All-Payer Claims Databases

Deltek Analyst Stephen Moss reports.

Since November 2009, the health care market has seen change at a pace so dramatic and dizzying, it verges on unpredictable. However, one change that GovWin predicted early was the rise of the all-payer claims database (APCD) across all fifty states. In 2009, prior to the passage of the Affordable Care Act, and again in 2010, GovWin published these predictions. It will become clear in this in-depth analysis that the implementation of APCDs will continue as predicted over the next several years. The APCD is an integral tool for the achievement of true health care reform, especially in light of current and projected state budgetary deficits; increases in state Medicaid enrollment and spending; the implementation of health insurance exchanges; and the push for efficient, data-driven, outcome-based care.

From whence we came: A look back at APCD 1.0
In 2009, when we wrote our first piece on the APCD, only six states had an APCD in place. Today, the number has doubled to 12 states, with four actively implementing an APCD. Over those two years, we have seen state legislatures, policymakers, consumers, providers, and bureaucrats explore and implement an APCD. The increased transparency the database allows attracted them, and the promise for a deeper understanding of the drivers of health care spending across programs and providers further enticed them. Ultimately, the stakeholders in the 31 states that have deployed, or are seriously considering the deployment of an APCD, have been convinced by the promise for access to data to drive cost containment and increase efficiencies.
This is not to say that there are not legitimate, substantive concerns and roadblocks facing APCDs. Issues such as patient and consumer privacy, information security, and finding the funding for planning and implementation, not to mention the $1 million annual funding necessary to operate the database, have all been raised. Further, there are concerns about the practical complexity involved with the implementation of a database pulling data sets from many disparate sources. Finally, perhaps the most consistent obstacle is the political will required to mandate the data collection necessary to operate the database. In all but two states with active APCDs (Washington and Wisconsin), the legislatures enacted laws to mandate private health plan (including medical, dental, pharmacy) data be reported. In an anonymous, en-masse fashion, the data reported fills gaps in cost information previously only gathered from providers, facilities and state-run assistance programs. The concern for patient privacy and funding, combined with the often arduous legislative process, has led to fits and starts in states with legislation defeated or stalled in long-study processes. Without the mandated data collection for all insurers, providers, facilities, and government agencies, the data collected will inevitably be incomplete.
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