Employers Push Against Insurers Blocking Access to Health Data

Employers that sponsor health plans told a congressional panel Thursday they need better access to their claims data from health insurers and policy administrators so they can design lower-cost, high quality coverage for their workers.

Both Republicans and Democrats agreed at a hearing held by the House Education and the Workforce Committee’s Subcommittee on Health, Employment, Labor, and Pensions that better guarantees for employers to access their health-care data is critical to their ability to control costs. “Employers often struggle to access their own health plan and spending data from their third-party-administrator,” subcommittee Chairman Bob Good (R-Va.) said.

“Without this information, employers and providers are unable to adequately design innovative payment models and assess quality and savings,” he said.

Employers are pushing for better legal guarantees to access their data, which they say is necessary to fulfill their fiduciary responsibility to administer plans in the best interest of members. Despite transparency regulations in place requiring hospitals and health insurers to make the data public, employers say large insurers, which typically administer their plans, often argue the data constitute trade secrets to deny them access.

In December, the House passed legislation (H.R. 5378) that includes provisions bolstering legal requirements that health-care providers and insurers disclose information about health-care costs. Similar bipartisan legislation (S. 3548) has been introduced in the Senate, but no action has yet been taken.

Owning Claims Data

“We believe we should own our claims data, and we can make the best and informed decisions to meet our fiduciary responsibility to our employees and their families,” said Michele Beehler, senior director of health and wellbeing with Schweitzer Engineering Laboratories Inc., which manufacturers electric power system products. The Pullman, Wash.-based company covers nearly 10,000 people in 37 states.

Beehler cited as one example a reduction in costs for an employee whose medication cost $10,000 a month with out-of-pocket costs of nearly $3,000 a month. SEL identified a generic equivalent sold through Mark Cuban Cost Plus Drugs for $12.80 a month, saving the employee nearly $36,000 a year and saving SEL an additional $84,000 for a total savings of $120,000.

“That’s the power of transparency,” she said.

SEL uses its claims data to review contracts with its plan administrator and other providers to avoid hidden fees, identify large price discrepancies, manage its prescription drug program, and contract directly with “high-quality hospitals” like Pullman Regional, which helped it save nearly $2 million in 2023, Beehler said.

However, “at SEL we went through an arduous process that lasted over 18 months while we tried to get our claims data, both in discussions with our third party administrator as well as back and forth with data submissions that weren’t complete in nature. This shouldn’t be the norm,” she said.

Association Health Plans

Democrats on the subcommittee disagreed with Republicans about the need for association health plans, which allow employers to group together to get better bargaining power and create new plan designs.

The Biden administration in December proposed withdrawing a 2018 Trump administration rule expanding the use of the plans. “One of the benefits of the ACA [Affordable Care Act] is that essentially everybody pays average. In an association plan you let a low-cost group to pull out, which essentially causes everybody else to pay more,” Rep. Bobby Scott (D-Va.) said.

But Laura Josh, general manager of the California Schools VEBA, a tax-exempt trust that provides health-care benefits for 70 employers covering 150,000 members in southern California, said the group is similar to association health plans and is able to use its collective purchasing power to lower health-care premiums and ensure access to comprehensive benefits.

Between 2017 and 2020, VEBA kept its pharmaceutical spending increases to less than 2% a year compared to a national average of 7%-8% for large employer groups, Josh said.

Josh called for removing federal and state barriers to employer participation in value-based programs such as VEBAs that lower costs by offering “high-performance” networks and direct contracting with providers. In order to implement a direct contracting program, however, special legislation had to be enacted by the state of California so that VEBA could use risk-bearing contracts under which providers can be financially rewarded or penalized based on care quality and outcomes, she said.