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Business Forum: Give employers medical claims data
Saturday, November 13, 2010

Insurers recently drew the ire of government officials by announcing that the new health care law would force them to raise premiums. Others have called for hospitals and doctors to be more transparent about their prices, in hopes that patients might be able to shop around and make more informed treatment decisions.

Price transparency is important but it won't do much to lower health costs. After all, most Americans don't pay for their health care directly -- they get it through work. So individual patients have little incentive to comparison shop for their care.

Transparency of medical claims information, on the other hand, can deliver billions of dollars in savings. Employers, who pay for most private health insurance in this country, should make sure that they have access to such data and that they're taking full advantage of it.

What is medical claims data? Essentially, it's a summary of how employees are using their benefits. An employee's detailed health records are protected by privacy laws. But by examining de-identified data, technology can be used to find out things like how often workers are visiting the doctor and whether they face potential serious health risks.

Armed with this information, powerful software programs can be used to analyze where a firm's health plan dollars are going -- and engage employees in programs to reduce unnecessary costs, mitigate health risks and improve the quality of care.

This process of analyzing claims data to save money on health care and improve health outcomes is at the core of a business strategy called Healthcare Performance Management. Advanced HPM software can be used to aggregate and sort work force population claims data, identify medical spending trends and cut health costs.

Unfortunately, many businesses are walled off from their medical claims data. Their insurance companies often refuse to share it. That has to change. Policymakers should require carriers to give employers who pay their premiums access to claims data that are rightfully theirs.

Two years ago, lawmakers in Texas granted employers access to select privacy protected employee health information, including total paid claims, their employees' general census data and total monthly premiums.

Implementing this insurer transparency requirement at the federal level would open the door to huge savings.

Without action, American businesses are going to be crippled by health care costs. Medical claims data can help businesses ward off those increases. Employers should agitate for access to claims data -- and policymakers should support their efforts by removing the barriers to this data.

George Pantos is the executive director of the Healthcare Performance Management Institute.

First published on November 13, 2010 at 12:00 am