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February 2014 St@teside

Resources on Using All-Payer Claims Databases for Rate Review

In September 2012, CMS awarded 21 states Cycle III Rate Review Grants to support their health insurance rate reviews and promote price transparency. The recipient states will be using these grants to create and cultivate All-Payer Claims Databases (APCDs), where they can collect, analyze, and publish health pricing and medical claims reimbursement data. The State Health Reform Assistance Network (State Network) hosted a Small Group Convening on January 23-24, 2014, bringing together state officials and technical experts to discuss APCDs and the potential role they can play in the rate review process and with price transparency efforts. The agenda and selected presentations from the meeting, as well as related resources on APCDs and rate review, are compiled and listed by section on the State Network’s website. Selected presentations are also detailed below.

APCDs: A Foundation for Data-Driven Decisions and Rate Review Process Overview
In many states, the ACPDs are housed in a different agency (or sometimes in a non-state organization) other than the insurance agency, which conducts rate review. Thus, there is a need for greater interagency/inter-organizational coordination, as well as better understanding between the two agencies. These two presentations provide an overview of APCDs and the rate review process to give agencies a better understanding of coordination issues.

Leveraging APCDs for Rate Review and Regulatory Activities
This presentation considers some of the potential uses of APCD data to support rate review and related regulatory activities; how the APCD timeline aligns with timing for rate review; the barriers for using APCD data for various analyses; and the additional data that may be needed for those analyses.

Developing Measures and Analytic Approaches

As states build and cultivate their APCDs, they will have numerous challenges and opportunities in developing APCD data housing and analytic models. This presentation examines these challenges and opportunities, as well as key issues around managing vendor relationships for analytic work, building their APCD infrastructure, and using APCDs for price transparency, cost, and payment reform analyses.