Health insurers in one large West Coast state now have to disclose claims data that for decades was proprietary, in a reluctant but heralded move towards transparency.
Washington Governor Jay Inslee has signed into law a bill creating a "fully-functional" all-payer claims database, making available to the public, researchers and healthcare companies a variety of healthcare cost data. The new law builds on an existing initiative by requiring insurers to submit information, whereas it was previously voluntary.
"Last year there was a lot of disagreement about the all-payer claims database," Inslee said, referring to opposition posed by from Premera Blue Cross, Washington's largest insurer, which changed its stance this year. "Quality and cost information are now going to be available to all of us," Inslee added.
With every insurer in the state mandated to contribute data for all of their health plans, including third party administrative clients, the database will be more comprehensive and hopefully help lead to more ways for residents to make meaningful healthcare choices, according to the Washington Health Alliance, the group that currently runs the database.
The expanded database will be used to identify regional patterns, total costs of care by health condition, type of procedure or treatment by geographic area, and high-value systems or "centers of excellence" for particular types of care, said Nancy Giunto, the group's executive director.
Washington Health Alliance research topics so far have included variation in utilization of healthcare services targeted for more appropriate use. A 2012 study found that people living in Everett were more likely to get CT scans than the rest of the Puget Sound region, with Everett girls ages 5–14 being 134 percent more likely to get a CT scan than young girls living in Tacoma. The database also showed that men ages 55-64 in the suburb of Renton were 80 percent more likely to have spine surgery than men in all of Seattle.
Among the coalition of businesses, health plans and providers that lobbied for the new disclosure mandate were the National Federation of Independent Business Washington chapter, Group Health Cooperative, the Everett Clinic, United Healthcare, Providence Health & Services, the King County government, the state Food Industry Association, the Retail Association, and the state hospital, medical and pharmacy associations.
"Businesses and consumers will now have access to meaningful cost and quality information to make informed healthcare decisions," said Patrick Connor, Washington state director for the National Federation of Independent Business.
"Group Health believes this transparency is a critical step forward in helping all healthcare consumers better understand the costs to provide quality care that results in positive outcomes," said Scott Armstrong, Group Health President and CEO.
Washington joins more than a dozen states with an existing comprehensive all-payer claims database, and several more with initiatives in the midst of implementation, including Connecticut and New York.
Among the kinds of problems the Washington Health Alliance is already tackling are issues like avoidable emergency care utilization, compared across commercially insured
populations and those covered by Medicaid.
