Private Payer Information on Anesthesia and Other Services: Claims Data to Be Available Next Year
Aetna, Humana and UnitedHealthcare have announced plans to establish an online database of paid claims that will give consumers, employers and federal and state governments information about the price and quality of healthcare services.
The announcement follows closely behind CMS’ public release, on April 9, 2014, of line-item data on $77 billion paid out to more than 880,000 physicians and other Medicare Part B suppliers in 2012. (See April 21, 2014 Alert: How Much Did Medicare Pay Each of 32,641 Anesthesiologists in 2012?)
In 2011, Aetna, Humana, UnitedHealthcare and Kaiser Permanente created the Health Care Cost Institute (HCCI) to provide data to qualified researchers on more than 5 billion claims dating from 2000. This database allowed HCCI to release three annual healthcare cost and utilization reports that tracked trends in national healthcare spending.
The purpose of compiling the data was to promote better understanding of the drivers of escalating healthcare costs. The database also allowed focused research such as that by a team of investigators who determined that consumers paid more of a growing healthcare bill (average of 8 percent increase per year) than did employers or insurers (average of 4.9 percent increase per year) between 2007-2011 (Herrera CN, Gaynor M, Parente ST, Town RJ. Trends Underlying Employer-Sponsored Health Insurance Growth For Americans Younger Than Age Sixty-Five. Health Aff October 2013 32:101715-1722).
The 2011 claims database is accessible to researchers only—not to commercial entities, including the health plans themselves, to prevent their using the information in negotiations with providers, and not to the public. The data are aggregated and do not permit identification of individual patients, physicians or hospitals. They include the price, volume and intensity of services delivered to patients with private coverage from one of the four health plans. Medicare data—until the arrival of the first HCCI database, the only source of claims data for many studies—are used for comparative cost information. A summary is made available to the public twice a year.
The future claims database, in contrast, will be open to the public, using a secure portal. It is expected to be online in early 2015. It is specifically intended to be a consumer tool, offering patients and others a “reference price” for health services in their geographic areas, based on aggregated data from the participating insurers. Different from the Medicare data released last month, the public will not be able to see how much in total an individual insurer paid a specific doctor, hospital or other provider, or download all of an insurer’s payment data.
HCCI, which will manage the database, will offer three levels of granularity. The first level will allow any consumer to find, by zip code, average price information for an episode of care such as a knee replacement or heart surgery. “It will also show a range of high- and low-end prices to indicate how much variation there is for a given service. [David Newman, HCCI executive director] likens the information to car-buying site Edmunds.com.” (Tozzi J. Health Insurers Want to Make Medical Prices Easier to Discover. Bloomberg Businessweek May 15, 2014.) The basic unit of information is the service or procedure unlike the Medicare database, where it is the provider.
The second level will give consumers covered by Aetna, Humana and UnitedHealth Group access to more detailed price information relating to their own networks, including their out-of-pocket liability for given medical services. The third level will have the greatest amount of detail and will help employers customize the information to be given to their employees.
What Information Does the HCCI Database Include?
Source: HCCI Data Dictionary
According to the HCCI press release, the benefit of the database for providers will be “timely and accurate information about costs and quality [that will allow] them to see information on other providers as well.”
Seeing information on other providers is of considerable value to physicians attempting to establish or adjust their own fee schedules. (Note: using public, third-party information for this purpose, without any agreements on charges between competitors, does not generally create antitrust problems.) Average actual health plan payments by service in one’s geographic area could provide very useful benchmarks.
It remains to be seen how the “service” and “payment details” will be defined. For anesthesia services, the payments amounts alone will be less helpful if the breakdown between base and time units is not also given, since longer procedures generate higher charges and payments.
Average cost information on other medical and hospital services could prove quite valuable in determining the allocation of bundled payment amounts.
Future plans for the HCCI database encompass obtaining claims data from other insurers—Blue Cross Blue Shield and Cigna are notably absent in this iteration, although some Medicare Advantage and Medicaid managed care plan information is included—and “refining the transparency platform” to add “more comparison features and, in the longer term data from fee-for-service Medicare and Medicaid programs, as and when it becomes available.” The press release does not mention the source of the information that will permit assessments of quality—but that important issue, and the form of the database’s price and service information, will be defined as the database develops. We look forward to learning more in 2015.