Ever wanted to find the cheapest price for a surgery but had no luck accessing information?
There’s a plan to change that in Kentucky, and it’s currently under consideration by the administration of Gov. Matt Bevin, which must give the green light to build a health care cost comparison website for the state.
This week, Kentucky earned an F on the 2016 Report Card on State Price Transparency Laws, an annual report released by the independent health policy organizations Health Care Incentives Improvement Institute and Catalyst for Payment Reform.
Kentucky’s main offense? Not having the database or a consumer website.
“Do you think it’s OK that a mom and her husband will have to pay an excess of $2,000 based on random selection of hospitals to deliver their baby?” said Francois de Brantes, executive director of the Health Care Incentives Improvement Institute.
Eighteen states have an all-payer claims database, which takes an individual’s health care bill for, say, a colonoscopy, and inputs that information into a database along with millions of other people’s bills. The goal is to provide detailed pricing information from Medicaid, Medicare and private insurance claims.
Kentucky doesn’t have a streamlined system that allows patients to compare pricing or facilities when planning for a medical procedure. If a consumer is looking for information, the state sends them to Hospital Compare, a federal website based on Medicare claims, and to the Kentucky Hospital Association’s website to compare hospital costs.
Jeffery Talbert is with the University of Kentucky Center for Clinical and Translational Science. The center has worked for more than three years to build the database and a consumer website to go along with it.
Talbert said it would be expensive to create the Kentucky Health Data Trust, and that’s a major roadblock to getting it started. He said there’s a plan to secure funding from the state, federal government, universities and nonprofits, but the center needs Bevin to get the ball rolling.
“When the administration changed, we can’t get it on the priority [list],” said Talbert. “They’re interested — they haven’t said no, they haven’t said yes.”
In an emailed statement, officials with the state Cabinet for Health and Family Services said the proposal for funding for a statewide database in under consideration.
“An all payer claims database is under development but the extent of its functionality and implementation is unknown at this time,” said Cabinet spokeswoman Jean West.
Seeking Support — But Not a Mandate
There’s no state legislation that requires that the government fund a medical pricing website or that health insurers turn over claims data, a factor that also contributed to Kentucky’s failing grade on the state pricing report card.
However, Talbert said he doesn’t want legislation mandating funding or insurer participation for two main reasons: He said he’s seen in other states that once legislation is proposed, insurers and others can pick and choose what data they turn over. And he said building a database is not as simple as collecting data, plugging it into a website and publishing.
“There’s an incredible amount of time that has to be built around cleaning and checking data to make sure that the data results weren’t entered incorrectly,” Talbert said.
Talbert said he’d rather able to run reports and send data back to insurers to be checked.
But de Brantes said legislation is needed to ensure the state would have to find funding and authorize the project within a specific time frame.
Kentucky already has claims information from Medicare, Medicaid and state health workers, which makes up 55 percent of insured people in the state. Price information from these people – identities encrypted – is ready to go.
Another factor holding up the launch of a Kentucky database is a decision earlier this year by the Vermont Supreme Court to exempt self-funded plans from the state mandate. The decision could have implications for other states.
Self-funded plans refer to when employers take on the risk of insuring their own employees and contract with an insurer to provide benefits. Larger companies are commonly self-funded, and they make up a large portion of the remaining 45 percent of insured people in Kentucky whose data would need to be collected.
Nationwide, a quarter of employed people have health plans that require deductibles on average of $1,000 before insurance kicks in.
That makes the consumer data and website that much more important, according to Susan Zepeda, president of the Foundation for a Healthy Kentucky.
“If they know that it’s going to cost a lot more for this procedure versus down the road and they have the same quality outcomes, I think people will vote with their feet,” Zepeda said.