Vermont’s Department of Banking, Insurance, Securities and Health Care Administration has fined MVP Health Care $75,000 for a month-long delay in its filing of medical claims data.
Christine Oliver, deputy commissioner of the department, said the state “had an issue with MVP” last year. This time BISHCA took “immediate action.” The fine was levied the first week of October. There was also a “glitch,” she said, with data from Blue Cross Blue Shield of Vermont that was resolved. Both companies have submitted the data to a state contractor, OnPoint, Inc., which will process the information.
Why did the state fine MVP?
“We see how important this is,” Oliver said. They were a month behind, and that’s pretty serious. We know this database is going to be the basis of health care reform and the Blueprint for Health. It’s really important information.”
Last year, BISHCA began requiring medical insurers who do business in Vermont – BCBS, MVP and Cigna — to transfer claim information to the state on an annual basis.
The “all claims database,” known as Vermont Health Care Uniform Reporting and Evaluation System, includes every claim that has been filed by providers in the state.
The information was supposed to be made available on Oct. 8 to Dr. William Hsiao, who is developing three medical reform design plans for Vermont.
OnPoint needs another three weeks to verify the data. The delay may push back Hsiao’s report to the Vermont Health Care Reform Commission into mid-January — the second week of the next legislative session. Hsiao, a Harvard economist, had planned to issue his report at the end of December.
Steve Kappel, a Vermont-based health care policy analyst who is working with Hsiao, said the timeframe for developing the plans was already very tight.
“Data becomes the cellar hole for all of our construction,” Kappel said. “The good news (is) the state is building database. Like any major construction project, it’s running late. We are going to do everything we can to deliver on time. There is more of a danger that the information won’t be as complete and well-considered as we would like it to be.”
The Vermont Legislature hired Hsiao to develop three different medical system designs, including “single-payer,” “public option” and a third proposal, as yet to be determined.
Lawmakers set two main criteria for the plans: They must provide universal health care to Vermonters and contain medical costs. Each design proposal requires extensive analysis of financial data and provider claims.
“Vermont has tried to do this before in an analytical exercise focused on cost,” Kappel said. “We’re going to do rigorous mathematical modeling, but with more awareness of legal and political opportunities and limitations.”
Kappel said the state has given the team a lot of useful data already, including Medicaid data and the BISHCA health insurance survey.
Some of the proposals under consideration include bundled and capitated payments. The insurance claims are “bedrock data,” he said, “if we’re going to start changing reimbursements.”
Everyone pays “something different” for a 15-minute office visit, Kappel said. Public payers reimburse less than private insurers, who pay different amounts to different providers. Right now, Kappel said, there are of “tons of different payments.”
