Time for Medicaid Transparency
It's time to use technology to ensure that Medicaid claims data can be used by the state and the public to drive cost savings and better health outcomes.
Medicaid spending eats up 30 percent of Illinoiss budgetary pie. Not only is Medicaid gobbling up a good chunk of the budget, its girth is expanding. Between 2003 and 2008, Medicaid enrollment grew at an average rate of 7.8 percent a year while Illinois’s population only grew 0.5 percent.
But what are we getting from all that spending? Its not clear. Illinois lacks a reliable information resource that details how Medicaid dollars are spent and what health care outcomes are achieved. Taxpayers cant see if their dollars are being used wisely. Meanwhile, Medicaid outlays continue to grow.
How about creating an online transparency database of Medicaid claims (protected for individual privacy) that can be accessed by program administrators and the public?
In its June 2009 report to Governor Pat Quinn, the Taxpayer Action Board recommended Illinois use technology to ensure that Medicaid claims data can be used by the state and the public to drive cost savings and better health outcomes. In particular, the Board recommended that the state provide privacy-protected access to the public regarding State Medicaid claims information, with all unique, identifying information removed.
Putting ideas into action, Illinois State Legislator Patti Bellock introduced legislation (HB 5241) to do just that. Specifically,
it would “implement an internet-based transparency program under which
the Director shall make available through the Department’s Internet
website non-aggregated information on individuals collected under the
State’s Medicaid program.”
In a June 8, 2009 article in Roll Call, Newt Gingrich and Jim Frogue argued that states should:
Immediately make public all Medicare and Medicaid claims data, but only in a manner that vigorously protects patient privacy. Claims data contain all the answers on how health care dollars are spent. This data show in details where the dollars go, what hospitals and facilities perform which procedures in what volume and with what success rate. It also shows infection rates and every other metric imaginable.
Online transparency would help focus many sets of eyes on Medicaid spending: It would be the single best tool to identify and root out fraud Sen. Tom Coburn (R-OK), a physician, believes that a full third of all health spending is wasted on defensive medicine, paperwork and outright fraud.
Claims information can be presented in a manner that protects privacy: Fortunately, there is long precedent for that as the CMS has released Medicare claims data to university researchers for decades with patient identities safely scrambled by multiple algorithms.
Health care transparency is safe political ground. Gingrich and Frogue reference a 2008 poll which found that 98 percent of Americans believe they have the right to know cost and quality data about their health care provider.
Promoting Medicaid spending transparency would:
- Offer government administrators better insight on how Medicaid resources are spent and what health care outcomes are achieved;
- Allow taxpayers greater insight into how their dollars are spent by state government;
- Fulfill a recommendation of the Taxpayer Action Board; and
- Promote Governor Pat Quinns stated desire for an honest, open, and transparent state government.