August 1995

Michigan Statewide Health Data Base

by Martin Ackley, Consultant for Health Policy

Behind-the-scenes discussions to create a standard health data base in Michigan are beginning to sound a lot like health care reform. The purpose of the data base is to arm consumers with specific data to empower "smarter" health care decisions. Such a market-driven, competitive system is expected to generate greater efficiencies, lower health care costs, and better outcomes, similar to the goals of many 1992–3 health care reform proposals.

Mandatory statewide health data bases have been in existence in this country for over a dozen years, and Michigan is the largest state that does not have one. Summer meetings involving legislators and their staff and representatives of health providers, purchasers, and consumers have focused on the need for a data base and how it should look.

House Bills 4975–9, introduced June 15, 1995, and Senate Bills 633–7, which will be introduced when the Senate returns in September, would establish policies and procedures for a mandatory health data system. It would be a statewide clearinghouse for health-related data that would provide specific and compatible information on both providers and purchasers.

The bills describe in general terms the data to be collected:

• Clinical and financial information on diagnoses, treatments, or procedures, by health plan, health setting, or health practitioner
• Data related to the organization of health services
• Data describing the health status of patients
• Data characterizing the quality of health service outcomes
• Statistical adjustment of all data elements according to the health status of the patient

The specifics of a data plan would be formulated and later administered by the Michigan Health Data Institute and its 13-member board of directors; the board would be appointed by the governor and comprise consumers and an equal number of providers and purchasers. The board of directors also would establish a fee schedule for providers and purchasers to fund the operation of the data base.

High Anxiety

A mandatory statewide health data base would be a far cry from what Michigan has now. The voluntary Michigan Inpatient Data Base collects and analyzes certain inpatient hospital data, but there are limits to what is available to the public. At the same time, many public and private entities (hospitals, HMOs, health systems, and others) are using data base services and computer software packages to build their own health data bases. Problems arise when separate data bases use different data elements and definitions. From a consumer’s standpoint, it’s like comparing bandages to bedpans. Understandably, providers and purchasers have been very guarded with their data. A mandatory, comprehensive, and accessible data base would expose their strengths and weaknesses. It would measure their competence and their charges, and providers and consumers are concerned that big purchasers will make health care decisions based on cost alone and eventually drive down quality. Another concern is that the data will be misinterpreted and unfairly assess the value of the health care provider.

Frank Webster, executive director of the Capital Area Health Alliance and a former hospital administrator and Blue Cross and Blue Shield of Michigan (BCBSM) executive, said the field has been tilted in favor of providers, and to have real health care reform, that has to change.

"We have the greatest health care system in the world, but it’s too expensive," Webster said. "We can bring those costs down. Employers can’t just be payers anymore; they’ve got to become prudent buyers. But the group that benefits the most from a statewide data base system is the providers because the outcomes data will show them what procedures are the most successful."

"There are high levels of anxiety about these bills," said Larry Horwitz, executive vice president of the Economic Alliance of Michigan, a strong supporter of the legislation. "People plan to use this [data] to make purchasing decisions. That is the exact reason behind these bills—to allow consumers to do more focused purchasing."

The Michigan State Medical Society (MSMS) and Michigan Health & Hospital Association (MHA) espouse qualified support for the legislation. The MSMS stipulates that any data collected must be adjusted for special patient conditions and not used in a punitive fashion. "Physicians are not confident at this time that those protections are there," said Greg Aronin, manager of government relations for MSMS. "Health data is extremely complicated, and right now the bills don’t have value to providers." Aronin says MSMS will not have an official position on the bills until it reviews them thoroughly.

The MHA recognizes that hospitals are the easiest sources to gather health care information. They just don’t want to be the only source. "It ought to be all providers," said MHA group vice president for advocacy Laura Redoutey, "physicians, hospitals, clinics, and ambulatory centers. Information that is valid and credible ought to be available to the public, and there ought to be a mechanism to pay for that collection of data as well."

On the Fast Track?

The bills are sponsored by Republican and Democratic members of the House and Senate Health Policy committees. The bills are being pushed by the Economic Alliance, a strong coalition of business and labor interests. Such other important stakeholders on this issue as MSMS, the MHA, and BCBSM, agree at least in principle with the concept of a health data base.

Senator David Honigman, a bill sponsor and member of the Senate Health Policy Committee, has been conducting public hearings and asked for suggested changes to the bills by the end of August. With the legislature returning to session on September 12, it appeared the bills were picking up steam.

However, key legislative staff for the chairmen of both Senate and House committees say there are no committee hearings scheduled or commitments made. "There is no agreement to take the bills up," said Tim Goodrich, legislative aide to committee chairman Sen. Dale Shugars. "In fact, in relation to [committee] plans for the fall, it’s very faint on our radar screen because of the technical aspects of the bills and the various groups that would have to come to agreement."

No one has asked House Health Policy Committee chairman Rep. John Jamian to take the bills up this fall either, according to his legislative aide Kathy Holcomb. "Representative Jamian supports the concept [of the health data bills], but feels they need changes," Holcomb said. "We want to do more research on them. There could be some problems as they’re written—they’re too broad and they create another state agency."

Senator Shugars has an advisory task group studying data and consumer information issues and is likely to wait until its recommendations come out before moving on the bills. "But if Sen. Honigman can work out an agreement, we’ll sit down and look at it," Goodrich said.