- Issue: All-payer claims databases (APCDs) can facilitate state efforts to control the rising cost of health care and increase its value. By aggregating data on the health care services that health insurers and public programs pay for, they offer a broader perspective on cost, service utilization, and quality than any single entity can provide. An increasing number of states are creating or are implementing APCDs.
- Goals: Synthesize experiences and lessons learned from the creation and implementation of eight diverse, state-level APCDs, including their intended uses, formation, governance, funding, staffing, use of vendors, sources and types of data collected, linkages with other data, analytic capabilities, and privacy practices.
- Methods: Interviews with APCD staff and stakeholders and a review of documentary evidence.
- Key Findings and Conclusions: State approaches to APCD development varied from governmental initiatives and public-private partnerships to voluntary efforts. Successful implementation requires engaging with stakeholders; establishing salient use cases; determining a suitable governance structure; securing sustainable funding; setting realistic implementation goals and timeframes; and ensuring data quality and analytic rigor while protecting data privacy.
Identifying and addressing the drivers of high health care costs are more important than ever. Growth in health care spending has been a major component of growth in state budgets, which are being strained by a decline in tax revenues during the COVID-19 pandemic.1 The high cost of health care is also reducing employers’ ability to maintain health insurance benefits, especially during an economic downturn, and continues to burden consumers with out-of-pocket expenses that compete with other basic needs.2
Controlling health care spending and ensuring its value require having systemwide information on costs, utilization, and quality of services that no single purchaser or payer can produce. To construct a more comprehensive picture of the health care delivered to their residents, 21 states have created or are implementing all-payer claims databases (APCDs) to collect and aggregate information on payment for health services from commercial health insurers, some self-insured employee benefit plans, and the Medicaid and Medicare programs (Exhibit 1).3 Another 11 states have indicated strong interest in doing the same. In several states, stakeholders such as health care systems, purchasers, and researchers have voluntarily created APCDs.4
This report, the first in a two-part series, summarizes the experiences of eight state APCDs. The purpose is to inform states what to consider when creating an APCD, and help states realize the potential of their APCD. Study sites (Exhibit 2) were selected to exemplify diverse approaches and contexts for implementing an APCD as well as the challenges and benefits of doing so (see the section, “How This Study Was Conducted” in the full report). The APCDs, which have been in operation for four to 17 years, were also selected to highlight advanced uses of data (as described in the companion report). This series builds on existing research,5 including a previous case study examining how Massachusetts leverages data generated by its APCD to inform a statewide cost-containment agenda.6