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Employers may be contributing to high health care costs by refusing to feed claim data into state claim databases.
A working group organized by the Aspen Institute cites lack of self-insured employer plan support as one of the factors hurting state efforts to hold down health care costs.
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State all-payer claims databases can help regulators fight rising costs by showing them what's happening in the market, the working group says in its final report.
"One notable limitation is that states may not require self-insured plans, which cover the majority of those with employer-sponsored coverage, to submit data," the working group says.
If states had better, more complete information about claims, they could promote price-based health care provider competition by offering consumers better health care shopping tools, the working group says.
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The working group says some of the other strategies that could increase competition and hold down costs include reducing financial incentives for hospitals and physician groups to consolidate, unwinding some consolidation efforts that have caused problems, and keeping insurers, employer plans and other payers from negotiating secret contracts with health systems that may end up reducing price competition.
Today, "consolidation can allow health systems to tamp down on competition and protect their dominant position by dictating contract terms with payers that enhance their control over the composition of provider networks, limit referral options, restrict patient choice, and reduce transparency," the working group. "Yet those contract provisions are often labeled as proprietary, even to purchasers, making it almost impossible to identify and assess their anticompetitive impact or to respond with informed policy."
Employers and others with a fiduciary duty to health plan enrollees should be able to see the contract terms, the working group says.
The working group says one kind of contract provision that should be discouraged is an anti-steering provision — a provision that keeps a plan from using cost-sharing costs to encourage patients to seek higher-value care.
States should also look hard at exclusive contracting clauses. Those are provisions that keep an insurer or plan from using providers from a competing health system as in-network providers.
The Aspen Institute runs virtual and in-person seminars for business, community and political leaders. It has no direct ability to shape policy, but its working groups' reports may influence how the working group participants and other policymakers make policy.
The co-chairs of the health care cost working group were Kathleen Foote, a retired antitrust chief for the California attorney general's office, and Holly Vedova, a retired director of the Bureau of Competition at the Federal Trade Commission.
The working group also included representatives from organizations such as the American Enterprise Institute, the Brookings Institution, Families USA and Texas 2036.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
