The U.S. Supreme Court has delivered a blow against the efforts by states to track health care quality and costs.
States need data from all payers in their states to monitor the success of their policy reforms. That data comes from the All-Payer Claims Database, or APCD, which are large, state-run databases that collect claims and provider information about price, quality and utilization.
The high court examined whether Vermont could require all payers, including self-insuring employers (ERISA plans), to report claims to the database. The state wanted to obtain a full picture of all the health care delivered and paid for in Vermont.
The court, in a fairly predictable opinion, struck down the Vermont’s law.
Why is this important to New Jersey, which does not have an All-Payer Claims Database, other than for hospital claims reported to the state Department of Health? The decision shows that until Congress requires all payers to report data — which lawmakers have the power to do — the only way to use claims data to improve quality, increase transparency, and help consumers make informed decisions is for payers to voluntarily submit their data.
Elizabeth Mitchell, President and CEO of the Network for Regional Health Improvement, wrote recently that NRHI members, including the Quality Institute, are in a good position to support this work.
Elizabeth’s comments are valuable and worth sharing. I have posted them here:
As you may have heard, the Supreme Court handed down a decision this week in Gobeille v. Liberty Mutual. In a nutshell, the ruling found that the state of Vermont could not require self-funded health insurance plans (regulated under ERISA) to supply claims data to the state’s all payer claims database (APCD). This ruling is disappointing for those of us working toward greater transparency of quality and cost information, particularly because data from ERISA plans makes up a significant percentage of claims data. The seventeen other states that have databases similar to Vermont’s, as well as states developing or considering developing claims databases, are also impacted by the ruling.
Despite the setback this ruling creates for quality and transparency efforts across the country, there are a number of important points raised in the justices’ opinions that offer us some hope:
- Justice Kennedy, writing for the Court, made clear that the Secretary of Labor has the authority to establish reporting and disclosure requirements for ERISA plans, including “to require ERISA plans to report data similar to that which Vermont seeks.”
- Justice Breyer’s concurring opinion goes one step further and states that “preemption does not necessarily prevent Vermont or other States from obtaining the self-insured, ERISA-based health plan information that they need. States wishing to obtain information can ask the Federal Government for approval.” He also offers some examples of how states and the Department of Labor could exercise this option, such as by having the Secretary of Labor “develop reporting requirements that satisfy the states’ needs, including some State-specific requirements, as appropriate” or delegating to a particular state the authority to obtain the data.
- Justice Breyer also writes that the Department of Health and Human Services has similar authority to require ERISA plans to report data under the Affordable Care Act.
These points are significant, and while they do not set precedent that will bind future courts, they do offer an alternative roadmap for states like Vermont seeking to compel payers to participate in a state APCD. In other words, Gobeille v. Liberty Mutual does not sound the death knell for state APCDs. And, of course, states have the option to adopt voluntary reporting models.
The ruling underscores the importance of regional health improvement collaboratives that encourage the voluntary submission of data across payers. Instead of relying on the blunt force of a legislative mandate and risk legal challenge, states may opt instead to champion the multi-stakeholder collaborative model, where payers volunteer their data because they see the value in participating. The success of these models rests on collaborative leadership, long-term relationships, and trusted convening for which regional collaboratives — like those comprising NRHI’s network — are so well known.
In short, NRHI’s true north remains leading with multi-stakeholder collaboration and demonstrating the value of actionable information for providers, purchasers and patients.