The state is moving closer to the creation of a database that will track the intimate details of our medical choices – linking our social security numbers, dates of birth and other demographic information to the health care we receive.
While the regulations for this new database could set off privacy warning bells, the “all-payer claims database” may be a useful tool for healthcare consumers – if used and governed correctly.
The name of the database is somewhat confusing. Once up and running in the next year or so, the database will be a compilation of information from doctors, hospitals and other healthcare providers about how much people actually pay for their medical care, including dental expenses and pharmaceuticals.
It sounds like something that should already be available, but the prices healthcare professionals list are rarely – if ever – the prices people or insurance companies actually pay for the care they receive. This database would fill that gap.
The Connecticut General Assembly passed the law requiring the creation of the database in 2012. It put the initial planning for the database, including the writing of the regulations governing its set up and use, under the Office of Health Reform and Innovation, which falls under Lieutenant Governor Nancy Wyman’s purview.
About a dozen states already have a health-cost database up and running, while many more states are working on setting one up.
Connecticut’s database is still in the planning stage.
Money to set up the database is currently coming from federal grants given to the state to implement the health insurance exchange. It is unclear where money for the maintenance of the database will come from in the future.
In New Hampshire, where a health-cost database has been up and running since 2005, consumers can go on a state website to see, for example, how much a hospital in Nashua charges for knee surgery compared to a hospital in Manchester. Some states are using their databases to also compare the quality of care received.
There has been some pushback from insurance companies against the health-cost databases, according to Patrick Miller, a public health professor at the University of New Hampshire and the co-chair of the All-Payer Claims Database Council.
“These (databases) are frightening to insurance companies,” said Miller. “They’ve been setting prices without accountability.”
There are still many details to be ironed out in Connecticut. The state has not said how much detail consumers will be given. Will we be able to see how much a specific procedure costs by doctor, or by the clinic or hospital where the procedure is performed? Or will the state adopt a more general, potentially less helpful, town-by-town or county-by-county approach?
The current regulations only say that residents will be able to find on a website information about the “cost and quality of health care services” in order to make “economically sound and informed health care decisions.”
It is also unclear if Connecticut’s database will reveal how much the government pays for care through Medicaid and Medicare. In the past it has come to light that the government also pays different rates to different providers.
Each state that has a health-cost database has set up the collection and use of the data differently, according to Miller.
It is also up to the individual states to determine how to keep the information private. Every state needs to determine “who is granted access to what under which circumstances,” he said.
The regulations as currently written require that the data will be scrubbed of personal details before released online or to private researchers.
Connecticut will also likely follow the lead of other states and pay a private company to store the data. The business that wins the contract will face state and federal laws governing the privacy of health information, as well as the hazard of liability should the data leak out.
The state still needs to clarify who will oversee the database once it’s up and running, and more specifically who will be the gatekeeper of the information once it’s collected. As of now, since it is being funded through the insurance exchange it will likely be overseen by the new CEO of the exchange, Kevin Counihan, who is a former health insurance executive.
The next meeting to discuss regulations for the database is 10 a.m. Thursday, Feb. 14, in Room 410 at the State Capitol.
Suzanne Bates is a fellow at the Yankee Institute. She lives in South Windsor.