in an attempt to carry out Gov. John Kitzhaber’s request to transform the healthcare system by coordinating care, rewarding quality outcomes and using a global budget to pay for healthcare costs.
One tool that could be helpful in driving down costs is a statistical warehouse known as the all-payer, all-claims database, created by a 2009 law, which lets the state collect mountains of healthcare information.
“The authors of this provision had a very broad perspective of what it can do,” said Gretchen Morley, the health analytics director at the Oregon Health Authority, who’s been developing the database.
But despite that broad perspective, the database -- which includes information on how much insurance companies pay for various health procedures -- is off limits to the public as well as news organizations such as The Lund Report.
Earlier this year, Oregon received an “F” for healthcare transparency in a national report produced by two business groups, the Health Care Incentives Improvement Institute and the Catalyst for Payment Reform. Greater transparency from the all payer, all-claims database may give consumers a better idea of healthcare prices so they can make more informed healthcare purchasing decisions.
Currently only academic research groups that can prove the use of this information meets high academic rigor are allowed access to the data base, said Jesse Ellis O’Brien, the healthcare advocate at the Oregon State Public Interest Research Group.
But if it were available to the public, OSPIRG or journalists might learn how much Regence BueCross BlueShield pays for a procedure compared to Health Net or Medicare, including hospital costs. They might also learn which hospitals charged more than others for similar procedures.
By making the data base publicly available, consumers could have a better opportunity to choose health plans that give them the best value, according to O’Brien. “We definitely would advocate for making it more accessible,” he said.
But, Alison Goldwater, the vice president of provider services at Regence, told the policy board that information should remain confidential. “Publicly disclosing private contract rates will drive rates higher.”
That’s not true, O’Brien countered, saying that Regence’s competitors have told him privately that transparency could help them get lower rates from hospitals throughout the state.
On the other hand, Bill Ely, a chief actuary at Kaiser Permanente, cautioned the use of the all-payer, all-claims database to get a true measure of healthcare cost, noting that an s integrated healthcare model, such as Kaiser, doesn’t rely on a claims system to determine costs.
But Ely did welcome the idea of setting up an all-payer, all-claims advisory group, as outlined in one of the straw proposals presented to the board by Diana Bianco of Artemis Consulting.
“Only after a thorough understanding of the data is obtained can we make it useful for the state,” Ely said.
Although the recommendations for the all-payer, all-claims database recommendations could be put in place in 2014, Kitzhaber has asked the policy board to come up with recommendations that could come before the February 2014 legislative session.
One idea that seems likely is pushing private commercial insurers that participate in Cover Oregon to focus on a coordinated care approach similar to that adopted by the Oregon Health Plan.
To qualify for the exchange, insurers would have to instigate the primary care home model as well as use global budgets and quality metrics, said Board Chairman Eric Parsons.
“We should do everything we can to channel care to primary care and preventive care,” he said, before warning about being too prescriptive in the board’s policy directions. “I want to encourage the direction but not bind providers to any rules.”
Another proposal would reward insurance companies to show a sustainable inflation rate, with merit badges, that participate in Cover Oregon. And, the Insurance Division could reduce or reject rates increases if insurance companies were unable to show they were following innovative practice solutions.
“Oregon’s rate review process has been very effective at forcing insurers to operate more efficiently,” O’Brien said.
O’Brien pushed for using rate requests to hold insurers accountable, and, by extension, hospitals and other healthcare providers accountable for controlling healthcare costs.
But Goldwater once again dismissed Regence’s ability to force providers to adopt cost containment measures.
O’Brien agreed that insurance companies might be unable to negotiate provider contracts if they push too hard to hold down costs. But, if the Insurance Division required all insurance companies to apply this pressure, and quantify their cost containment strategies, the health systems could be held accountable along with the insurers, he said.
OSPIRG delivered a petition signed by 24,000 Oregonians, calling for the Insurance Division to make insurance companies prove they were working to control medical cost and demanded that insurers notify their consumers when they seek rate hikes.
Sen. Chip Shields, D-Portland, pushed a bill in the past session, SB 413, which would have required this, but the bill was killed on the Senate floor, at the behest of Sen. Laurie Monnes Anderson, D-Gresham.
But the state’s consultants didn’t advocate one popular idea. Joel Ario, a former Oregon insurance commissioner, downplayed the effectiveness of wellness programs and patient health engagement in the individual market, despite evidence that larger employers have been able to persuade employees to take up healthier lifestyles.
“Wellness programs have shown significant success in the large employer market, where human resources can work with employees,” said David Cusano, a senior research fellow at the Georgetown University Health Policy Institute in Washington, D.C. “It’s questionable how much wellness programs can work in individual and small group markets.”
The health policy board will meet again Nov. 5 in Hood River to begin approving policy recommendations for the governor and Legislature.
Christopher David Gray can be reached at firstname.lastname@example.org.