Muña backs bill regulating healthcare costs in CNMI

The top official of the Commonwealth Healthcare Corp. supports a bill that proposes to regulate healthcare costs in the CNMI and aims to assess the total cost of healthcare in the CNMI by establishing a claims data warehouse.

CHCC chief executive officer Esther Muña said the mechanism provided by Senate Bill 19-61 is long overdue.

“I am in support of this bill. A mechanism for the tracking and analysis of healthcare utilization and costs in the CNMI is long overdue, and improved local capacity for holding insurance companies accountable for how premium dollars are spent could not come at a better time for our community,” Muña said.

She said this will be the first time that light will be shed on the CNMI-wide pattern of healthcare use.

“The aggregated health data in the Claims and Clinical Data Warehouse called for in this bill will illuminate, for the first time, CNMI-wide patterns of health care costs and utilization and provide CNMI residents with transparent information on the cost of their health, the health status of our population, and allow for further analysis into healthcare quality improvement,” Muña said.

That data will be essential for decision makers, she added.

“I am committed to the belief that such data is essential to helping policymakers, providers, payers, and patients make informed choices about health care and coverage,” she said.

Muña also noted that within the short time that the CNMI fell under the federal regulatory umbrella of the Affordable Care Act, CNMI residents were rebated over $490,000 from local insurance carriers due to insufficient medical loss ratios. This was between 2011 and 2013.

“Requiring insurance companies to spend at least 80 cents of every premium dollar on medical claims, or rebate the difference to beneficiaries, is an important consumer safeguard that the CNMI can and should continue to regulate locally,” Muña said.

According to her, the lone act of collecting this data does not improve health care quality or reduce costs but the data aggregation called for in SB 19-61 will provide “unprecedented insight” on the status of health care in the CNMI.

This is because the bill aims to “improve accountability for how health insurance premiums are spent by requiring health insurance insurers and health care providers to submit reports on Medical Loss Ratio and claims and clinical data to the CNMI Insurance Commissioner.”

“CHCC realizes that in order to reach the full potential of the CNMI Claims and Clinical Data Warehouse, reports and analyses based on the data convey the true value of the mechanism,” Muña said.

The bill, introduced by Sen. Sixto Igisomar, (R-Saipan) would direct CHCC to establish this claims and clinical data warehouse and would establish a definition for plan year and calendar year, require insurers and providers to provide claims and clinical data, and to conduct and report studies on the cost and quality of care, population health conditions, healthcare disparities, and other health matters.

“CHCC is committed to fulfilling the responsibilities called for in this bill and looks forward to its passage into law,” Muña said.