Another Case Before Supreme Court Could Influence Health Care Reform

2 min
May 26, 2015

King v. Burwell, the case challenging federal subsidies for health insurance, isn’t the only healthcare case pending before the U.S. Supreme Court with the potential for national repercussions.

A Vermont case involving claims data reporting could play a significant role in government efforts to collect and analyze healthcare data, a process many believe will lead to policies that can improve care and reduce the cost of delivering it.

Over the past decade, a growing number of states have established state-sponsored, all-payer claims database systems — known as APCDs — to collect and analyze information from health insurers, hoping to use the information to guide payment reform efforts.

So far 16 states have established mandatory, state-sponsored APCD systems. More than 30 other states — including California — are considering or pursuing some form of APCD information gathering. The California Legislature is considering a bill — SB 26 by Sen. Ed Hernandez (D-West Covina) — that would establish a statewide APCD ….

Joseph Smith, president of West Health Policy Center, said having data from self-funded plans is important, but states shouldn’t wait to get all claims before launching APCDs.

“States have found important value in having the ERISA plan claims. Including claims from self-funded employers provides a more accurate picture of healthcare utilization, cost and quality in each state. That being said, states should not wait for every payer in the market to be on board to start their APCDs. The state’s APCD can grow incrementally, once critical mass has been built and others see how their sector might benefit,” Smith said.

West Health Policy Center, a national organization aimed at improving the country’s healthcare system, is working with the APCD Council to help states develop standardized reporting measures.

“Our research has shown these databases can lower healthcare spending,” Smith said. “Every state, including California, should be pursing increased healthcare price transparency because better information leads to better decisions.”

Please click here to read the full story at California Healthline.