Bookmark and Share

May 2010 St@teside

New SCI Issue Brief -- All Payer Claims Databases: An Overview for Policymakers

The State Coverage Initiatives has released “All-Payer Claims Databases: An Overview for Policymakers” in conjunction with the National Association of State Health Data Organizations (NAHDO) and the Regional All-Payer Health Information Council (RAPHIC). This issue brief outlines why states should consider developing these databases in their states and provides basic information about governance, financing, and data collection.

States have used All-Payer Claims Database (APCD) analysis to answer a variety of questions. For example, states have used APCD data to:

  • Provide cost information to support consumer-driven health care choices, providing information about the varying cost of procedures in different medical facilities (e.g., Massachusetts, New Hampshire, Maine);    
  • Help employers understand variations in the cost and utilization of services by geographic area and in different provider settings (Maine, New Hampshire);
  • Develop a tiered-network insurance product for the small-group marketplace (New Hampshire);
  • Explore the value equation (cost and quality) for services provided (New Hampshire);
  • Inform the design and evaluation plan of payment reform models including the medical home model and accountable care organizations (Vermont, New Hampshire);
  • Evaluate the effect of health reforms on the cost, quality, and access to care in a state (Vermont, Maryland);
  • Compare the prevalence of disease across a population (New Hampshire, Utah);
  • Compare utilization patterns across payers to inform state purchasing decisions for programs such as Medicaid (New Hampshire) and to identify successful cost containment strategies (Vermont, New Hampshire); and,
  • Estimate the cost of potential legislative changes affecting health insurance and later calculate the actual cost and impact of the legislation.

This brief provides an overview of statewide APCDs and covers the following topics:

  • What are APCDs?
  • Which states currently have APCDs and which states are exploring APCDs?
  • Why develop APCDs?
  • Who are the stakeholders of APCD systems?
  • What are the major concerns or challenges related to APCDs and how they have been addressed?
  • How are states using APCD information?
  • How are APCDs governed and funded?