N.H. to become first state to use health insurance claims to rate networks 

  • FILE - This Dec. 3, 2014, file photo, shows the Anthem logo at the company's corporate headquarters in Indianapolis. Aetna Inc. and the Blue Cross-Blue Shield carrier Anthem Inc. each reaffirmed on Friday, Nov. 20, 2015 their 2015 earnings forecasts. They also said their commercial business has developed as expected through October. That includes insurance sold on the exchanges, a key component in the Affordable Care Act's push to expand insurance coverage.(AP Photo/Darron Cummings, File) Darron Cummings

Monitor staff
Published: 6/15/2018 10:43:20 PM

Years of information about payments for health insurance claims in New Hampshire that is being used to help patients do comparison price shopping will soon help the state judge health networks and may even help those networks improve, especially for behavioral health.

“It may be that there is a non-traditional provider or a lower cost provider that is performing a service,” said Jennifer Patterson, Director of Health Policy for the Insurance Department. An upcoming change in rules, she said, should help the state ensure that insurance providers know about or make use of alternatives such as nurse practitioners, social workers or even telemedicine.

As of August, New Hampshire will be the first state in the country to use information about years of health insurance payments, known as all-payer claims data, to implement something called the network adequacy rule.

Under that rule, regulators determine whether insurance companies can give access to the services that their policies cover, and can do it in each of the state’s counties.

The new network adequacy rules divide health care into four categories with different requirements, including how far service providers can be from patients. As of August, the New Hampshire Insurance Department will begin using data on actual claims in evaluating insurance network adequacy.

“We’ll be using our all-payer claims database to support increased transparency, making apples-to-apples comparisons,” said Patterson. “This will allow an increased understanding of what is available.”

As the name implies, all-payer claims data is a collection of insurance claims that have been submitted for various health procedures in the state over a period of time, with information about patients removed. It gives a picture of what is available and what is actually being used that is more accurate and detailed than mere lists of available providers or company-specific information about claims.

First established in Maine in 2003, these databases have become much more common and now exist in some form in about half the states. New Hampshire used its all-payer claims database on NHHealthCost.org, which shows average cost per facility for about 100 medical procedures and a dozen dental procedures for the state’s 26 hospitals and many stand-alone clinics.

Using the database to develop and implement network adequacy rules will be something new, however. Doing so, Patterson said, will not only help the state judge the effectiveness of insurance networks, but because the same system will be used by insurance companies it can help them improve their offerings, especially in the fast-changing arena of behavioral health, including addiction treatment and mental health services.

State law was recently amended to include behavioral health as part of the requirements for insurance network adequacy.

“From the carrier perspective, it helps them understand the landscape of potential providers with whom they might contract. Medical practice is changing over time, the way services are delivered is changing over time, and core services people need to access close to home may be changing,” said Patterson.

The New Hampshire Insurance Department’s new network adequacy rule was approved this week by the Joint Legislative Committee on Administrative Rules.

The existing network adequacy rules were drafted more than 20 years ago and set to expire at the end of July.

(David Brooks can be reached at 369-3313 or dbrooks@cmonitor.com or on Twitter @GraniteGeek.)
David Brooks bio photo

David Brooks is a reporter and the writer of the sci/tech column Granite Geek and blog granitegeek.org, as well as moderator of the monthly Science Cafe Concord events. After obtaining a bachelor’s degree in mathematics he became a newspaperman, working in Virginia and Tennessee before spending 28 years at the Nashua Telegraph . He joined the Monitor in 2015.

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