Hoffer: Data on health trends falls short
By Neal P. Goswami
VERMONT PRESS BUREAU | June 26,2014
MONTPELIER — Vermont has fallen short of a statutory requirement to give health care consumers up-to-date information on medical procedures that would allow them to compare cost and quality, according to a nonaudit report from the state auditor.
Lawmakers created the Vermont Health Care Uniform Reporting and Evaluation System in 2009 to track health care data and highlight price trends and variation across Vermont’s health care providers. The system is supposed to eventually enable consumers to compare costs when making decisions on common health care procedures.
The report, “VHCURES: Past, Present, and Future,” has a smaller scope of review than a traditional audit and does not contain recommendations.
State Auditor Doug Hoffer said Wednesday the state has met five of six statutory requirements, but that a final requirement — to make the information available to the public — remains unfulfilled.
The responsibility has shifted several times, from the former state Department of Banking, Insurance, Securities and Health Care Administration, or BISHCA, to that department’s new incarnation as the Department of Financial Regulation, and then to the Green Mountain Care Board.
Hoffer said the value of the database to consumers is “a no-brainer.” The review by his office is intended to spur action, he said.
“As to why we’re not there yet, I can’t speak to the board — they were only given this responsibility a year ago,” Hoffer said. “As for their predecessors, I expect everybody had a lot of things on their plate, which is fair. It’s a big topic.”
Hoffer added, “There’s no failure here. It’s just a matter of people having plenty to do.”
The Legislature, which is “never really good on following up on what it did yesterday,” has yet to follow up on the effort, he said.
The system collects data from insurers, tracking what providers charge and what insurance pays. The data can be used to create patient-specific costs for procedures and track health care outcomes.
“It contains millions of bits of information, about almost … every medical expense paid by an insurance company, including Medicare and Medicaid,” Hoffer said. “That’s a lot of information.”
New Hampshire has used a similar system to provide cost information to consumers. Vermont is working on a next phase that will do the same, according to Hoffer.
“We know from New Hampshire’s experience that it can be made available to regular folks,” Hoffer said.
Ultimately, the system aims to add health care quality information to give consumers wide-ranging information about health care costs and outcomes from providers.
“Right now it’s basically raw data, just a massive amount of raw data that a relatively small amount of people have the skill to use for research purposes and analysis,” he said. “It’s not even close to being accessible to us.”
“It could be, though,” said Andrew Stein, the principal investigator who wrote the report. “The resources have not been put forth.”
Allowing consumers to compare prices should “put downward pressure on prices,” Hoffer said.
“In theory, it should lead to, if not a reduction, then a moderation in growth, because if people find out that they can pay less, some of them are going to do that,” he said.
“Furthermore, to those who are losing customers to the guys that are charging less … they’re going to have to think hard about changing their pricing,” Hoffer said.
Al Gobeille, chairman of the Green Mountain Care Board, said the board began an assessment after receiving the report.
“We agree in large part with the auditor’s findings,” he said. “Really, the question is how do you fix these things in a database as large as VHCURES,” he said.
The board has extended a request for proposals to develop a way to deliver the information to consumers, Gobeille said. However, he noted the law includes no time frame for implementation and said it is unclear when information will be available to consumers.
“I don’t want to set a time or make a date on a calendar,” Gobeille said. “I want to focus on the process.”
Finding an effective way to deliver information to consumers is the board’s chief concern. Gobeille said New Hampshire’s website has not been effective.
“The question is: How did they work, and did they lower prices? Did they lead to more interaction between the database and the individual patient? I think the jury is still out on that,” he said.
“I’m not wedded to the fact that a website with pricing information on it has shown to be attractive to the patient,” Gobeille said.
Vermont’s system must include a combination of pricing and quality information. It could come in the form of a website or smartphone and tablet application, he said.
The board is taking steps to keep personal information secure as the system is developed, Gobeille said. Privacy advocates, including the Vermont chapter of the American Civil Liberties Union and the state’s health care ombudsmen, took part in executive session talks when developing the request for proposals, he said.
“They all came in and we all had, basically, a frank conversation about how to get this done,” he said. “I think what we came up with in our RFP, as much as you can guarantee data security, will do that.”
Stein said the state, like others across the country, has seen a shift in recent years to higher-deductible health care plans where patients generally pay more out-of-pocket expenses before insurance kicks in. Having access to more information will help health care consumers make better decisions, he said.
“It makes this type of information, comparative price and quality information, all the more valuable,” Stein said. “The truth of the matter is that this is a nationwide phenomenon that patients are kept in the dark, and Vermont legislators charged different state entities in recent years with bringing patients more into the light.”
Health care advocates, including Falko Schilling of the Vermont Public Interest Research Group, praised the report Wednesday.
“VPIRG applauds the work of the auditor’s office,” Schilling said. “This report … is a great first step toward getting critical information about the price of various health care procedures into the hands of Vermont consumers.”