Michael McGovern, partner, had his “What Brokers Should Watch in Claims Data Sharing” article published by Employee Benefit News. As employers increasingly rely on health plan claims data to evaluate costs, improve plan design, assess vendor performance, and support employee health initiatives, they also face growing privacy and compliance risks. This article examines the tension between maximizing the value of health data and complying with HIPAA and other privacy requirements.
Requests for broader access to claims data often begin as practical business solutions but can quickly raise important questions about who needs access to sensitive health information, how much data is truly necessary, and what safeguards should apply once data leaves a health plan's control. Michael emphasizes the importance of carefully negotiating business associate agreements, defining clear limitations on data use, scrutinizing subcontractor arrangements, and addressing data retention, destruction, and cross-vendor sharing practices.
“For benefit brokers and advisers, the practical takeaway is simple: treat data-sharing requests as a risk-allocation exercise, not just an operational convenience. Ask why the data is needed, narrow the scope to what is truly necessary, confirm who will receive it and make sure the contract reflects those answers with real specificity.”
Employers, brokers, and advisers should view health data-sharing arrangements as risk-management exercises, not merely operational conveniences. Organizations can benefit from data-driven insights while minimizing privacy, litigation, and reputational risks by ensuring data requests are narrowly tailored, contractually defined, and supported by appropriate security controls.
Employee Benefit News subscribers can read the full article here.