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
- Promote a consumer driven health care system
- 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