SPH researchers scrutinize state insurance claims to provide policymakers data about healthcare usage patterns
Maryland is one of the few states that compiles information in a database outlining each and every insurance claim. Every single insurance company and large employer that processes health care payments for patients in the state, must report their payment figures to this database. “We’re lucky to be in a state that does this,” Health Services Administration Assistant Professor Dylan Roby says. “Usually you can’t compare across providers. In most states, there isn’t such a database.” Maryland, Delaware, Colorado, and Vermont have passed laws that require all insurance payers and large employers to report their payments, he says.
The chance to scrutinize this database is an important an interesting opportunity, especially right now in the state of Maryland. The School of Public Health has signed a Memo of Understanding with the state for access to the data, in order to carry out multiple specific research projects to provide information to lawmakers creating state health policy.
“As a state, Maryland is unique in its historical use of all-payer rate setting for hospitals, and the current transition to global payments for each hospital that incentivizes investment in primary care and community health,” reads the document outlining the university’s scope of work with the database. “This transition, the implementation of Medicaid expansion and private insurance market reforms in 2014, and the unique characteristics of hospital payment in Maryland could provide interesting lessons to Maryland and other states … in understanding the reasons behind regional variation in health care spending and use, and the influence of policy change and global budgets on spending and use over time.”
Researchers, led by Principal Investigator and Department of Health Services Administration Chair Dr. Luisa Franzini, will mine the data to assess variations across geographic areas and demographic subpopulations in terms of health care spending and patterns, and will consider whether physician practice patterns drive these differences. Dr. Roby points to an established finding that care can be driven “by what providers can do, rather than what patients need.” For example, in Florida a large percentage of the population might have knee replacements by age 82, because there are plenty of those specialists there. In Minnesota, however, the same population might instead be treating knee problems with exercise and anti-inflammatories—because of relevant Mayo Clinic research that goes on in that geographic region.
Researchers will be looking at how variations in care may be driven by other factors too, such as population characteristics, provider availability, environmental and economic differences, maternal age and child development, or implementation of local programs (such as specific hospital approaches to the state’s new global payment incentives).
Maryland hospitals now have more incentive to focus on prevention, thanks to the state’s new incentive structure, Roby says. Looking at every private payment for medical service (but not Medicare and Medicaid, which are not a part of this database) will go a long way toward giving policymakers the information they need to assess the progress of the new state healthcare funding policies.
“We are applying this data to solve real problems in the state of Maryland,” Dr. Roby says.