Is a Tro­jan horse lurk­ing be­hind trans­parency push?

Modern Healthcare - - COMMENT -

Re­gard­ing the ar­ti­cle “Health in­sur­ance gi­ants to make pay­ment data ac­ces­si­ble to pub­lic” (ModernHealth, May 14) the Health Care Cost In­sti­tute is, ac­cord­ing to its web­site, “sup­ported by Aetna, Hu­mana, Kaiser Per­ma­nente and United-Health­care to pro­mote in­de­pen­dent, non­par­ti­san re­search and anal­y­sis on the causes of the rise in U.S. health spend­ing.”

HCCI is go­ing to build a data­base of health­care pay­ments based on claims data sub­mit­ted by health plans. That re­minds me of some­thing. Oh, yes, In­genix, the Unit­edHealth Groupowned data­base of usual and cus­tom­ary charges that, ac­cord­ing to the New York at­tor­ney gen­eral, was ma­nip­u­lated by health plans through se­lec­tive con­tri­bu­tion of claims data in or­der to bilk plan en­rollees of hun­dreds of mil­lions of dol­lars in ben­e­fits.

One won­ders why health plans might want to send claims data to a plan-sup­ported, not-for-profit en­ter­prise that is col­lect­ing pay­ment in­for­ma­tion. Could it be that by se­lec­tively sub­mit­ting claims with lower pay­ments (i.e., deeply dis­counted con­tracted pay­ments), the plans could lever­age this data in ne­go­ti­a­tions with providers for deeper dis­counts, or change leg­is­la­ture and reg­u­la­tor per­cep­tions of the rea­son­able value of provider ser­vices?

Fair Health is an es­tab­lished not­for-profit that al­ready has such a data­base of pay­ments, and it was funded by the fines levied against the plans that abused the In­genix scheme. It has an elab­o­rate au­dit mech­a­nism in place to en­sure that claims data sub­mis­sion to the data­base are not se­lec­tive. That is where this data ought to be col­lected and ac­cessed. I see the tracks of a Tro­jan horse.

Dr. Myles Riner Mill Val­ley, Calif.

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