By Mark Tosczak
The North Carolina Chamber of Commerce is pushing to establish comprehensive databases of health care cost information to move the state toward a more efficient health care system.
Leaders of the group, which represents some 35,000 businesses employing more than 1.26 million people, say companies are frustrated with the unpredictability of rising health care costs and have questions about the value companies get for their health care spending.
“Businesses are really frustrated. They don’t know what to do,” said Gary Salamido, vice president of government affairs for the chamber, which last week released its second report on ways to control health costs and improve quality. North Carolina companies, he said, have little confidence in the ability of the federal or state government to improve things.
The report examined two potential components of a more comprehensive health care information system.
The first, an all-payer claims database, could provide information about how much employers, insurance companies and others pay for various health care procedures. Such information is now available for patients covered by Medicare and Medicaid because these are taxpayer-funded plans, but there is no single, authoritative source of that information for North Carolinians not covered by those programs.
That makes it difficult for patients, employers and insurance companies to determine which providers offer the best quality at the best price.
A 2017 report from the N.C. Institute of Medicine concluded that an all-payer claims database that included data from public payers, such as Medicaid, and private payers, like Blue Cross and Blue Shield of North Carolina, would increase “opportunities to improve quality, control cost, and understand variation in care, all of which are important interests for state government, employers, insurers, providers, and the people of North Carolina.”
But now, it’s nearly impossible for individuals or employers to price shop because there’s no accessible way to determine if the price a physician, hospital or other provider has negotiated is higher or lower than other providers. Studies based on national data as well as the examples of some other states show that prices for even routine procedures can vary dramatically from one provider to the next, even within the same state.
In Minnesota, which has an all-claims payer database, an analysis allowed the state to determine there was wide variation in the cost of knee replacement surgeries, from as low as $6,186 to as high as $46,974.[sponsor]
Salamido said he believes the state’s largest insurer, Blue Cross and Blue Shield of North Carolina, will be receptive to an all-payer database.
“The new leadership of that organization, Dr. Patrick Conway, he knows how to do this,” Salamido said. “That’s what his expertise was when he was with [the federal Centers for Medicare and Medicaid].”
Sharing medical records
The second component the chamber is examining are health information exchanges. These are systems that pull health records and other information from multiple health care providers into a single system. The idea is that by sharing more information, health care quality can be improved and costs reduced.
In 2015 the state enacted a law creating the N.C. Health Information Exchange Authority, which seeks to connect providers and patient records paid for by Medicaid, the government health insurance program for the poor, and other state-funded health care. Hospitals, doctors and some other providers are facing a June 1 deadline to connect to the system, with additional providers connecting by June 2019.
Salamido says the chamber’s research suggests that regional health information exchanges covering different parts of the state could incorporate data from employers and private health insurance programs, though he expects that effort will likely take a few years. Regional exchanges could eventually be connected to create a statewide system.
“My instincts are telling me that one community or one region developing will key other areas or regions, get their competitive juices flowing,” Salamido said. He thought there might be some progress on this over the next 12 months, but a more likely timeline for getting a private-sector led regional health information exchange fully operating is three to five years.
State business leaders see it as a critical factor in helping the state thrive economically.
North Carolina ranked 33rd among the states in health outcomes in 2017, dropping from 32nd the year before and 31st in 2015 — the highest spot the state has ever earned on the report since the first one was issued in 1990. The rankings, developed by the United Health Foundation, are based on a variety of health outcomes and factors, such as education, that influence those outcomes.
Chamber leaders would like to see the state rank among the top 10 in the country by 2030.
“Getting health care right fundamentally is an underpinning of a successful future for North Carolina,” Salamido said.