By Stacey Pogue and Abigail Knapp
States, like all employers, are struggling to provide quality health care benefits for employees amid rapidly rising commercial health care costs and recognize that shifting more costs onto employees through higher premiums and deductibles exacerbates affordability concerns. However, as large health care purchasers (often the largest in their state), state employee health plans (SEHPs) can wield their market leverage and internal expertise in ways few other employers can to address the underlying drivers of health care costs.
A new report from the Center on Health Insurance Reforms, supported by Arnold Ventures, examines how SEHPs in five states—California, Kansas, Massachusetts, Minnesota, and Utah—access and utilize claims and price transparency data to improve affordability for their employees. Key findings include:
- Robust access to their own claims, but limited use of other data: SEHPs in study states generally have long-standing, full access to their own claims data. However, they report mixed use of data from all-payer claims databases (APCDs) and virtually no use of price transparency data.
- Use of many data-driven cost containment strategies: SEHPs in study states leverage their claims data access to inform a wide range of strategies aimed at making networks more efficient, directing members to lower-cost providers or sites of service, and reducing the rate of growth in provider reimbursements.
- Steps to better equip SEHPs to pursue data-driven cost containment strategies:
- Ensure SEHPs have the internal or independent capacity to analyze claims data.
- Ensure that all state APCDs can release granular data to SEHPs without undue delay.
- Improve the quality and validity of price transparency data.