Gregory D. Curfman, "All-Payer Claims Databases After Gobeille"
January 23, 2017 The Fifth Annual Health Law Year in P/Review symposium featured leading experts discussing major developments during 2016 and what to watch out for in 2017. The discussion at this day-long event covered hot topics in such areas as health policy under the new administration, regulatory issues in clinical research, law at the end-of-life, patient rights and advocacy, pharmaceutical policy, reproductive health, and public health law. The Fifth Annual Health Law Year in P/Review was sponsored by the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, Harvard Health Publications at Harvard Medical School, Health Affairs, the Hastings Center, the Program On Regulation, Therapeutics, And Law (PORTAL) in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital, and the Center for Bioethics at Harvard Medical School, with support from the Oswald DeN. Cammann Fund. Learn more on our website: http://petrieflom.law.harvard.edu/events/details/5th-annual-health-law-year-in-p-review
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Gregory D. Curfman, "All-Payer Claims Databases After Gobeille"
- 1. All-Payer Claims Databases (APCDs) After Gobeille Gregory Curfman, MD Harvard Medical School January 23, 2017
- 2. 2Office of External Education Harvard Health Publications APCDs After Gobeille Carmel Shachar, JD, MPH Aaron S. Kesselheim, MD, JD, MPH Ameet Sarpatwari, JD, PhD
- 3. 3Office of External Education Harvard Health Publications APCDs After Gobeille Background • Health care spending approaching 20% GDP • Cost control is a high national and state priority • States need comprehensive data on utilization and spending • Medicare data not representative of entire population • Medicare prices set administratively, but not private insurance prices (wide variation)
- 4. 4Office of External Education Harvard Health Publications APCDs After Gobeille • APCDs developed to fill this information gap (Maryland first in 1995) • Total of 16 states have established APCDs • APCDs collect claims and payment data from all payers • Comprehensive picture of state spending • Key feature: inclusion of negotiated prices for services • APCDs support price transparency efforts
- 5. 5Office of External Education Harvard Health Publications APCDs After Gobeille • APCDs inform state health policy decisions • Massachusetts Health Policy Commission • Used APCD data to set state spending targets • APCD data used to bar Partners HealthCare from acquiring South Shore Hospital (antitrust)
- 6. 6Office of External Education Harvard Health Publications APCDs After Gobeille Supreme Court’s Decision • Gobeille: An expansive preemptive SC decision • Justice Kennedy wrote the opinion (6-2), with Justices Ginsburg and Sotomayor in dissent • ERISA contains a broad preemption clause • Clause defines federal-state division of authority • Supreme Court ruled that ERISA preempts Vermont’s APCD law for self-insured health plans (63%) but not fully-insured plans (37%)
- 7. 7Office of External Education Harvard Health Publications APCDs After Gobeille Justice Breyer’s Concurrence In his concurrence, Justice Breyer raised concern about 50 different state-reporting requirements. He proposed: -Department of Labor (DOL) could itself collect data for APCDs -DOL could grant permission for APCDs to require data reporting from self-insured (ERISA) plans
- 8. 8Office of External Education Harvard Health Publications APCDs After Gobeille • In July 2016 DOL responded with Notice of Proposed Rulemaking to expand data reporting, but with limitations • Summary data only • No payment or quality data on an encounter basis • Annual reporting (not monthly or quarterly) • DOL proposal still in draft form and not finalized
- 9. 9Office of External Education Harvard Health Publications APCDs After Gobeille • NASHP and APCD Council are developing a Common Data Layout (CDL) • Single national standard for claims data • Uniform data reporting elements • Applicable to self-insured and also fully- insured plans (fully-insured plans not affected by Gobeille)
- 10. 10Office of External Education Harvard Health Publications APCDs After Gobeille • Voluntary data contribution by payers • Health Care Cost Institute (HCCI) • Aetna, Humana, Kaiser Permanente, and UnitedHealthcare • Zack Cooper et al.: Geographic variation in private health insurance spending due to price variation
- 11. 11Office of External Education Harvard Health Publications APCDs After Gobeille - Summary • Success of DOL proposed regulations in preserving APCDs remains an open question • Implementation of DOL proposal will depend upon the leadership of the Trump DOL, which remains uncertain • Trump Administration has had a complex relationship with health care reforms • Alternative strategies, such as incentives for voluntary data contributions, may be necessary
- 12. THANK YOU! Gregory Curfman, MD