An Easy and Profitable Way to Turbocharge Disease Management?

Al Lewis

When an employer group shifts from one health plan to another, why not allow them to take their claims data to the next health plan? That way, the new plan would gain immediate knowledge of the specific disease burden faced by its new members and be able to act accordingly vis-à-vis care management programs and other interventions. As it stands now, the new plan would have to wait many months and even then would lack the history that the earlier plan no longer needs. And when the new plan “finds out" about a member's condition, it might be due to a claim for an event that could have been prevented had the carrier had access to the earlier data.

Here’s how the system would work. When a group signs up with a carrier, it could reserve the right to have its data transferred if it changes carriers. Obviously, it wouldn’t be able to “see” its own patient-identified data any more than it does now, but the data would accompany the change of carriers.

This can certainly be done without an Act of Congress. It might need to be safe-harbored by a brief regulation or administrative ruling under the Health Insurance Portability and Accountability Act, but I think one could argue that there is no prohibition against doing this now.

My question to the group is, what am I missing? Why aren’t we already doing this? Why wouldn’t a health plan offer this to an employer, for a fee, once it is clear that the employer is leaving for another carrier anyway?

Al Lewis is Executive Director of the Disease Management Purchasing Consortium

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