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The home for VPR's coverage of health and health industry issues affecting the state of Vermont.

Big Health Data Case Makes Vermont A Legal Testing Ground

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Gobeille vs. Liberty Mutual Insurance Company centers on Vermont's quest for the big data that policy makers say they need to reshape the health care industry.

Big data is all the rage these days, especially in the world of health care. And as Vermont looks to compile a massive repository of insurance claims information, it’s become a legal testing ground for the future of health reform nationally. 

The legal contours of a case known as Gobeille vs. Liberty Mutual Insurance Company are complex. But they center on Vermont’s quest for the big data that policy makers say they need to reshape the health care industry.

“You know, with our Type 1 diabetics, how good are we at controlling their blood sugar? How often are we seeing them? Those types of questions, looking at a total population, those happen through big data,” says Al Gobeille, the namesake in the Vermont case, and the chairman of the Green Mountain Care Board, a five-person panel that oversees virtually all aspects of the health care industry in Vermont. “And it’s things like VHCURES that allow that to happen.”

The VHCURES database Gobeille is referring to is supposed to be a repository for every health insurance claim in the state. That claims data, however, comes from insurance companies. And one of them is not willing to hand it over. 

Liberty Mutual Insurance Company says Vermont has no authority to compel it to disclose the data. And Gobeille says their refusal has shrouded the grand view that providers and regulators need to evaluate the system as a whole.

“It would be awful tough to judge the majesty of the Green Mountains through the vision of a drinking straw. And so it’s the same thing in health regulation – the smaller the pool you can look at, the more inaccurate you are,” Gobeille says.

The lack of Liberty Mutual’s data represents only 137 patients in all of Vermont. But Green Mountain Care Board Chair Al Gobeille says the issue is one of precedent.

The lack of Liberty Mutual’s data is more of a speck in the viewfinder than a wholesale blockage – it represents only 137 patients in all of Vermont. But Gobeille says the issue is one of precedent. And in order to preserve the integrity of data in the future, he’s asking the U.S. Supreme Court to help Vermont establish that precedent now.

The federal government has for the most part deferred to the states when it comes to the regulation of insurance industries. There’s one big exception however, and it involves companies that are self-insured.  

A federal law known as ERISA governs those self-insurance plans, and that federal law preempts state statute. Liberty Mutual says that since the claims in question involve a self-insurance plan, it’s exempt from state regulations calling for the release of the data. 

Vermont won its case in a lower court in 2013, but the Second Circuit Court of Appeals overturned that decision, and handed a victory to Liberty Mutual in February of 2014. Gobeille late last month submitted what's known as a writ of certiori, asking the U.S. Supreme court to hear the case.

A spokesman for Liberty Mutual said the company will withhold comment on the case until it finds out whether the Supreme Court has agreed to take it up.

A spokesman for Liberty Mutual said the company will withhold comment on the case until it finds out whether the Supreme Court has agreed to take it up.

Tricia Riley, executive director of the nonpartisan National Academy of State Health Policy, says the claims data from insurance companies make up the information underpinning needed to evaluate the system, and monitor the success or failure of changes being made to it.

“You need that baseline. You need to know what you’re spending, to know what you’re going to save. You need that information to figure out new ways to delivering health care,” Riley says.

Riley says the eyes of policy makers across the country are on Vermont as it looks to win this key test case, and that the fate of “all-payer claims” databases in 15 other states also hinge on the outcome of the Vermont case.

The eyes of policy makers across the country are on Vermont as it looks to win this key test case, and that the fate of "all-payer claims" databases in 15 other states also hinge on the outcome.

Self-insurance plans account for more than half of all the bodies covered by company-sponsored insurance plans in the U.S. The integrity of health claims data, according to Riley, will rely on mandatory reporting from those self-insurance plans. 

Riley says the existence of those all-payer claims databases will also improve public understanding of what different health care providers are charging different customers for different services and procedures.

“It’s an important public function, to provide credible accurate data to the public about what health care costs really are, in order to have a transparent and open discussion about how to contain those health care costs,” Riley says. 

Gobeille says he’s heartened by the fact that the solicitor general, who represents the federal government in cases before the U.S. Supreme Court, has sided with Vermont in the case. But he says it’s likely that the justices will wait until they have a contradictory ruling in another jurisdiction before bringing the question to the bench.

"It's an important public function, to provide credible accurate data to the public about what health care costs really are." - Tricia Riley, National Academy of State Health Policy executive director

Vermont spends about $3 million a year to update and maintain VHCURES.

“I mean, there’s a lot of money into this … And so, the average Vermonter needs to know that this is something that can build a better health care system, and can contribute to better health. That’s why it’s a priority,” Gobeille says.

Gobeille says he expects to learn by Monday whether the Supreme Court has agreed to hear the case.

Correction 12:03 p.m. 6/26/15 This post has been corrected with the proper acronym for Vermont's health claims database. It is VHCURES, not VCURES.

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