Under a new law that went into effect last month, public entities such as towns and schools can request insurance claims data from health carriers and hospitals as they shop for group policies covering their employees.
Public employers can also demand the information for use as they design wellness programs with the goal of improving the health of their workers, and so reducing the premiums they might otherwise pay.
Connecticut is not the only state to consider improved transparency in health care data ”“ New Hampshire has had a health cost price transparency program in place since 2007. In a study published last November by the New Hampshire Insurance Department and the Center for Studying Health System Change, researchers said the system has not resulted in a measurable reduction in health care costs.
The Connecticut bill requires carriers and health centers to furnish:
- medical, dental and pharmaceutical utilization data;
- claims paid by year, practice type and service category for in-network and out-of-network providers;
- monthly premiums paid by an employer; and
- the number of people insured under the policy by month and coverage tier, including single, two-person and family.
The bill does not apply to agencies with fewer than 50 employees. Any public agency requesting the information must share it with worker unions if asked.
Utilization data includes the aggregate number of procedures performed for the employer”™s covered employees, by practice type and service category, and prescriptions filled for those employees, by prescription drug name.
Carriers do not have to provide some types of information, such as expenses for stop-loss coverage, reinsurance, health educational programs and other cost-containment programs.
While there is no time limit on complying with requests, the department added it expects carriers and health centers to do so “as soon as commercially reasonable.”
With the fall typically the heaviest shopping period for health insurance plans that renew in January, the law could besiege carriers and hospitals with such requests.
Perhaps surprisingly, the Connecticut Association of Health Plans did not outright fight the bill, but expressed reservations with the underlying intent of the legislation and said it could impose costly and burdensome requirements on its members.
“The anticipated level of reporting ”¦ is enormous,” CAHP testified this year. “Pharmacy utilization data alone constitutes thousands of transactions requiring that health plans provide reams of data under this proposal. Similarly, reporting procedures and services by practice type is likewise costly and extremely burdensome.”
CAHP had asked that entities requesting the information be forced to bear the cost of producing it. The association also warned that despite a requirement that identities of individual policyholders be scrubbed from any claims data furnished, it would be fairly easy for staff at small agencies to tie specific claims with the identity of individual employees.
For its part, the Connecticut State Medical Society had supported the bill, and opined it should be extended to cover any employer in the state.
In a circular published last month on the eve of the bill”™s enactment, the Connecticut Insurance Department said it does not interpret the law to include requests for data made on behalf of towns and cities by their brokers, but allows towns and schools to share the data with their broker on their own initiative.
