Health Finance & Structure Transparency

Pillar Chair

Paul Spiess

About the Health Finance & Structure Transparency Pillar

This Pillar work group has a draft work plan, with the intention of finalizing the scope and detailing the plan by the end of the first quarter.  Our draft work plan of analytic efforts, reports and briefs, whose intended audience consists of policy makers, employers, brokers, hospitals, providers and carriers, includes the following:

Communication, Education & Outreach

Host a health care system cost transparency event for policy makers and employers highlighting reports from the NH Department of Insurance, NH Center for Public Policy Studies, and the NH Department of Health and Human Services in early 2009.

Cost and Utilization

  • 2005–2007 Cost and Utilization Summary of NH Commercially Insured Lives. Conduct a study using the reports developed by the Maine Health Information Center and in use by NHPGH, on three years of cost, utilization, and preventive care measure data for NH’s commercially insured population.
  • Provider Primary Care Study. In an effort to overcome systemic challenges with provider identification in claims data, this study will select a subset of primary care procedures for drill down and provide an analysis of cost and utilization differences between various primary care settings (independent practices, clinics, hospitals, hospital-owned practices).

Quality

  • * Score Card. Support efforts of NHPGH in its cost and quality report card development and distribution.
  • * Quality Transparency Planning. Develop a Quality Transparency Working Group who will deliver a report to the Initiative on current transparency efforts and future needs by Q3 2009.

Insurers 

  • Policy Brief on Carrier Discounts by Provider. An examination, based upon the underlying HealthCost database and additional Initiative analysis, of carrier discounts by provider. Would examine both inpatient and outpatient cost differences.
  • Policy Brief on Benefit Value Equation. Summarize and issue a brief on the recent findings from the NH Department of Insurance Supplemental Reports, examining the relationship between premium and medical loss ratios by product and employer group size.

Other

  • Patient Migration Study – Phase II. To provide further clarity as to where NH residents live as compared to where they receive care, we will examine the data, providing community-by-community details on both incoming and outgoing patient migration. This information will support the Successor Group to the 2008 HIT and HIE Working Group, as well as to local communities who wish to improve local HIE efforts.