All-Payer Claims Database (APCD)
Academic Articles and Reports Roundup: January 2017
Anna Zaret, Managing Editor February 4, 2017
As we moved into the first month of 2017, we continued to see articles addressing concerns about healthcare costs and the role of the market in healthcare. This month’s Roundup covers 1) state oversight of vertical integration in healthcare|2) the influence of provider and insurer market share on price negotiations|3) frameworks for analyzing product-hopping antitrust claims|and 4) former President Obama’s comments on “repeal and delay” of the ACA. Source Executive Editor Jaime S. King and Erin Fuse Brown published The Double-Edged Sword of Health Care Integration: Consolidation and Cost Control (Indiana …
Continue Reading Download PDF
Academic Articles & Reports Roundup: November 2016
Anna Zaret, Managing Editor December 1, 2016
Happy December! We hope everyone got some rest and had a delicious feast over the Thanksgiving holiday. Our roundup of November academic articles and reports covers publications on the following issues: (1) the effect of the Supreme Court’s decision in Gobeille on All-Payer Claims Databases (APCDs)|(2) pharmaceutical pricing|(3) price transparency tools’ impact on consumer choice of hospital|and (4) cross-market hospital mergers. APCDs In All-Payer Claims Databases – Uses and Expanded Prospects after Gobeille (New England Journal of Medicine), John D. Freedman, Linda Green, and Bruce E. Landon discuss how the …
Continue Reading Download PDF
Academic Articles & Reports Roundup: October 2016
Anna Zaret, Managing Editor November 1, 2016
We hope you had a happy Halloween! October’s roundup includes articles covering 1) price transparency|2) provider collaborations in California|3) antitrust doctrine on state immunity|4) payment reforms|and 5) consumer healthcare costs. For the next few months, we will be using the Roundup to focus on a few great healthcare price and competition articles, rather than reporting on a wider array of articles that came out in the month. If you think we have overlooked any interesting articles, please feel free to send us what we’ve missed! Price Transparency In The New …
Continue Reading Download PDF
Academic Articles & Reports: August 2016
Anne Marie Helm, Managing Editor September 1, 2016
This last round up of the summer features articles on a range of topics including (1) competition in healthcare markets|(2) strategies for reducing healthcare costs|(3) pharmaceutical pricing|(4) ACOs|(5) other ACA aspects and effects|(6) post-Gobeille strategies|and (7) antitrust enforcement. We hope everyone is settling into school and work after some time off. Happy (almost) fall! Competition in health care markets: In Choice and Competition in Public Service Provision, by Timothy J. Besley and James M. Malcomson, published by the Center for Economic Policy Research, looks broadly at markets involving services like …
Continue Reading Download PDF
The Source’s Jaime King and Others on What’s Left For States After Gobeille
Anne Marie Helm, Managing Editor March 13, 2016
On March 1, the Supreme Court decided Gobeille v. Liberty Mutual Insurance Co., holding that ERISA preempted a Vermont law’s APCD reporting requirements for self-funded employee health plans (see our case brief here). This case has enormous implications for price transparency and cost containment strategies, especially at the state level. To lay out the issues and offer predictions as to Gobeille’s consequences, Health Affairs Blog ran a four-part series on the case, including one by Source Executive Editor and favorite collaborator Erin C. Fuse Brown called The Consequences Of Gobeille v. Liberty Mutual For Health Care …
Continue Reading Download PDF
Court Rules 6-2 in Gobeille: ERISA Pre-empts VT Transparency Law
Elizabeth Nicholson, Research Fellow March 2, 2016
Today, the Supreme Court decided Gobeille v. Liberty Mutual Insurance Co. in favor of Respondent, Liberty Mutual. The Court held that ERISA does, in fact, pre-empt Vermont’s all-payer claims database (“APCD”) statute as the statute applies to ERISA plans. Earlier, we included this case brief on the Source Blog. THE MAJORITY OPINION Justice Kennedy authored the majority opinion. He was joined by Justices Roberts, Thomas, Breyer, Alito, and Kagan. In its majority opinion, the Court acknowledged that Section 1144(a) of ERISA—that “any and all state laws insofar as they may …
Continue Reading Download PDF
Issue Brief: Gobeille v. Liberty Mutual (SCOTUS)
Elizabeth Nicholson, Research Fellow December 10, 2015
OVERVIEW The reach of All Payers Claims Database (“APCD”) legislation is currently being tested in Gobeille v. Liberty Mutual Insurance Company, Docket No. 14-181, which is presently before the U.S. Supreme Court. The case stems from Liberty Mutual’s refusal to comply with Vermont’s reporting requirements under that state’s APCD statute, which the insurer argues is preempted by The Employee Retirement Income Security Act of 1974 (“ERISA”)—a notoriously broad statute that preempts any state law that “relates to” a self-insured plan. FACTS Pursuant to Vt. Stat. Ann. Tit. 18, Section 9410, …
Continue Reading Download PDF
Updated Issue Brief: All Payer Claims Databases
Elizabeth Nicholson, Research Fellow December 8, 2015
Introduction: What is an All-Payer Claims Database? An All-Payer Claims Database (“APCD”) is an electronic system that aggregates claims and administrative data from public and private payers. APCDs allow states to monitor utilization and healthcare charges across all payers, and, as such, are key tools for policymakers to identify and respond to systematic trends among (nearly) all delivery settings. According to the APCD Council (a collaboration between the University of New Hampshire and the National Association of Health Data Organizations), 18 states have existing APCDs.[1] Further research by the Source …
Continue Reading Download PDF
Academic Articles & Reports Round-Up: November 2015
Elizabeth Nicholson, Research Fellow December 2, 2015
We hope you all had a great Thanksgiving, full of friends, family, and cheer! November yielded some interesting articles and perspectives on health care markets and consolidation, price transparency, payment reform, prescription drug pricing, more ACA litigation, and health care spending. Enjoy! HEALTH CARE MARKETS/CONSOLIDATION Multiple articles discussed the effects of health care markets and consolidation on various health care entities. Early in November, the Alliance for Health Reform published an article entitled Health Care Consolidation. The article uses numbers and statistics to paint a vivid picture of the increase in …
Continue Reading Download PDF
Issue Brief: 2015 Price Transparency Initiative State Survey: Price Disclosures
Elizabeth Nicholson, Research Fellow October 21, 2015
OVERVIEW State legislatures have shown a lot of interest in health care price transparency initiatives this year. At least 27 states have proposed price transparency legislation in 2015. This legislation takes the form of disclosure requirements aimed primarily at health care providers and health insurance carriers.[1] These initiatives require individual health care providers, hospitals, and insurance carriers to disclose health care prices, charges, and reimbursement rates in a variety of ways. HEALTH CARE PROVIDERS The majority of current price transparency initiatives are aimed at health care providers. These initiatives require …
Continue Reading Download PDF