Do Your Vendor Contracts Prevent You From Accessing Healthcare Plan Data?

March 27, 2023
Michael Cochran

Do Your Vendor Contracts Prevent You From Accessing Healthcare Plan Data?

As a plan sponsor, one of your primary responsibilities is to obtain, manage, and share your benefits data with vendors as needed to create value for the plan. However, without complete access to your benefits data, it is virtually impossible to successfully fulfill your fiduciary responsibilities, and your benefit plan may suffer as a result. You have a right to obtain this data without hindrance. One strategy to accomplish these duties as a plan sponsor is to update your vendor contracts, including Non-Disclosure Agreements (NDAs) and business associate agreements (BAAs), to ensure that access to provider and claims data is sufficient to meet your fiduciary duties under Employment Retirement and Income Security Act (ERISA).  

More data transparency for plan sponsors

Over the last few years, several measures have been taken by Congress to ensure more healthcare data transparency. This tasks employers with more responsibility to ensure their vendor contracts don’t restrict access to data.  

One such measure is the Consolidated Appropriations Act (CAA), which prohibits group health plans, health plan insurers, and issuers of health insurance coverage (collectively referenced as Covered Parties) from entering into contracts that restrict a plan sponsor from accessing and sharing information about their plans.  

The so-called “no gag clauses” provision prohibits Covered Parties from entering into contracts with health care providers, networks or associations of providers, third-party administrators, or other services providers offering access to a network of providers, if the contract would directly or indirectly restrict the Covered Party from doing any of the following:

  • Providing provider-specific cost or quality-of-care information or data, through a consumer engagement tool or any other means, to referring providers, the plan sponsor, participants, beneficiaries, or individuals eligible to become participants or beneficiaries of the plan.
  • Electronically accessing, de-identified claims information or data for each plan participant, or coverage information, provided that such access is consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Additionally, health insurers and third party administrators must share this data with a plan sponsor’s Business Associates (BAs) who are engaged in plan design, administration, and financial, legal, and quality-improvement activities on behalf of the plan sponsor.  

Time to review your vendor contracts for data transparency  

If you are an employer providing benefits through group health plans, you have a fiduciary responsibility to plan participants to access relevant data from your healthcare vendors. Increased transparency rules make it easier for employers to get access to this data, which in turn will enable employers to hold their healthcare vendors accountable. Access to transparent data allows both employers and their covered participants to make informed decisions about their healthcare.

This starts with your vendor contracts. Plan sponsors should review their Administrative Service Agreements (ASAs), NDAs, and BAAs to look for language limiting access to crucial financial information, provider data, service codes, and more. A plan sponsor’s access to healthcare data for the purpose of administrating their plans complies with privacy laws and obligations laid out by the Department of Labor in addition to HIPAA and 42 CFR Part 2.  

What if you don’t have transparency from your healthcare vendors? The first step is to reach out to your vendor and request the appropriate data. Under the CAA, Covered Parties can’t use tactics such as claiming a proprietary interest in plan data to refuse you access to the data. If your vendor isn’t willing to comply with your request, consider reaching out counsel familiar with ERISA, CAA, BAAs, and privacy laws can help you mitigate arguments from vendors who want to limit access to information based on proprietary rights or compliance with privacy laws.  

Data transparency begins with Abett

A healthcare system that offers high-quality and cost-effective care begins with transparency. Healthcare data transparency offers many benefits, including increased vendor and provider accountability, improved decision-making for both employers and employees, and ultimately, increased competition and lower costs. Without full access to your healthcare data, you aren’t fulfilling your fiduciary responsibility to your healthcare plan participants. The Abett Lockbox is a valuable tool for employers seeking more data transparency from vendor contracts.  

The Lockbox simplifies your benefits data management by giving you complete control of all of your benefits data, not just what your suppliers are willing to provide. This creates a single source of truth into what data you’re getting from your vendor contracts and real-time insight into what data you’re missing. By seeing the gaps in the data, you can go back to your ASAs, NDAs, and BAAs to ensure you’re getting access to the vendor data you and your plan participants are entitled to.  

Don’t allow vendor contracts to limit access to your healthcare data. Learn more about how you can unlock the power of your healthcare data with Abett today.