On Wednesday, March 27, 2019, State Health and Value Strategies, in partnership with the Peterson Center on Healthcare, hosted a webinar on the ways in which several states and one community organization are using their multi-payer claims databases. More states are leveraging multi-payer claims databases to better understand how their health care systems are operating and implementing data-driven decision-making. States may not be aware, however, of the strategies other states and organizations are adopting to leverage claims databases to support health care transformation goals. During the webinar, presenters from the state of Vermont and Rhode Island, as well as the Washington Health Alliance, discussed how they are employing claims databases to enhance the value of care and will share lessons learned for those seeking to optimize their own databases.
All payer claims databases (APCDs) and multi-payer claims databases are a source of information that, when used effectively, can provide insight into how states’ health care systems are functioning and facilitate data-driven decision-making. This issue brief looks at the progress states and community organizations have made in using their APCDs and other multi-payer claims databases for various strategic purposes, and offers considerations for states that are seeking to optimize their own claims databases to achieve health care system performance improvement goals. The State Health Policy Highlight, Achieving Transparency and Value Using Multi-Payer Claims Databases, provides an overview of how states are leveraging their claims databases and reviews the lessons experienced states and community organizations have to offer other states seeking to optimize their own databases.
All-payer claims databases (APCDs) collect and compile medical, pharmacy, and sometimes dental claims, eligibility, and provider files from public and private payers. APCDs are currently being used for a variety of functions, including population health analysis, comparative analysis of provider and facility quality, cost management for Medicaid and other public programs, support for provider payment reform initiatives, and consumer transparency tools.
All-payer claims databases (APCDs) offer state policymakers and stakeholders access to the information they need to evaluate the cost and quality of health care. More than 30 states currently have, are implementing, or hold interest in forming an APCD. On this webinar, expert speakers outline the key elements of an APCD, offer advice on their formation, and discuss developing reports and analyses based on the resulting data.
The State Network hosted a Small Group Convening in New Orleans, LA on January 23-24, 2014, bringing together state officials and technical experts to discuss All-Payer Claims Databases and rate review.
This paper examines the critical components of states’ APCD reporting efforts to date and suggests essential steps to creating credible and robust analytics. Drawn from interviews with APCD leaders, state-specific documents, and the experience of the authors, this paper is intended to help states with functioning and developing APCDs identify the building blocks necessary to create and evolve a comprehensive analytic program. This information may also be useful to those charged with designing APCD outputs, such as datasets and reports.
The purpose of this paper is to assist states embarking on APCD initiatives by highlighting key considerations for building statewide APCDs and potential solutions based on experiences in early-adopting APCD states.