Health Affairs recently published a report on the way state insurance departments can help with making the data from the Transparency in Coverage (TiC) requirements more readable and accessible to “help constrain health care cost growth and improve affordability for state residents.”
The Transparency in Coverage requirements mandated insurance companies to publicly post the prices that they pay for health care services, for the purpose of providing patients with information to make educated decisions when it comes to their health insurance and health care. However, Health Affairs notes that “this potential may be largely unrealized without a state-federal partnership to improve data access and quality.”
To that end, Health Affairs notes that there are several states that have launched their own efforts to restrain health care cost growth and to improve the affordability of insurance coverage. Many of those efforts “could benefit from access to more robust, real-time, and provider-specific information about the prices insurers are paying.” The report goes on to note several ways price data could be used, such as to support anti-trust enforcement, purchasing alliances, and independent dispute resolution for out-of-network billing.
The report also notes that “[s]tate departments of insurance share responsibility with the federal government for the enforcement of the TiC rules, which apply to self-funded employer plans and insurers selling group and individual insurance.” State departments of insurance are the “front line of enforcement” for ensuring that fully insured individual and group-market insurers comply with the TiC rules. States can also require that insurers are held to higher than the minimum federal standards, as long as they do not conflict with (or prevent the application of) federal law.
Health Affairs ideates that state insurance departments could require state-regulated insurers to do the following: provide a data directory or library index, so that users can identify what is in the TiC files; submit to regulators file extracts to allow for an assessment of data quality; and take corrective actions in cases of missing or low-quality data. Beyond those ideas, state departments of insurance could also use the data submissions to “inform public-facing reports about health system cost-drivers and other issues.”
The report concludes by saying, “federal policy makers recognized that the prices commercial insurers pay for health care goods and services are one of the main drivers of premium growth. In theory, opening the black box of what has been, to date, largely secret pricing agreements among hospitals, doctors, and insurers could help us identify and target regulatory policies or market-based solutions to keep costs in check.” However, it cannot be done without the TiC data being accessible. Therefore, “[a]s the front line of oversight and enforcement for a large segment of the market, state departments of insurance can play a critical role by raising the bar for data access and usability, and holding insurers accountable if they aren’t complying.”