Carmel Shachar, "Potential Roadblocks in Health Care Big Data Collection: Gobeille v. Liberty Mutual, ERISA, and All-Payer Claims Databases"
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The document discusses the implications of the Supreme Court's decision in Gobeille v. Liberty Mutual regarding the Employee Retirement Income Security Act (ERISA) and its preemption over state All-Payer Claims Databases (APCDs). It highlights post-Gobeille concerns about the impact on healthcare data collection and state initiatives, and suggests potential solutions, including voluntary data contributions and incentives for data sharing. The analysis emphasizes the challenges faced by states in managing healthcare spending and data analysis as a result of this ruling.
![ERISA BACKGROUND
Center for Health Law and Policy Innovation 5
• Employment Retirement Income Security Act of 1974 (ERISA)
– Federal statute setting minimum standards for most voluntarily
established pensions and other employee benefit plans
– Regulation of ERISA plans “exclusively a federal concern.”
– Standardized financial disclosure and reporting requirements,
standards of conduct, responsibility and obligation
– Preemption clause – “‘all state laws insofar as they . . . relate to
any employee benefit plan”
• Supreme Court’s interpretation of ERISA preemption clause
– State law is preempted if “it has a connection with or reference
to such a[n employee benefit] plan.”
– Preemption limited to “state statutes that mandate[] employee
benefit structures or their administration.”](https://image.slidesharecdn.com/shacharroadblockstohealthcarebigdata-160616172847/85/Carmel-Shachar-Potential-Roadblocks-in-Health-Care-Big-Data-Collection-Gobeille-v-Liberty-Mutual-ERISA-and-All-Payer-Claims-Databases-5-320.jpg)
![GOBEILLE V. LIBERTY MUTUAL
Center for Health Law and Policy Innovation 7
• Majority Opinion (Kennedy, J.)
– ERISA preempts Vermont’s APCD
– Vermont law has a “connection with” ERISA plan
ü “governs . . . a central matter of plan administration”
(reporting, disclosure, and recordkeeping)
ü “interferes with nationally uniform plan administration”
• Concurrence (Breyer, J.)
– “[S]erious administrative problems”
– States should work with the Department of Labor or the
Department of Health and Human Services](https://image.slidesharecdn.com/shacharroadblockstohealthcarebigdata-160616172847/85/Carmel-Shachar-Potential-Roadblocks-in-Health-Care-Big-Data-Collection-Gobeille-v-Liberty-Mutual-ERISA-and-All-Payer-Claims-Databases-7-320.jpg)
Carmel Shachar, "Potential Roadblocks in Health Care Big Data Collection: Gobeille v. Liberty Mutual, ERISA, and All-Payer Claims Databases"
- 1. Center for Health Law and Policy Innovation [email protected] www.chlpi.org POTENTIAL ROADBLOCKS IN HEALTHCARE BIG DATA COLLECTION GOBEILLE V. LIBERTY MUTUAL, ERISA, AND ALL-PAYER CLAIMS DATABASES MAY 6, 2016
- 2. Overview • Introduction • Overview of Gobeille v. Liberty Mutual • Post-Gobeille Concerns for Big Data • Potential Solutions 2Center for Health Law and Policy Innovation
- 3. INTRODUCTION PRE-GOBEILLE ERISA PREEMPTION AND APCDS Center for Health Law and Policy Innovation 3
- 4. VERMONT ALL-PAYER CLAIMS DATABASE Center for Health Law and Policy Innovation 4 Insurers required to submit: medical claims data, pharmacy claims data, and other information regarding health care Compiled into a publically accessible resource Vermont issued regulations to implement a health care claims reporting system, establish an All-Payer Claims Database (APCD)
- 5. ERISA BACKGROUND Center for Health Law and Policy Innovation 5 • Employment Retirement Income Security Act of 1974 (ERISA) – Federal statute setting minimum standards for most voluntarily established pensions and other employee benefit plans – Regulation of ERISA plans “exclusively a federal concern.” – Standardized financial disclosure and reporting requirements, standards of conduct, responsibility and obligation – Preemption clause – “‘all state laws insofar as they . . . relate to any employee benefit plan” • Supreme Court’s interpretation of ERISA preemption clause – State law is preempted if “it has a connection with or reference to such a[n employee benefit] plan.” – Preemption limited to “state statutes that mandate[] employee benefit structures or their administration.”
- 6. GOBEILLE V. LIBERTY MUTUAL (2016) AN EXPANSIVE PREEMPTIVE DECISION Center for Health Law and Policy Innovation 6
- 7. GOBEILLE V. LIBERTY MUTUAL Center for Health Law and Policy Innovation 7 • Majority Opinion (Kennedy, J.) – ERISA preempts Vermont’s APCD – Vermont law has a “connection with” ERISA plan ü “governs . . . a central matter of plan administration” (reporting, disclosure, and recordkeeping) ü “interferes with nationally uniform plan administration” • Concurrence (Breyer, J.) – “[S]erious administrative problems” – States should work with the Department of Labor or the Department of Health and Human Services
- 8. GOBEILLE V. LIBERTY MUTUAL Center for Health Law and Policy Innovation 8 • Dissent (Ginsburg, J.) – ERISA does NOT preempt Vermont’s APCD – Vermont law did not “impermissibly intrude on ERISA’s dominion over employee benefit plans” üLaw does not impose a “substantial burden” on ERISA üVermont law and ERISA’s reporting requirements “elicit different information and serve distinct purposes” ERISA reporting - Evaluate the financial soundness of the plans Vermont law - Evaluate and improve the quality and cost of health care provided in Vermont
- 9. POST-GOBEILLE CONCERNS MAJOR IMPACTS ON APCDS Center for Health Law and Policy Innovation 9
- 10. POTENTIAL IMPACT OF GOBEILLE Center for Health Law and Policy Innovation 10 – 18 states have APCDs, 12 developing APCDs – Need proprietary data to control the growth of healthcare spending Impact on states’ programs and initiatives
- 11. POTENTIAL IMPACT OF GOBEILLE Center for Health Law and Policy Innovation 11 – Colorado - Price transparency, competition for maternity services and hip and knee replacements – New England - Medicaid versus commercially insured children – Maine – Opioid prescription Impact on health services research (examples)
- 12. POTENTIAL IMPACT OF GOBEILLE Center for Health Law and Policy Innovation 12 Reduces number of claims in APCDs • Undermines research that requires very large datasets • Example: Multiple sclerosis drug natalizumab (Tysabri) Impacts the external validity of post-GobeilleAPCD data • Removes a key portion of the population from APCDs • Medicare and Medicaid enrollees differ from privately insured Loss of a key resource for gauging the health status and needs • Hampers efforts to efficiently allocate health resources • Difficult to draw actionable conclusions • Example: Danish/Medicaid data
- 13. POTENTIAL SOLUTIONS CREATIVE MEASURES TO SAVE APCDS Center for Health Law and Policy Innovation 13
- 14. POTENTIAL SOLUTION: DOL Center for Health Law and Policy Innovation 14 Department of Labor to use ERISA authority to regulate – Justice Breyer concurrence : DOL Secretary “may be authorized to require ERISA plans to report data” Concerns with DOL DOL may not be able to waive preemption • Risk of further litigation DOL cannot compel non-self- insured plans to deliver information under ERISA • Incomplete data set Unlikely that DOL will pass regulations anytime soon • Next administration may take different view
- 15. POTENTIAL SOLUTIONS: VOLUNTARY DATA Center for Health Law and Policy Innovation 15 Voluntary data contributions by payers – Health Care Cost Institute dataset – Aetna, Humana, UnitedHealthcare
- 16. POTENTIAL SOLUTIONS: PROVIDING INCENTIVES Center for Health Law and Policy Innovation 16 Incentives for data sharing • Tax incentives relating to health insurance costs • Incentives to third-party administrators • Offer incentives only to employers and insurers who meet certain standards in scope Non-financial incentives • State legislation to protect employers that disclose employee health care information • Address HIPAA concerns • Address NDA concerns • Address other confidentiality concerns
- 17. 122 Boylston Street Ÿ Jamaica Plain, MA 02130 [email protected] Connect with us online HarvardCHLPI HarvardCHLPI www.chlpi.org