The country's largest state insurance exchange wants to be an active purchaser negotiating on behalf of consumer, and a data-driven convener of affordability and quality.
Covered California is hoping to learn from data on the 1.4 million people enrolled in health plans through the exchange, to track progress on such health problems as chronic condition management and preventive care and to help plans most accurate price for the risk of the market.
Covered California has signed a five year, $9.3 million contract with Truven Health Analytics to operate a database of claims and enrollment information, the Los Angeles Times reported.
The exchange wants to collect data from health plans on physician and hospital treatment and prescription drugs, to "understand the quality of care being provided," Covered California executive director Peter Lee told the LA Times.
How many Covered California customers are getting regular blood tests or eye and foot exams? How many of those 50 and older are getting recommended colonoscopies? Those are questions the exchange wants to probe as it increases its focus on health plan quality ratings, as part of its consumer advocacy mission.
Already, Covered California has dabbled with data-driven policy making in a collaboration with University of California researchers who compared exchange plan enrollees and pre-exchange hospitalizations to gauge the risk of the new membership.
They found that Californians who enrolled in exchange plans first, in October 2013, were more likely to be sick or in need of healthcare than those signing up in April 2014 at the end of open enrollment, who were on average 11 percent healthier. The findings were published in Health Services Research, and were also used to guide risk adjustment methodology among the health plans.
Covered California used the data to convince insurers to price premiums lower in the following year, saving an estimated $100 million for consumers with rates that on average increased less than 5 percent, according to Lee.
"This represents the best of what a health insurance exchange can do: develop our own information about the health of our consumers so that we can come to the table as smart negotiators on their behalf," Lee said. "This is one of the ways active purchasing works to ensure quality products at the best possible value."
"What was special about this effort is that we were able to give insurance plans something they did not have access to before," said Covered California chief actuary John Bertko, one of the study's authors. "It gave them valuable information to better estimate their costs and offer more appropriate rates for consumers."