Drive more data

March 1, 2009

Payers have vast amounts of data that could be used in so many ways, if only HIPAA would allow it

National reports - Managed care plans need to prepare for new and more complex reporting of their aggregated data, experts say, particularly as health reforms accelerate at the federal level.

"President Obama's proposal for healthcare reform is going to be big on the need for plans to do more with their data," says Leon Cosler, professor, Albany College of Pharmacy and Health Sciences.

He says an increased responsibility could be placed on plans to provide information to providers and other stakeholders on evidence of care disparities.

Aetna and some large insurers have just begun to collect race and ethnic-origin data voluntarily from members for the sake of caring for specific populations at risk for certain diseases or more severe morbidity related to chronic conditions.

Cosler says plans hold huge information sources within their claims data, but the data isn't particularly useful until it's aggregated, sorted and synthesized into meaningful results, and that process can be extremely complex from a technology standpoint as well as from a regulatory standpoint.

Robbi-Lynn Watnick, senior healthcare compliance consultant for the Altarum Institute, a non-profit objective research and consulting firm, says HIPAA protections provide necessary security for the data, so additional steps required to achieve HIPAA compliance must be followed when plans translate their data.

Some experts forecast that federal regulators could examine HIPAA and other existing rules in the context of new reporting requirements and determine that the rules need modification. It's purely conjecture, but the idea is not entirely far-fetched, according to Cosler.

Any potential modification of HIPAA would depend on "what line policy makers are willing to cross or willing to stand on," Watnick says.

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