Why Can’t MA Do This?

May 16, 2012 in Member Stories

Our state has a split healthcare personality. Massachusetts wants to be a leader in health care but is widely regarded as an outlier when it comes to health care policy. Our care and cost structure is unusually consolidated into three major payers and a small number of providers. Our state policies reflect this consolidation.
The situation is evident when it comes to price transparency. All Payor Claims Databases (APCD) are state-level registries designed to inform health care and health insurance policy. This story about the Colorado APCD has a very prominent patient access bent. Where is the patient engagement message for the MA APCD?
In an move to update HIPAA, federal regulators recently issued a Request for Information on governance and privacy for health records aggregators such as APCDs. Although the jargon is thick, the opportunity is clear. With current HIPAA, the feds set a fairly low privacy and patient access bar and waited for states to raise it as they see fit. The result, in Massachusetts and many other states, has been APCD and Health Information Exchange projects inaccessible to patients.
Leadership in health care is no longer just about doctors and hospitals. As family healthcare costs top $20,000, it’s time for us to demand transparency and patient engagement from both our public and private institutions.

3 responses to Why Can’t MA Do This?

  1. Adrian – great question. I’ve asked the Patrick administration for an update on the APCD and for clarification about what consumers will see once the database is up and running. I’m also trying to clarify how the APCD fits into the transparency plans in the House and Senate cost control bills. Have you looked into this?

  2. Adrian – this is what I got back from the Division of Health Care Finance and Policy when I asked them to respond to your post. The delay is my fault. I don’t imagine that you’ll find this adequate – but I’m curious to get your read…

    “The state’s All Payers Claim Database is an innovative database that will increase transparency around how much carriers reimburse for each treatment. The availability of this information would create a dialogue about where people are getting their health care, how much providers are charging and how much insurance plans are paying for this care. This increase in transparency would assist the comprehensive efforts to control health care costs, which is a top priority for the Patrick-Murray Administration. .

    A Data Release Committee was created to advise the DHCFP Commissioner on the release of data from the APCD. Committee members were nominated through a public process, and represent a diverse group of health care expertise and perspective. The Committee met recently to discuss plans for data release for a variety of purposes, including transparency initiatives around cost and quality. Additionally, the Health Care Quality and Cost Council’s MyHealthCareOptions website has shared cost and quality data on Massachusetts providers for several years. “

  3. Indeed, this response should not be adequate for any patient.

    What laws or regulations is the Data Release Committee following?

    Why do we, the patient, have to struggle to know exactly how much we paid and the insurer paid on our behalf?

    How can the patient make an optimal decision about deductibles and co-pays at The Connector (state health insurance exchange) if our specific expenses are not displayed right then and there when we are about to select a plan?

    Why is the state creating a credit-bureau-like entity to track our spending without giving us the benefit of checking for errors, upcoding and fraud?

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