Wyoming employers mull all-claims database

Wyoming has always had an independent streak. And when it comes to taming runaway healthcare costs, it may continue marching to the beat of a different drummer.

A group of businesses in the Cowboy State may band together to obtain costs for medical procedures and hospital visits--and then negotiate with providers directly, WyoFile reported.

Wyoming, which has declined to expand Medicaid coverage and has been generally hostile to the Affordable Care Act, has among the highest insurance rates in the nation, with premiums regularly increasing by double digits. As a result, many hospitals in the state, particularly those in the few sizable population centers, have been cost-shifting more to insured patients to make up their shortfalls.

"The more costs can be transparent, and we can see how costs are set, the better," Kelly Weidenbach, director of the public health system in Natrona County, told WyoFile. "You can't have a capitalistic system if customers can't see prices and shop around."

Price transparency through an all-claims database, as under consideration in Wyoming, could save $100 billion over the next decade. But for a vast majority of the states, price transparency currently remains out of reach.

Some of the largest employers in neighboring Montana already have done that to keep premiums in check. Missoula County, Montana, gathered price data from other large employers and determined they were paying some of the highest hospital rates in the nation. So they renegotiated, using Medicare rates as a baseline, and got hospitals to agree to eat the costs of readmitted patients. It has saved $1.5 million to date as a result--including $145,000 for a rehospitalized cardiac patient, according to WyoFile.

"With pooled data we can expose the price variation, and with a bundled payment you provide an incentive to the delivery system to squeeze out unnecessary procedures," Anne Ladd, director of the Wyoming Business Coalition on Health, told WyoFile. "Then we put the delivery system on notice that, 'I don't mind paying the right amount for a neck surgery when it is needed, but I don't want to pay for it when it is not needed.'"

Whether Wyoming decides to pursue an all-claims database remains to be seen. As the most sparsely populated state in the nation, it has few areas where hospitals compete, thereby providing less of an incentive to cut deals with employer groups on prices.

To learn more:
- read the WyoFile article

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