By Stacey Pogue and Abigail Knapp
States, like all employers, are struggling to supply high quality well being care advantages for workers amid quickly rising business well being care prices and acknowledge that shifting extra prices onto workers by way of greater premiums and deductibles exacerbates affordability issues. Nonetheless, as massive well being care purchasers (usually the biggest of their state), state worker well being plans (SEHPs) can wield their market leverage and inner experience in methods few different employers can to handle the underlying drivers of well being care prices.
A brand new report from the Heart on Well being Insurance coverage Reforms, supported by Arnold Ventures, examines how SEHPs in 5 states—California, Kansas, Massachusetts, Minnesota, and Utah—entry and make the most of claims and worth transparency knowledge to enhance affordability for his or her workers. Key findings embody:
- Sturdy entry to their very own claims, however restricted use of different knowledge: SEHPs in examine states typically have long-standing, full entry to their very own claims knowledge. Nonetheless, they report combined use of knowledge from all-payer claims databases (APCDs) and just about no use of worth transparency knowledge.
- Use of many data-driven price containment methods: SEHPs in examine states leverage their claims knowledge entry to tell a variety of methods aimed toward making networks extra environment friendly, directing members to lower-cost suppliers or websites of service, and lowering the speed of progress in supplier reimbursements.
- Steps to raised equip SEHPs to pursue data-driven price containment methods:
- Guarantee SEHPs have the inner or impartial capability to investigate claims knowledge.
- Make sure that all state APCDs can launch granular knowledge to SEHPs with out undue delay.
- Enhance the standard and validity of worth transparency knowledge.