Provider QualityFebruary 14, 2023
Population Health StrategistApril 17, 2023
Protecting Access to your Client's Data
As the government is talking about greater healthcare data transparency, the carriers are concerned about the additional cost to share data and trying to protect their IP (contract rates). Vital Incite is finding new barriers that we are navigating in order to secure accurate and complete data. We wanted to share some of the issues to consider as you work with carriers.
- Some carriers are now charging a file set up fee- your carrier contract language and discussions should incorporate the global requirement that files be sent to Vital Incite without an additional fee to set up the file transmission.
- Monthly fees to send files – most notably, we have recently seen the following carriers and PBMs requesting recurring fees: Anthem, Aetna, Express Scripts, CVS
- Cost for run out claims once you have terminated - Anthem
To date, we have been successful negotiating to ease these restrictions, but this does lengthen our integration process. The best approach to circumvent these barriers is to have language in health plan-carrier contracts that protect access.
Language we suggest includes:
- Increased language to prevent Vital Incite from sharing specific data elements with advisors or employers or language that then precludes the advisor from using the information to alter plan designs, redirect care, etc. -UMR/UHC
- File feed distribution to the data recipient of your choice with no fees for either set up or monthly delivery.
- Access to, at no cost, 3 years of historical data.
- The complete file feed that you want to receive can be referenced in an exhibit to the contract -- Vital Incite can provide this format to you upon request.
- Data delivered by the 10th of every month.
- If there are errors within files, corrected files will be delivered within 10 business days of the error being communicated to the data source.
- The data within the file can be shared with key representatives of the health plan, including your company’s leadership and its health benefits advisory firm.