All-payer database lawsuit before Supreme Court could hurt HIEs

Tools

A lawsuit currently before the United States Supreme Court about state imposition of all-payer claims databases could have significant adverse effects on health information exchanges (HIEs), according to a perspective article in the New England Journal of Medicine.

Nicholas Bagley from the University of Michigan Law School and Christopher Koller from the Milbank Memorial Fund warn that the lawsuit, if held in favor of the insurance company fighting a state law requiring all payer claims to be included in a data base to provide claims transparency, could have implications far beyond that particular database. In the lawsuit, Gobeille v. Liberty Mutual, the insurer is arguing that since it's governed by the federal Employee Retirement Income Security Act (ERISA), it does not have to comply with Vermont's state law requiring insurers to submit the claims information. If Liberty Mutual wins, then employers that self-insure would not have to report to state entities--not just to the all-payer data bases, but other public initiatives, such as HIEs.  

"These exchanges enable the sharing of clinical information among healthcare providers so that, for instance, emergency department personnel have access to a patient's medical records and claims history when the patient arrives in the department," Bagley and Koller point out. "Although some of these exchanges are private provider-to-provider efforts, others are organized under state auspices. These state-sponsored exchanges depend on the participation of all of the insurers and employers that pay for health care in the state--both to submit information and to help finance them. If self-insured employers can opt out, these new exchanges could founder."

Arguments before the Supreme Court were held Dec. 2, according to the Wall Street Journal.

The lawsuit comes at a time when HIEs, still relatively new, are trying to sustain themselves and meet consumer demand, offering not only interoperability and ways to meet the patient engagement requirements of the Meaningful Use program but also untethered personal health records, care coordination and other services. A win by Liberty Mutual could undermine HIEs' efforts to bring together all of the stakeholders in a state and hamper their data exchange efforts.  

To learn more:
- read the NEJM article
- here's the Wall Street Journal article

Related Articles:
Report: HIE-sponsored PHRs offer 'one-stop shopping'
HIEs evolving as demand increases
HIE sustainability: How organizations stay relevant, innovative (special report)
Supreme Court takes Vermont all-claims database case