Increase managed care transparency, long-term care providers urge Senators

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Sen. Charles Grassley (R-IA)
Sen. Charles Grassley (R-IA)


The government should collect and release more claims information from managed care plans, the nation's largest long-term care provider association stated in a recent letter to leaders of the Senate Finance Committee.

Managed care -- in the form of Medicare Advantage and Medicaid managed care organizations -- is “rapidly gaining popularity,” but data limitations have made it hard to look at cost and quality benefits, according to the Aug. 12 letter from the American Health Care Association/National Center for Assisted Living.

The Centers for Medicare & Medicaid Services could release managed care claims data in public use files, as it does for Medicare fee-for-service claims, AHCA proposed. There are other reporting options as well, but the goal should be more robust and accurate comparisons to the fee-for-service model, the association emphasized, noting that research so far has shown “results are mixed.”

Congress also should require CMS to release fee-for-service claims data and Minimum Data Set data in a more timely manner, the letter stated. Currently, the nearly two-year lag time before this data is released means that providers do not have timely information about how quality improvement efforts have worked. The claims data also should be available at a more reasonable price point than it is now, given that “only large providers with resources” can purchase it.

The association sent the letter to Finance Committee Chairman Sen. Ron Wyden (D-OR) and Ranking Member Sen. Charles Grassley (R-IA). In June, they requested stakeholder input about how to make healthcare data more accessible and useful.

AHCA also said that it wants the government to ensure that Minimum Data Set systems meet interoperability standards, and it pressed Congress to make funding for electronic health records systems available to post-acute and long-term care providers.