New York Offers All-Payer Database Regulation

The New York State Department of Health has released for comment regulations governing the operation of an all-payer data base it believes will have a positive impact on the effort to evaluate the cost and quality of health services. Calling the current payment data collection system “fragmented, inconsistent and incomplete,” DOH says an all-payer approach will improve comparability of information in a way that will enhance disease prevention and evaluation of treatment costs. An all-payer database is also seen as supporting a single set of risk adjustment calculations, which will help payers and regulators “prescribe and determine appropriateness of premium rates.” In a presentation made late last year, NYSDOH estimated New York’s total all-payer enrollee count could reach as high as 19.3 million, with commercial healthplan enrollment accounting for 9 million enrollees and Medicare, Medicaid and CHIP accounting for 9.3 million enrollees in New York. The New York State Health Exchange accounts for an additional 1 million insured individuals. The Supreme Court ruled last March that the state of Vermont couldn’t compel self-insured healthplans to submit claims data to that state’s all-payer database. As a result of that ruling, New York officials are asking self-insured employers to submit claims data voluntarily. For a copy of the draft regulation, visit www.health.ny.gov.