As a result of a recent case decided by the U.S. Supreme Court, advocates of healthcare transparency may need to adjust their data collection strategies.
In Gobeille v. Liberty Mutual Insurance Company, the Supreme Court considered a challenge to a Vermont law requiring disclosure of payments relating to healthcare claims and other information relating to healthcare services to a state agency.
The state had enacted an all-payer claims database (APCD) to collect data from health insurers, healthcare providers, healthcare facilities, and governmental agencies. Included as health insurers were health plans established by employers and regulated by the Employee Retirement Income Security Act of 1974 (ERISA).
Liberty Mutual Insurance Company (Liberty Mutual), the sponsor of a self-funded ERISA plan, objected to the application of the law to its health plan. The Supreme Court, in a 6-2 decision, agreed with Liberty Mutual and ruled that ERISA pre-empted the Vermont statute as it applies to ERISA plans.
APCDs are state-sponsored or state-designated databases for the collection, aggregation and analysis of various healthcare data, including pricing. Several states have established or are considering establishing such databases.
Vermont’s law requires the reporting of information relating to healthcare costs, prices, quality, utilization, or resources required by a state agency, including data relating to health insurance claims and enrollment.
The Vermont database is to be made available as a resource for insurers, employers, providers, purchasers of healthcare, and state agencies to continuously review healthcare utilization, expenditures, and performance.
The state agency overseeing the database issued regulations requiring reporting data regarding services provided to Vermonters regardless of whether the treatment is provided in Vermont or out-of-state and about non-Vermonters who are treated in Vermont.
The Vermont law is intended to:
Determine the capacity and distribution of existing resources,
Identify healthcare needs and inform healthcare policy,
Evaluate the effectiveness of intervention programs on improving patient outcomes,
Compare costs between various treatment settings and approaches,
Provide information to consumers and purchasers of healthcare, and
Improve the quality and affordability of patient healthcare and healthcare coverage.
The state included information from employer plans so the data collected would provide a more comprehensive picture of the healthcare system.
Submissions to the Court estimated that about half of those Americans with health insurance receive coverage from their employers and 61% of such persons are covered by a self-insured plan. In Vermont, about 20% of the database’s content originated from self-insured plans. Without including ERISA plans, the state believed, the data collected would be incomplete.
Liberty Mutual’s self-insured health plan provides benefits in all 50 states to more than 80,000 individuals. Blue Cross Blue Shield of Massachusetts is the third-party administrator of the plan.
While Liberty Mutual on its own did not employ enough Vermonters to make it subject to the law’s mandatory reporting requirements, it was required to report because of its relationship with Blue Cross, which covers a large number of Vermonters and was required to report pursuant to the Vermont law.
Entities covered are required to submit data monthly, quarterly, or annually, depending on the number of individuals they serve, with entities like Blue Cross reporting more frequently than entities serving fewer customers.