All payer claims databases (APCDs) and other 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 or 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. It identifies three broad data use categories and provides a high-level description of the approaches taken by select states and one community organization, with attention to practices that may not be as widely used across states, or in areas that states and community organizations are just beginning to pursue.
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.
State Health and Value Strategies, in partnership with the Peterson Center on Healthcare, hosted a webinaron March 27 during which 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 shared lessons learned for those seeking to optimize their own databases
The start of the 2021 rate review process for the Affordable Care Act (ACA) Marketplaces coincided with the initial outbreak of COVID-19 cases, and early forecasts were ominous, with rate increases projected as high as 40 percent. There was also widespread concern about how to set rates when insurers’ COVID-related costs looked anything but predictable. In short, it looked like, after a period of relative stability in Marketplace rates, enrollees might be in for a rollercoaster ride. This expert perspective provides a brief overview of how the rate review process has developed since the first ACA OEP in 2013 and how those developments came together this year to enable regulators and insurers to manage uncertainty and achieve more stable rates for the 2021 plan year.
This expert perspective provides a roadmap for states to assess their vaccine coverage policies in Medicaid and, if necessary, to close any coverage gaps that might otherwise inhibit vaccine uptake during a crucial period of mass immunization. The concluding section discusses the possibility of congressional action that may alter the federal landscape for Medicaid vaccine coverage.
Several COVID-19 vaccines could be on the market soon. State and federal officials have begun devising strategies for distributing and administering the vaccine and communicating with the public, but an equally important element will be the extent to which health care payers, including private insurers, will cover the costs for recipients. The Affordable Care Act (ACA) requires that most health insurers and employer health plans cover certain preventive services without cost-sharing, including vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). However, ensuring that a COVID-19 vaccine is a free preventive service for all who need it, when they need it, is by no means guaranteed. This expert perspective discusses recent federal efforts to expand private insurance coverage of a vaccine, and provides a roadmap for states to close remaining coverage gaps that could inhibit vaccine uptake.
