In a 6-2 decision released earlier this March, the U.S. Supreme Court (SCOTUS) ruled against the state of Vermont in the case Gobeille v. Liberty Mutual, putting at risk the breadth of all-payer claims databases (APCDs) and the expansive advantages they yield. SCOTUS's decision effectively denies states the ability to mandate claims submission from self-funded employer groups covered under the federal Employee Retirement Income Security Act (ERISA), which was passed in 1974 primarily to safeguard pension funds and retirement benefits from corrupt practices. The Court's ruling means that the comprehensive view of claims data that is critical to the many state and regional healthcare transformation initiatives across the country may soon become less comprehensive, impairing the ability of analysts and policymakers to perform cross-payer measurement, monitoring, and evaluation.
APCD solutions are designed specifically to fill critical information gaps, offering a reliable, population-wide data set to help understand what is happening in healthcare within a specific patient population, practice, community, state, or region. For researchers, policymakers, purchasers, and providers alike, APCDs serve as the most credible single source of truth for population- and provider-based analytics.
This is why proponents of APCDs, including Trish Riley, Executive Director of the National Academy for State Health Policy (NASHP), warn that SCOTUS's decision is "a slippery slope that could limit states' broader health reform activities." For health improvement initiatives to successfully fulfill their obligations to "protect public health, regulate health delivery, and address healthcare costs and quality," they ultimately need the kind of robust data unified exclusively by an APCD in the pre-Gobeille world.
In the new post-Gobeille world, Riley cautions that the Court's ruling could impoverish the data critical to improving the delivery and quality of healthcare: "Can APCDs be effective without all claims, particularly since self-funded plans cover the majority of employees who have employer-sponsored insurance?"
In trying to understand what is at stake for APCDs across the nation, NASHP, the APCD Council, and the National Association of Health Data Organizations (NAHDO) have begun hosting working sessions to help navigate the path down the post-Gobeille rabbit hole and find solutions to safeguard the valuable APCD resource. Issues discussed in their workgroup's recently published documentation include the enforcement of APCD statutes, definition of ERISA-exempt plans, and voluntary data submission of self-funded claims data among others.
This same group is also working on a possible strategy with the U.S. Department of Labor (DOL) to provide a regulatory solution that would enable continued access to ERISA-plan data by state APCD programs. (The SCOTUS ruling pointed to the DOL as the appropriate federal agency to address the issues brought forward in the case.)
Additionally, the APCD Council and NAHDO have published a brief highlighting the ways in which APCD data are used to support the most paramount needs of employers, specifically those with self-funded plans impacted by the Court's decision. This value equation for employers – supplying data to APCDs enables them to identify inefficiencies in the care and cost for their own employees – is a powerful argument that may help dissuade employers and their reporting plans from seeking exemption under Gobeille – a win/win proposition for all.