Data: Voluntary Multi-Payer Claims Database

Overview

The health care industry is big business. Employers spend billions of dollars on health care for their employees every year. But nearly one-third of health care spending is deemed wasteful with unnecessary procedures, administrative costs and medical errors. 

For many years, employers have struggled to provide high-quality health care to their employees. Oftentimes they don’t realize what choices are available or they are unaware of which providers are safe or had the best patient outcomes. In no other industry do we encounter this lack of transparency and accountability.

In a country where up to 400,000 lives are lost every year because of preventable medical errors, the Wyoming Business Coalition on Health is spearheading the movement in Wyoming and the region to bring transparency around safety, quality and resource use in our healthcare industry. Our goal is to provide employers with the means to find identify high-value health care so they can make better healthcare decisions in regards to their employees. 

The Leapfrog Hospital Quality Survey was originated by the Leapfrog Group, a national non-profit organization driving a movement for giant leaps forward in the quality and safety of American health care. The Leapfrog Quality Survey collects and transparently reports hospital performance, empowering purchasers to find the highest-value care and giving consumers the lifesaving information they need to make informed decisions. Each participating hospital is given a Hospital Safety Score, or a letter grade, based on their record of patient safety, helping consumers protect themselves and their families from errors, injuries, accidents, and infections.

Why?

Healthcare costs in Wyoming are the highest in the country. This can be a prohibitive obstacle for existing local employers wanting to hire additional personnel, and it is a serious barrier when recruiting new employers into the state. For our mutual benefit, we need to work together to address these high costs.

By pooling our claims data, can see just how widely prices vary among providers. Armed with data (as opposed to anecdotal information) we can have conversations with those whose prices are at the upper end of the spectrum.

For example, why are health care cost in Wyoming 46% – 53% higher in Wyoming than Montana? Like Wyoming, Montana is a rural state with mostly one-hospital towns and shortages of physicians. This is a prime example of data analytics raising an issue, and of how data can be used to help address the problem.

We ask our employees to use their healthcare dollars wisely, but don’t provide them with tools to do so. We need to provide them with up-front price and quality information. As smart consumers, we can get this information before we buy anything else. Why do we let the healthcare industry get away with keeping healthcare costs hidden? A multi-payer claims database allows us to arm our employees with reliable pricing information BEFORE they elect to have a test or procedure. It can help us guide them to higher-quality, lower cost providers and away from those who are the opposite.

Yet, the biggest benefit, over the long run, of a multi-payer claims database will be in changing the way we pay for healthcare. Our current fee-for-service system is, in large part, responsible for our broken, fragmented delivery system that results in poorly coordinated care and less than optimal outcomes. This database will allow us to build what are known as “bundled payments.”

What are bundled payments?

A bundled payment groups all the charges for an episode of care into a single payment. Instead of getting separate bills from the surgeon, surgical assistant, anesthesiologist, medical imaging, pharmacy, physical therapy, hospital and others; the patient is given an up-front, all-inclusive price with guarantees.

As a coalition, we have paid for thousands of knee and hip replacement surgeries, cesarean sections, normal vaginal deliveries, appendectomies, and many other common tests, procedures and surgeries.

Clearly some patients cost less and some cost more, depending upon their age, co-morbidities and other complicating factors. But by examining the actual claims data, we can determine the average price paid.

Once we know the average price paid, we can start to talk to the providers about a reasonable and fair cost. It would be our goal to negotiate bundled prices that are lower than our current actual payments.

When the bundled price is established, those who work in the healthcare delivery system will have an incentive to find ways to do the test, surgery or procedure more efficiently – to squeeze out the extra costs. With bundled payments, the more efficient the providers become, the more profit they gain.

It is important to note the key difference between a bundled payment and fee-for-service: with a bundled payment, the providers are rewarded for finding ways to do things less expensively. Under fee-for-service, they are not.

Click here to see current publicly available information from the Wyoming Multi-Payer Claims Database (MPCD) https://mpcd.wyo.gov

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