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Health insurance giants to make payment data accessible to public


By Paul Demko
Posted: May 14, 2014 - 7:15 am ET
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(Story updated at 2 p.m. ET.)

A new initiative by three of the country's largest health plans has the potential to transform the accessibility of claims payment data, according to healthcare finance experts. UnitedHealthcare, Aetna and Humana announced a partnership on Wednesday with the Health Care Cost Institute to create a payment database that will be available to the public for free.

“The potential is enormous,” said Katherine Hempstead, a senior program officer at the Robert Wood Johnson Foundation. “It's just a tremendous public service.”

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The database will be created by HCCI, a not-for-profit group established in 2011, from information provided by the insurers. HCCI expects it to be available in 2015 and that more health plans will join the initiative prior to its launch.

UnitedHealthcare is the largest insurer in the country in terms of the number of individuals covered through its products. All three participating plans are publicly traded, for-profit companies.

Stephen Parente, chair of HCCI's board, said the organization was approached by the insurance companies about the initiative. “I'm not quite sure what the magic trigger was,” said Parente, who is a professor at the University of Minnesota and advised John McCain's 2008 presidential campaign on healthcare issues. “We've kind of proven as a nonprofit and an independent group that we can be trustworthy in working with their data.”

Experts say cost transparency is being spurred by a number of developments in the healthcare sector. The trend towards high-deductible plans is giving consumers a greater incentive to understand how much healthcare costs and to utilize it more efficiently. In addition, the launch of the exchanges under the Patient Protection and Affordable Care Act has brought unprecedented attention to the difficulties faced by individuals in shopping for insurance coverage.

“There's so many things that are kind of pushing the industry toward this more transparent state,” Hempstead said. “There's just this drumbeat that people want to have this information.”

Insurers may also be realizing they aren't likely to have a choice about sharing payment information. In recent years, more and more states have passed laws requiring the creation of claims databases. Currently, 11 states have all payer claims databases, and six other states are in the process of creating such a resource, according to the All-Payer Claims Database Council.

“They see statehouse after statehouse passing legislation on all-claims databases,” Parente said. “The insurers are not completely deaf to that.”

David Newman, HCCI's executive director, also sees a financial incentive for insurers if they're going to be forced to create such databases anyway. “There are great economies of scale associated with this effort,” Newman said. “Handling big data is not cheap.”

But Dan Mendelson, CEO of Avalere Health, a research and consulting firm, also sees potential pitfalls. Most notably, he points out that insurers are not used to sharing information with competitors and therefore it might not be easy to integrate those systems accurately. “It's not an easy thing to do,” Mendelson said. “They're starting down an important but long road.”

Follow Paul Demko on Twitter: @MHpdemko


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