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Health Care Price Transparency: The APCD Landscape Just Changed

Senior Health Care Data/Policy Consultant, Freedman HealthCare, LLC

Dr. Mathieu is a nationally recognized subject matter expert and leader in the APCD field, drawing from more than seven years of experience in the development, implementation, and operation of an All Payer Claims Database that includes Medicare, Medicaid, and commercial insurance plan claims data. As a Senior Consultant with Freedman Healthcare, Dr. Mathieu supports clients in solving complex challenges by leveraging his experience working with diverse stakeholders to address needs through actionable healthcare data analytics and reporting.

Recent action by the U. S. Department of Justice will change APCD approaches to transparency and the sharing of health care price and cost information.

On Friday, February 3 the U. S. Department of Justice announced the withdrawal of “three outdated antitrust policy statements related to enforcement in health care markets” to promote competition and support greater transparency. This creates an opportunity for APCDs to enhance public reporting and expand data access in pursuit of price transparency and cost containment goals. Of particular interest to APCDs is Statement 6 from Statements of Antitrust Enforcement in Health Care pertaining to provider exchanges of price and cost information. Statement 6 established an antitrust safety zone describing exchanges of information that would not be challenged under antitrust laws, “absent extraordinary circumstances.” Exchanges of price and cost data must satisfy three conditions to qualify for safety zone protection. Briefly, the data must be:

  1. Collected by a third party,
  2. More than three months old,
  3. “Sufficiently aggregated” to prevent identifying the prices charged by a specific provider.

A state mandated APCD satisfies the first two conditions, and many have adopted policies to comply with the third. Statute or regulations require APCDs to adopt Statement 6 in some states whereas antitrust and other concerns limit or prevent the collection and/or sharing of detailed health care price and cost information in others. Statement 6 has played a significant role in APCD decision making related to cost transparency and the sharing of detailed pricing data.

The withdrawn policy statements are non-binding and did not create legal rights or obligations. That said, Statement 6 has limited the willingness or ability of APCDs to support greater cost transparency and data sharing. This DOJ action, along with recent federal price transparency rules for hospitals and payers, are significant policy changes challenging outdated thinking that health care cost and pricing information is confidential, proprietary or constitutes trade secrets and is therefore protected from public reporting or further disclosure for APCD purposes.

Withdrawal of the DOJ antitrust policy statements will alter the transparency landscape and ability of APCDs to share detailed health care price and cost information through their data access and release programs. APCDs that currently publish this information can adjust policies to support even greater transparency and expand data sharing with qualified requestors. In some states, statutory or regulatory changes will be needed, and these will require time and political will to realize. This DOJ action is an important step that recognizes the need for meaningful policy change. On behalf of APCDs across the nation, we applaud this announcement.

Freedman HealthCare has supported APCDs across the country in developing comprehensive public reporting and data access and release programs. If you have questions or would like to learn more about recent federal health care transparency initiatives, please reach out to us at: [email protected].


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