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Florida Blue To Provide Claims Information For Statewide Database

Jacksonville-based Florida Blue's Riverside Avenue tower.
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

In a major turnaround, one of Florida’s largest health insurers is poised to provide 60 million insurance claims to a statewide database designed to help people shop for health care.

Jacksonville-based Florida Blue agreed to submit three years of claims data that will show what the company paid hospitals and health care providers, said company spokeswoman Toni Woods.

Florida Blue, which is the trade name of Blue Cross and Blue Shield of Florida, agreed to start submitting the claims after it was assured that the state would “properly protect our confidential and proprietary information and our members' information in accordance with state and federal law,” Woods said.

Woods could not say when the data would be submitted other than to offer, “We are close.”

But more than confidentiality concerns bedeviled insurance companies and HMOs that weren’t submitting the data to the state. Concerns also focused on whether the state’s contracted vendor, the Health Care Cost Institute, or the companies owned the data.

That has been cleared up, Woods said, noting that the state Agency for Health Care Administration “has clarified that issuers remain owners of their own submitted data.”

Another company, the Tallahassee-based HMO Capital Health Plan, also “has executed an agreement with the Agency for Health Care Administration and will submit the additional data as requested, we stand ready to assist in any way we can," according to Tom Glennon, senior vice president of business and community development.

The claim-information database has been a long time coming, and Gov. Ron DeSantis has twice said he’s told the Agency for Health Care Administration to “expedite” it.

The goal is for people to be able to compare the costs of services at a county level per facility and compare that to other counties across the state.

DeSantis sees the database as playing a key part in the development of “shared savings” options between insurance companies and their customers. He signed a bill (HB 1113) authorizing shared-savings incentives last week.

Under the new law, people can shop around for certain insured services and if they can get them for less than what the insurance company normally pays, they are entitled to a share of the savings.

“The transparency is great, but why would I want to go shop online if it makes no difference to me as a consumer?” DeSantis asked at the bill signing event last week. “If it’s just saving an insurance company money, I think a lot of patients would just have their time to themselves rather than doing this.”

The notion of consumers being able to capture those savings, DeSantis said, should make the difference.

“With those incentives in place, then I think our transparency tool will be something that can be used, and I think it will help put a downward pressure on health care costs,” he said.

Former Gov. Rick Scott initially pushed for the creation of what is known as an all-payers claims database in 2016 as a way to increase access to health care. Scott convinced the Republican-controlled Legislature to pass a law mandating that any insurance company that participates in Medicaid or the state-employee health insurance program provide the data to the state.

The law required AHCA to hire a vendor to run the site. The Health Care Cost Institute, commonly referred to as HCCI, has been paid $4.3 million to date on a $6.1 million contract.

HCCI was founded by four insurance companies, including Aetna, Humana and UnitedHealthcare, all of which write policies in Florida. Florida insurance companies were hesitant to provide the information to HCCI, which was founded by their competitors.

In addition to Florida Blue, plans affiliated with the company, including Florida Health Care Plan, Health Options and Capital Health Plan, had concerns about submitting the data. Another company, AvMed, also was not submitting the data.

It was not clear Wednesday if Florida Health Care Plan, Health Options and AvMed were following Florida Blue’s lead and submitting the data. Attempts to contact the companies for comment were unsuccessful.

Photo used under Creative Commons license.

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Christine Sexton - News Service of Florida