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Transparency Eyed To Hold Down Health Costs

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Florida Gov. Rick Scott, who has often criticized efforts to overhaul health care at the federal level, has contended for years that more needs to be done to lower the cost of what patients — and the government — pay for care.
But there are questions about whether Scott's own effort to help drive down costs will be a success before he leaves office in early 2019.

The Republican governor and former health-care executive wants legislators this year to spend $925,000 for a statewide database of insurance claims that can be used to provide the average costs of care at facilities and doctor offices across the state. That's on top of $4 million the state has already spent on the project.

While Scott is asking for more money, his administration is also moving ahead on a proposed rule, which some argue goes beyond what state law allows, that would require insurance companies or Medicaid HMOs that contract with the state — as well as affiliates of the companies and HMOs — to submit insurance claims on all of their Florida policyholders.

Justin Senior, secretary of the Florida Agency for Health Care Administration, testified to a Senate panel last month that the state is going to take the claims data and publish the average prices for nearly 300 medical procedures at hospitals and ambulatory surgical centers across the state.

The information, he said, will enable people to “get closer to the point as consumers where we can actually shop for health-care procedures.” In other words, if consumers know the price ahead of time, they will be able to search for the least-expensive alternative.

An early iteration of the state website, has been available to the public and contains cost information on 295 health-care bundles, ranging from acne to X-rays. The Agency for Health Care Administration signed a contract with Health Care Cost Institute, or HCCI, to collect and make available Florida-specific claims data and to develop and carry out an interactive consumer website that displays the information.

AHCA spokeswoman Shelisha Coleman said the site had 3,288 visitors between Nov. 28 when it was first launched and Jan. 2.

But some people, including House Health Quality Chairman James Grant, are concerned the information may not be utilized the way the state would like.

Grant, R-Tampa, calls himself an ardent supporter of making information on health-care costs available to consumers. But he said he's concerned the state missed the opportunity to ensure widespread use of the information because it did not require the new website to have application program interface, or API.

In short, APIs allow one application to share data with another application, and Grant said the state should never sign another technology contract that doesn't mandate APIs.

“There is so little data made available to consumers,” Grant says, adding, “a government website is probably not the most meaningful place to get adoption.”

Scott championed increased health-care transparency in 2016, a year after a bruising legislative battle over expanding Medicaid access to uninsured, childless adults. In lieu of expanding Medicaid access, Scott said he would help uninsured Floridians by working to lower the costs of health care.

The Legislature responded in part by giving the green light to an all-payers claims database requiring health insurers that participate in the state group health-insurance plans — and the insurers' affiliates — to submit claims data to the state. The bill also required health plans that participate in the Medicaid managed-care program and their affiliates to submit all claims data on Florida policyholders.

In addition to approving the database, the Legislature also agreed to provide more than $4 million to AHCA to pay for the creation of the database and website.

The website shows the average costs insurance companies paid for services, not the average costs hospitals or providers charged for the services. Health Care Cost Institute Director of Operations Kristine Burnaska says uninsured patients often are quoted undiscounted prices that are much higher than what health-care facilities agree to accept as payment from insurance companies.

“Providing uninsured consumers with the average amount that a facility might receive from an insurance company gives the consumer a starting point for price/payment negotiations with the facility,” she says.

Epilepsy Foundation of Florida CEO and President Karen Egozi has worked with uninsured people and those who suffer from epilepsy since 2005. Also, in 2010, her association became a navigator to help people who qualify for subsidized insurance coverage through the federal health exchange.

She says consumers don't think about negotiating health-care costs with providers and questioned whether providers would agree to negotiate. Egozi says people she helps are less interested in what insurance companies pay to reimburse hospitals and are more interested in what they will have to pay in premiums and co-insurance or co-payments.

Scott is not alone in his push to increase price transparency. Many health insurance companies offer tools to customers to help them research health-care costs before deciding which providers to see or where to go to the hospital, says Florida Association of Health Plans President and CEO Audrey Brown.

Toni Woods, of Florida Blue, said the Jacksonville-based insurer tries to educate customers about costs of care — as well as their portions of the costs of care — in a variety of ways and has made available a cost estimator that it dubs “Know Before You Go.”

The system allows customers to compare medical costs for several procedures, find providers and pharmacies and compare drug prices. She said it was used more than 193,000 times in 2017 by members who wanted to compare medical costs.

Meanwhile, the plan is to update the state's price website this spring with Florida-specific claims data. To that end, the Agency for Health Care Administration held a rule workshop over the summer where the insurance industry expressed concerns that the rule may go beyond what the law authorizes.

Tallahassee Attorney Bruce Platt noted in written remarks that the law applies to HMOs and insurance companies that provide group benefits to employers but appears to also include claims for individual policies, such as those sold through the federal health-care exchange.

Moreover, in his two-page letter to the Agency for Health Care Administration, Platt flagged concerns that the proposed rule required self-insured employers to submit claims data to the state. Insurance companies and HMOs that provide “administrative services” to self-insured employers don't own the data and cannot release the data without permission from the employer clients, he said.

While the agency didn't respond to all of Platt's concerns, it republished the proposed rule to make clear that the self-insured claims data would be released to the state “with the employers’ permission.”