On November 15, 2023, the Centers for Medicare & Medicaid Services released its proposed 2025 Notice of Benefit and Payment Parameters, the annual regulation which governs core provisions of the Affordable Care Act. This expert perspective focuses on aspects of the proposed rule likely to be of interest to state officials, including requirements for State-Based Marketplaces to align with the standards of the Federally Facilitated Marketplace, proposals for states to update essential health benefits, and initiatives to ease the eligibility and enrollment process for consumers.
Realizing the Potential of All-Payer Claims Databases: Creating the Reporting Plan
Freedman HealthCare, LLC—Linda Green, Amy Lischko, and Tanya Bernstein
States and regional collaboratives are moving ahead with creating all-payer claims databases (APCDs) to support health system measurement and improvement activities. While aggregated claims databases provide an unprecedented view of care across all settings, the process of collecting claims information alone does not improve health care quality or reduce costs. To effectively utilize the APCD and realize its full potential, states have begun to produce reports and analyses based on APCD data—a task requiring careful consideration and planning that has yielded many important
lessons. 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.