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Future of APCDs in the Wake of Gobeille

As many states continue to utilize all-payer claims databases (APCDs) to help improve the quality, cost and effectiveness of care, the U.S. Supreme Court’s recent decision in Gobeille v. Liberty Mutual Insurance Company will present some hurdles for states using (or thinking about using) APCDs moving forward.

Under the Gobeille decision, a Vermont statute which requires plans to provide information to Vermont’s APCD was pre-empted by the Employee Retirement Income Security Act (ERISA) as applied to ERISA plans. ERISA plans (i.e. self-insured plans) are excluded from the Vermont statute.

Vermont’s APCD will now have less information because self-insured plans account for a large portion of the number of insured. Additionally, the individuals in self-insured plans tend to be younger and healthier. Without the younger and healthier information in Vermont’s ACPD, the data in its APCD will be skewed by the older, poorer, and sicker populations of Medicare and Medicaid, which will render the APCD data less comprehensive and, thus, less valuable.

Vermont is not the only impacted state. Other states with APCDs will need to consider what the Gobeille decision means for their APCDs. The prospect of having less comprehensive data is a challenge states should start to evaluate.

There are some other possible options for states to consider (some of which were hinted at in one of the Court’s concurrences), but it’s probably best for states to first understand their existing landscape in the wake of the Gobeille decision.

For states, or any other entities, looking for help with the path forward for APCDs, HMA is here to help.