M I N N E S O T A pertise in what the exchange is, and that is an insurance marketplace. That should include small employers who are purchasers through the exchange, as well as individuals. It gets difficult to have that level of expertise. We need to rely on our care providers, as well as the expertise that health plans that will be selling insurance through the exchange bring to the table. DR. DEHNEL: Physicians should be on the board. The reality is that health insurance does influence the delivery of health care services. In order to see how an insurance marketplace design influences health care delivery, it’s crucial to have that voice at the table. DR. SAWYER: I agree with Peter, as long as there are folks like me representing other provider groups. We have very similar per-
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MR. MUNSON-REGALA: Should health plans have a seat at the table? Including folks who have subject matter expertise tends to be counterbalanced by arguments that those same people have an inherent conflict of interest because their livelihoods depend on the operation of the exchange. The same observation has been made about providers and facilities. If they participate in the governing structure, they may be in the position to impact their own bottom line. I’m not saying that’s a bad thing; I’m just saying that those are pros and cons of allowing folks with perceived conflicts of interest on the board. DR. DEHNEL: As long as you fully disclose a conflict of interest position, you simply recuse yourself from the discussion. Boards that operate well accommodate those different interest positions.
Up to $750 billion in our health care system is wasted every single year. Charles Sawyer, DC
spectives regarding the need to look out for the interests of patients. I agree there has to be some understanding of how the insurance industry fits into this equation. There also needs to be a voice that is independent and cares less about revenue or profit and is devoted to what patients actually need and the quest for universal access. If you really want the consummate nonpartisan advocate, it would be nurses. So I would add a third group, and that is the nursing profession. MR. MAYNARD: It’s largely about consumer shopping and selection process. That expertise is essential to making sure the exchange provides a successful way to acquire insurance or government benefits.
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DR. SAWYER: Peter, you’re right. It depends on the ethics of folks that serve on an organization like this and their ability to distance themselves from conflicts. By its very nature, the governance structure of an exchange will have to be robust. The small business community has a stake in this. Consumers have a huge stake in this. You’re going to need a mix of people around the table that have one interest in mind, and that’s getting people access to care and affordable coverage. That’s got to be the guiding principle. The plans have to be there because that’s where technical expertise is going to be if we’re going to continue with a private insurance model. MR. SCHUYLER: Stakeholder engagement
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during development of the exchange is extremely important and needs to include a cross-section of experts from all industries. That philosophy should carry over to the governing structure. MR. MUNSON-REGALA: Inherent challenges in this enterprise are barriers to data sharing and data analytics. We fully anticipate the minute we go live that someone will attempt to hack us, because we’re going to have access to personal and financial information that could be of value to someone. That’s a data security concern we have to deal with. There’s a data-sharing dynamic inherent with the requirement that we do eligibility and enrollment in real time. The only way we can do that is by connecting to the federal data hub that accesses information from the IRS, Homeland Security, and Social Security. That might pose datasharing challenges. At some point, we’re going to connect with the plans on information that they view as proprietary. DR. DEHNEL: There’s a distinction between proprietary versus protected information. That presents a huge issue in terms of what plans can work with as they collaborate with clinics and hospital systems. According to Minnesota law, there is a limited amount of information that health care providers can share with plans. Minnesota has gone above and beyond HIPAA statutes in terms of creating barriers to sharing information. As we construct this opportunity for enhancing care that’s called an exchange, looking at our data and enhancing our data analytics capabilities, we will have to revisit those barriers. Regarding data sharing, we’ll need to see what is possible, what is legal, and if there is a state statute that has to be modified in order for us to do this more effectively. MR. MUNSON-REGALA: Who should maintain, control, and disseminate that data? Should it be the exchange or some other entity? Speaking of conflicts of interest, a marketplace participant—which the exchange fundamentally is—has access to information that competitors may not. Do we prohibit the exchange from data mining their transactions to give information to their partners? Do we say that the exchange’s data should be maintained and safeguarded elsewhere? I suspect this dialogue’s going to occur during the next legislative session. MR. CHRISTENSON: What criteria should be used to determine the essential benefit set that
ROUNDTABLE
sponsored by Minnesota Physician Publishing, Inc.
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