Act 191 - Quality & Price Transparency

Insurer Disclosure of Physician Price and Quality Information
Blue Cross and Blue Shield of Vermont (BC/BS) recently circulated a proposed physician contract amendment designed to enable BC/BS to provide its members (your patients) with practitioner-specific cost and quality information.  In the near future, other insurers are likely to be addressing this issue as well.  Practitioners have 30 days to object in writing to the contract change, otherwise it will automatically go into effect. 

The proposed amendment is broadly drafted to provide the insurer with the flexibility to avoid the need for future contract changes, for example when the Department of Banking, Insurance, Securities and Health Care Administration (BISHCA) finalizes its quality and price transparency rule.  While BC/BS has informed VMS that the data it uses will be statistically valid and based on national standards such as NCQA, the language of the amendment itself does not include any standards for the information subject to disclosure. 

The proposed BISHCA rule will set up a process to make available health care price and quality information to insured and uninsured individuals. The rule will require health insurers with at least 5% of Vermont's insured population to provide comprehensive information to their insureds about the price and quality of hospital services, physician services, prescription drugs, and equipment and supplies. Price and quality information requirements will be phased-in.  For uninsured individuals, hospitals and large provider practices will be required to provide information about quality and charges, and about free care policies and government assistance programs.  The proposed BISHCA price and transparency rule is available on the BISHCA website at: http://www.bishca.state.vt.us/RegsBulls/propregs/Proposed_
HealthCarePrice-QualityTransparencyRuleH-2007-05.pdf

BC/BS has convened a clinical advisory committee of network physicians to share the BCBSVT  proposal on this issue and plans to convene a broader group this summer to continue to work on shaping their price and quality transparency initiative.  In addition, VMS staff will meet with the Director of Quality Improvement and the Director of Provider Relations from BC/BS as soon as possible to discuss BC/BS’ initiative to incorporate price and quality transparency into their operations.  VMS is monitoring this process to ensure that any price or quality information disclosed is credible and accurate, and to ensure that there is a process available for physicians to use to review and correct their information. 

While in concept VMS supports transparency, VMS believes that quality and price transparency must be approached carefully.  At its annual meeting in October of 2005, the Vermont Medical Society adopted a resolution establishing Principles for the Development of Pay for Performance Systems that will guide VMS as it works with insurers and BISHCA on these issues.  http://www.vtmd.org/Advocacy/Policies/2005/final%202005%20p4p.pdf

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