Viewpoint: Gobeille v. Liberty Mutual ruling a blow to innovation

Health system innovation was dealt a blow when the Supreme Court ruled in Gobeille v. Liberty Mutual Insurance Company in March that self-insured health plans were exempt from having to send information to Vermont’s all-payer claims database (APCD), according to a recent viewpoint published in the Journal of the American Medical Association.

The authors, from the O’Neill Institute for National and Global Health Law at Georgetown University, say the use of large databases to track costs and use of tools has great potential to cut unnecessary spending and improve care. They say the Employee Retirement Income Security Act (ERISA) of 1974, which is cited in the ruling as the reason such health plans don’t have to send information to state-run databases, creates a “regulatory vacuum by preventing state regulation of self-insured plans without substituting a federal regulatory scheme.”

Options remain to boost innovation, however, according to the authors.

For instance, they say states could encourage self-insured plans to voluntarily submit information. “Some states, such as Virginia and Wisconsin, have implemented APCDs and other data collection initiatives with voluntary reporting and have achieved positive results. … Under such agreements, health plans would be required to report data and, in exchange, would gain limited access rights to health department data, subject to privacy protections,” the authors note.

In addition, states could encourage hospitals and clinics to provide data, such as lab results, vital signs, patient surveys and more. Such information could better help states know about the health of their residents, the authors write.

Another avenue is action from Congress, which could put ERISA waivers in place that require reporting to APCDs. The government could take one more step and revise ERISA so that it can facilitate state regulation of all self-insured employee benefit plans, the authors add.

They conclude that the Supreme Court’s decision is “unlikely to be that last word” on the issue, adding that policymakers should look into other ways to keep track of price, use and quality of healthcare services.

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- here's the viewpoint