Health Data Corner

• The Delaware Department of Insurance is seeking to codify its proposed Affordability Standards, which would establish primary care investment targets through 2025 through new proposed regulation.
• Delaware’s Department of Health and Social Services released a new CostAware website, which uses data from the Delaware Health Care Claims Database and publicly shares health care pricing and quality data for providers in the state. The state plans to continue to incorporate additional pricing data and consumer features in the website throughout the year.
• The National Academy for State Health Policy (NASHP) released a new Interactive Hospital Cost Tool, which analyzes a hospital’s annual Medicare Cost Report (MCR) to provide insights into how much hospitals spend on patient care services, and how those costs relate to both the hospital charges (list prices) and the actual prices paid by health plans. Additional resources on unique features of the Interactive Hospital Cost Tool, such as the commercial breakeven feature, are also available.
• E. Lowry, A. Johnson, A. Hunt and T. Lee’s recent Health Affairs piece examines state performance within the Altarum Healthcare Value Hub’s 2021 Healthcare Affordability State Policy Scorecard, which examines four key domains: curbing excess prices in the system, reducing low-value care, extending coverage to all residents and making out-of-pocket costs affordable.

• “How To Get Health Data Infrastructure Right For This Moment Of Medicaid Transformation,” Health Affairs. January 18, 2022. Claudia Williams, CEO of Manifest MedEx, California’s leading health data network, and a former senior adviser for health innovation and technology at the White House, outlines three principles states can follow to make bold and achievable progress toward building smart data infrastructure to support Medicaid transformation.
• “Improving Data on Race and Ethnicity: A Roadmap to Measure and Advance Health Equity,” Grantmakers In Health (GIH). December 2021. In a new report, GIH, in collaboration with the National Committee for Quality Assurance (NCQA), discuss race and ethnicity data collection in federally administered health programs and outlines several recommendations for improving that data. These findings and recommendations build upon a previous report from October 2021 that examines the barriers and opportunities to improving the completeness, accuracy, and usability of race and ethnicity data at the state and federal levels.
• “The Colorado Health IT Roadmap,” Colorado Office of eHealth Innovation (OeHI), November 2021. Colorado released a new report that outlines a series of recommendations for “harnessing and expanding the digital tools and services that support the health of all Coloradans.” The three primary goals of the roadmap are to: ensure stakeholders share data and have equitable access to needed health and social information; facilitate access to high-quality, in-person, virtual and remote health services; and, to improve health equity through inclusive and innovative use of health IT and digital health solutions.
• “State All Payer Claims Databases Advisory Committee Report with Recommendations Under Section 735 of the Employee Retirement Income Security Act Of 1974,” October 2021. Under ERISA section 735, the SAPCDAC was charged with advising the Secretary of Labor regarding the standardized reporting format for the voluntary reporting by group health plans to State All Payer Claims Databases. Recommendations on data standardization from the SAPCDAC report include:
   
  • Using the APCD Common Data Layout (APCD-CDL) as the basis for standard reporting for submitting self-funded plan data to APCDs;
  • Working collaboratively with states to capture non-claims payments and other data needed to support cost and utilization analyses;
  • Creating a detailed data dictionary for the elements included in the APCD-CDL data layout
  The report also outlines additional recommendations for data submission; data privacy, security, and release; voluntary data submission; and more.
• “The History, Promise and Challenges of State All Payer Claims Databases,” Background Memo for the State All Payer Claims Database Advisory Committee to the Department of Labor, RAND Health Care. June 2, 2021. Using an APCD-focused literature review, environmental scan of APCD websites, and several key informant interviews, RAND recaps several key findings on the state of APCDs today and the events that have led to their development and use.

APCD Updates

• In 2021, six states are considering or have passed new legislation establishing all-payer claims databases (APCDs), including:
   
  • Alaska Senate Bill 93 was considered in 2021 and referred to the Finance Committee for further study; this legislation followed a feasibility analysis conducted in 2020;
  • Indiana House Bill 1402 was signed by the Governor in April 2021, establishing an APCD;
  • Nevada Senate Bill 40 was signed by the Governor in June 2021, establishing an APCD, following a 2020 Request for Information;
  • Tennessee House Bill 1258 was considered in April 2021 to establish an APCD using Consolidated Appropriations Act (CAA) funds and was sent to “summer study” by the Insurance Subcommittee;
  • Texas House Bill 2090 was signed by the Governor in June 2021, establishing a statewide APCD to “increase public transparency of health care information and improve the quality of health care in the state,” effective September 1, 2021; and
  • West Virginia Senate Bill 390 moved the state Health Care Authority under the state Department of Health and Human Services (DHHS), instead of being a separate entity, and gave authority of the APCD to the secretary of DHHS, effective from passage in March 2021.

Other Data Updates

• The Health Care Cost Institute (HCCI) released several new reports, including:
   
  • One on provider price variation, revealing significant variation in median prices for specific services both across metro areas and within metro areas;¹ and
  • Another on COVID-19’s impact on service utilization, which found significant reductions in preventive services in 2020 compared with 2019, including childhood immunizations, mammograms and pap smears, colonoscopies, and prostate cancer screenings.
• The National Association of Insurance Commissioners’ (NAIC) Special Committee on Race and Insurance has published draft Principles for Data Collection, establishing high-level guiding principles for the collection, use, and regulation of enrollee race, ethnicity, and other demographic data in the business of health insurance. These principles emphasize the expectation for health insurance companies to collect, maintain, protect, and report such data, and to do so in a voluntary manner that uses strategies and collection language that has been consumer-tested and widely recognized for accuracy and responsiveness. The report also provides examples, best practices, and additional resources that can be leveraged to support implementation of such data collection.

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_{¹ In examining six service items across metro areas, HCCI found an up to 25-fold variation in median prices (specifically, this variation was observed for blood test median prices, which had a median price of $18 in Toledo, Ohio, compared with $443 in Beaumont-Port Arthur, Texas. Even within the same metro areas, certain services could cost up to 39 times more (again, this observation was for blood test median prices, which, within El Paso, Texas, demonstrated the most variation – an $808 difference in their 10^th and 90^th percentile prices).}