Below is the HillCo client report from the April 15 TDI Health Care Price Transparency stakeholder forum.
 

  • TDI is working on ways to better present health care data to consumers
  • SB 1731 from the 80th legislature required the Texas Department of Insurance to create a new data collection program to collect certain reimbursement rates that health plans pay to insurers and to organize this information in a specific fashion
    • Held over 10 stakeholder meetings in the first 2 years after the bill passed 
  • SB 7 from the 82nd session created the Institute of Health Care Quality and Efficiency
    • One charge of the Institute is to streamline and enhance transparency in health care data
    • In 2012 they submitted their first report that had 25 recommendations to the legislature
      • Increase the data available to consumers
      • Create a consumer friendly website
      • Maximize consumer’s use of health care information
      • Identify how to target consumers effectively
      • Collaborate across state agencies for data collection
      • Encourage public/private partnerships
  • Objective:
    • Promote a consumer driven health care system
      • Give them some skin in the game
      • Access to information so they can fully participate in their own health care decisions
  • Goal:
    • Connect consumers to meaningful information to engage them in making thoughtful health care purchasing decisions
  • SB 1731 Data Call
    • Started in 2010
    • PPO and HMO’s that had at least 10,000 lives
    • Collect 6 months of claims data a year
    • Grouped into 11 regions
    • TDI evaluates data for outliers and reviews with companies for accuracy
    • Challenges:
      • Collecting on an aggregate level produces only one data point per issuer
      • Collection only six months of data could lead to inaccuracies
      • Cannot identify regional variation accurately
  • UT Audit Process
    • TDI received a $4.3M grant from HHS to partner with UT Public Health  to improve their data collection process
    • Removed inpatient claims data
    • Excluded HMO data (due to capitation)
    • Identified and removed 75 codes that require units of service
    • Compared data to a commercial BCBS benchmark
      • Only 30% of claims collected were reliable
    • Broke down into 8 specialty categories
    • Using only 2 CPT code modifiers
      • Professional
      • Clinical
        • Need to rethink how they collect these
    • Currently using 62 DRGs to collect inpatient data
      • Need to find a better method, maybe using ICD codes instead
    • Trying to create a consumer friendly presentation for all cost that would be associated with a medical visit
    • Billing is very complex and TDI collection is overly simplistic
  • Recommendations:
    • Update the form to include “units of service”
    • Reconsider the regional system
    • Full year data collection instead of half
    • Consider changes to data analysis
    • Reconsider the scope of codes collected
    • Develop “treatment events” that would give the consumer a better idea of all the costs that they might have out of pocket
  • Value Proposition
    • Economic benefit across stakeholders
    • Engages consumers
    • Informs employers supports researchers and policymakers

 
Public Comment
Dr. Dave Bryan, anesthesiologist

  • Some of the data online is way off
  • Payors and providers know the accurate costs
    • Need to connect with TDI somehow
  • Important for consumers to break data down by payor
  • Important for consumers to know the % of their claims paid in network vs. out of network by payor
  • Using Medicare as a benchmark for certain specialties will completely skew the data

Patricia Kolodzey, TMA

  • Rather than assess an episode of care, TDI should put information listing other services that might be involved in a certain procedure or treatment and let the consumer add up possible costs
  • Co-insurance will differ depending on a consumer’s deductible and time of year
  • Concerned with the concept of a state all payor database, need to be careful if you decide to look at this

Texas Society of Anesthesiologists

  • TDI has said that a lot of their data is unusable, yet the website is still active with incorrect numbers
  • Can you remove the data until it is fixed?
    • Intends to revise the data, will look at data sets to take down that have the greatest discrepancies

Stacy Pogue, CPPP

  • Believe information on treatment events would be beneficial
  • Need to start data collection with procedures that consumers would want to shop for to compare prices
  • Might want to consider including quality indicators too
    • Hospitalcare.gov has this information
    • Maybe can link data from other sources too

David West, Texas Association of Benefits Administrators

  • TABA has a lot of data that they could provide to TDI

Trey Berndt, AARP

  • How much consumer traffic is going to the website?
  • Do not know, not robust enough