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Uniform Claims Review Process Study Meeting - June 29, 2009 Agenda

The Uniform Claims Review Process work group will meet 9-11 a.m. Monday, June 29, 2009.

The meeting is intended to initiate discussion regarding the study requirement highlighted in bold below.

Sec. 13. STUDY OF UNIFORM CLAIMS REVIEW PROCESS.
    The commissioner of health shall establish a work group including representatives of the Minnesota Hospital Association, Minnesota Medical Association, and Minnesota Council of Health Plans to make recommendations on the potential for reducing claims adjudication costs of health care providers and health plan companies by adopting more uniform payment methods, and the potential impact of establishing uniform prices that would replace current prices negotiated individually by providers with separate payers. The work group shall make its recommendations to the commissioner by January 1, 2010, and shall identify specific action steps needed to achieve the recommendations(Laws of Minnesota, 2008 Regular Session, CHAPTER 358--S.F.No. 3780, Article 4)

Discussion starting point: 

  • Definition of uniform prices that would replace current prices negotiated individually by providers with separate payers”

We are especially interested in discussing a view of uniform pricing described in the 2008 Governor’s Health Care Transformation Task Force report (PDF), as described below:

(from Governor’s Health Care Transformation Task Force report, Appendix A, III-B2, page A-23 )

…all providers should establish and make publicly available a single price for each service billed on a fee for service basis or offered under a “basket of care” as defined in Recommendation III-B3. That price would be offered to consumers and would be accepted as payment in full by the provider from all private payers (and by public programs such as Medicare and Medicaid to the extent possible) for the service provided. Providers will no longer negotiate prices with numerous third party payers, and payment rates for a service to a particular provider will no longer vary based on the type of insurance a person has. Instead, providers will set prices that are visible throughout the community and easy to understand. This change is intended to promote greater competition by providers, as well as reduce health plan and provider administrative costs. (Providers and health plans could continue to negotiate on network participation by providers.) 

Preliminary discussion points, questions for the 6/29/09 meeting:

  1. What are the practical considerations of uniform pricing? (What does uniform pricing “look like”? What does uniform pricing mean in practice? How does it work -- how do you do it, and what does it take to do it?)
    1. What is being priced uniformly? 
    2. How are prices determined? 
    3. What obstacles would have to be overcome to implement uniform pricing? 
    4. What business and operational changes would be needed to effectively implement uniform pricing (what changes are needed in billing, coding, contracting, etc.)?
  1. What are the pros and cons (“potential impacts”) of uniform pricing?
    • Especially in terms of:
      1. Enhancing “transparency” and “consumerism”?
        • Plan competition
        • Provider competition
        • Consumer engagement
      2. Administrative burdens and costs in health care? (Short term? Long term?)
      3. Overall health care costs and outcomes? (Short term, long term?)
      4. Innovation and change?
      5. Other criteria?

 

Updated Tuesday, November 30, 2010 at 04:15PM