CHIA, the Center for Health Information and Analysis, was set up as an independent agency in 2012. Baker wants to bring it under state government control, a move that worries some advocates who fear it will undermine the agency's independence from political influence.
BOSTON - A proposal by Gov. Charlie Baker to move an independent health care information agency into the Executive Office of Health and Human Services is worrying some advocates who fear that the move will compromise the agency's independence.
CHIA, the Center for Health Information and Analysis, was set up as an independent agency by a 2012 health care cost containment law to provide health care data and analytics to the state.
Amy Whitcomb Slemmer, executive director of the advocacy group Health Care for All, which worked closely with former governor Deval Patrick's administration, said she worries that moving the agency into state government "might lend an air of politics to data that's incredibly important for our understanding of how our health care system is operating."
"Health Care for All wants to see CHIA continue as an independent body and source of robust data to tell us how we're doing as a state," Whitcomb Slemmer said.
CHIA collects and analyzes data related to health care spending, provider and payer costs, measures of quality, and other health care metrics that are used to help the state formulate health care policy and bring more transparency to Massachusetts health care. It is funded primarily through a tax paid by health insurers and hospitals.
Before 2012, the Division of Health Care Finance and Policy, which was part of state government, fulfilled many of these functions. The health care cost containment law, Chapter 224, took much of the division's work and moved it to CHIA. Baker now wants to move it back, through a proposal included in his fiscal year 2016 budget.
Rhonda Mann, a spokeswoman for the Executive Office of Health and Human Services said in a statement, "The critical data compilation and analysis of the Massachusetts health care system that the Center for Health Information and Analysis provides will be invaluable to the administration's health care policy and planning efforts to improve the quality and affordability of care in the Commonwealth."
Former state senator Richard Moore, D-Uxbridge, one of the authors of the 2012 law, said the reason the work was moved out of state government was "because we didn't want the statistics or studies they would do to be considered or viewed as a political document."
"We wanted them to be as independent as they possibly could," Moore said.
Moore said Baker's proposal could lead to a perception among doctors, hospitals, insurers or the public that the administration is coloring CHIA's information. "It's important if we're going get to cost containment and save money in the health care system, we have to base it not on whoever's governor or what their philosophy might be. We have to base it on facts," Moore said. "An independent agency is far more likely to be trusted."
CHIA declined to take an explicit stance on the move. CHIA spokesman Andrew Jackmauh reiterated CHIA's charge to provide impartial data and analysis on Massachusetts' health care system. "CHIA's value rests in its ability to report objectively on indicators like the annual target for growth in health care spending, introduced under Chapter 224. We look forward to engaging the Legislature throughout the budget process to ensure that CHIA remains appropriately positioned to continue meeting the goals of Chapter 224," Jackmauh said.
There have been concerns about CHIA previously. For example, the Massachusetts Hospital Association has complained about the high fees CHIA charges.
Tim Gens, executive vice president of the Massachusetts Hospital Association, said he thinks there needs to be a rethinking of the fee structure, since CHIA is paid for by hospitals and insurers but has adopted a broader public policy mission that serves government and the market. He thinks there is a need for accountability at CHIA regarding the work it does and its budget - something that could be improved with state oversight.
However, Gens said there is value in having an independent agency because it makes CHIA's work more credible.
Gens said the association has not yet taking a position on the move, but it will look to "balance the credibility that comes from having independence with the benefit that comes from having accountability."
Josh Archambault, director of health care policy for the conservative-leaning Pioneer Institute, said there have been concerns that CHIA does not have a board. The institute has questioned why CHIA released some reports late. CHIA's spending grew from $19 million in 2013 to $26 million in 2014, according to its annual reports.
"There are questions about how much money is being spent, whether people are getting a return on investment for that money," Archambault said.
Archambault has not taken a position on moving the agency, but he thinks the conversation is worth having. "It has started a conversation about the agency, and I think that can be beneficial regardless of whether the agency ends up being moved or not," Archambault said.
Insurers also are ambivalent about the move. Jenna McPhee, a spokeswoman for Blue Cross Blue Shield, Massachusetts' largest insurer, pointed out that there are 11 agencies within state government that oversee or regulate the health care market. "We applaud the Governor for taking a look at how to ensure that the oversight is aligned, efficient and effective as possible," McPhee said in an email. "Governor Baker is very familiar with the inner workings of the health care industry/system, and we think it's appropriate that the new administration is taking a fresh look at the oversight structure. We defer to the administration and the Legislature on the best model."
But Jim Kessler, general counsel at Health New England, a Springfield-based insurer, said while he recognizes that there would be a benefit to having CHIA work more closely with Medicaid, which needs good data analysis, he believes it would be best for CHIA to remain independent. "We would be concerned if CHIA ever became subjugated to the needs or the goals of a specific part of the state government and couldn't be able to serve the whole commonwealth, because there's a lot of needs for good, independent data," Kessler said.
State Sen. James Welch, D-West Springfield, chairman of the Joint Committee on Health Care Financing, said he has heard from some people who have concerns about removing CHIA's independence and from others who feel they have not been heard by CHIA.
Welch said he is neutral so far on the move. But he said he relies on CHIA's data as a legislator, and he has concerns about its independence. "If that agency's brought under the administration, certainly it would be hard to consider it as an independent agency at that point," Welch said.