Overview
Based on our audit, the Center for Health Information and Analysis (CHIA) does not update its consumer healthcare information website, CompareCare, at least annually: CompareCare currently contains only 2015 and 2016 consumer healthcare information. As a result, consumers do not have access to the latest information on comparative prices and costs for common healthcare services. Consumers may need this information to make proper choices regarding healthcare providers, healthcare quality, and healthcare costs.
Authoritative Guidance
According to Sections 20(a) and (b) of Chapter 12C of the Massachusetts General Laws, CHIA is required to maintain a consumer healthcare information website. Section 20 of Chapter 12C of the General Laws requires CHIA to provide information on this site that is updated at least annually. It also requires that the site reflect specific information:
(a) The website shall contain information comparing the quality, price and cost of health care services. The website shall also provide information about provider and payer achievement of cost benchmarks and growth goals. The website may also contain general health care information as the center considers appropriate. . . .
(b) The website shall provide updated information on a regular basis, at least annually, and additional comparative quality, price and cost information shall be published. . . . The website shall include: (1) comparative price and cost information for the most common referral or prescribed services . . . (2) comparative quality information . . . for each such service or category of service . . . (3) general information related to each service or category of service . . . (4) comparative quality information . . . that is not service-specific . . . (5) data concerning healthcare-associated infections and serious reportable events . . . (6) definitions of common health insurance and medical terms . . . (7) a list of health care provider types . . . (8) factors consumers should consider when choosing an insurance product or provider group . . . (9) patient decision aids . . . (10) a list of provider services that are physically and programmatically accessible for people with disabilities; and (11) descriptions of standard quality measures.
Reasons for Issue
CHIA officials told us that there were numerous past reasons, listed below, that they could not update CompareCare at least annually. However, we determined that none of the reasons listed below would have directly prevented CHIA from updating CompareCare as required by law.
- CHIA does not have access to any consumer’s health insurance information, health insurance coverage, or current status of annual deductible. Not having access to this information prevents CHIA from providing consumers with the exact cost of a medical procedure.
- Health plan and provider organizations have expressed concern to CHIA officials about the possibility of confusing their members and patients, since prices for medical procedures listed on CompareCare might not be accurate.
- CompareCare, much like other state consumer transparency websites, has had low levels of public interest.
- In a 2016 decision (Gobeille v. Liberty Mutual Insurance Co.), the United States Supreme Court ruled that the Employee Retirement Income Security Act preempted entities like CHIA requiring submission of claim data from self-insured employers. Because self-insured employers encompass the majority of the commercial insurance market, CHIA no longer had data on prices paid by national insurance carriers after this decision.
- In November 2019, former President Donald Trump’s administration announced that it would institute sweeping federal price transparency requirements for hospitals and health plans. Because CHIA wanted to be consistent with these requirements, it was waiting for the federal government to clarify its transparency strategy before updating CompareCare.
Recommendation
CHIA should maintain information that is updated at least annually on CompareCare.
Auditee’s Response
The Center for Health Information and Analysis (CHIA) acknowledges the accuracy of the audit finding that CompareCare has not been updated on an annual basis. The agency also acknowledges that the bullets listed under Reasons for Issue have not precluded CHIA from updating the site. However, CHIA believes that CompareCare still fulfills the primary purpose for which it was designed: providing general information on comparative prices for common health care services and provider quality, facilitating informed conversations between patients and their providers and insurers about health care choices, and helping consumers resolve common problems with health care. Consumers shopping for care will continue to find the most accurate information through their respective insurer, who will have access to their out-of-pocket costs, which are a function of their specific coverage and the status of their deductible, or provider.
Notwithstanding, CHIA maintains its commitment to a robust transparency agenda. Subsequent to the audit period, CHIA refreshed the data on CompareCare to reflect calendar year 2017 (the most current extract available to the agency). Having recently completed a yearslong project to make the [state database] more analytically accessible, CHIA now anticipates being able to produce the extracts necessary for annual updates to CompareCare. The agency is also engaged in ongoing discussions regarding additional opportunities to present meaningful information to consumers without duplicating efforts or creating market confusion.
| Date published: | December 31, 2021 |
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