Abstract
- Issue: Many states and stakeholders are seeking to control the rising cost of health care and increase its value. All-payer claims databases (APCDs) facilitate such efforts by aggregating data on health care services paid for by health insurers and public programs, thereby offering a broad perspective on cost, utilization, and quality of care.
- Goals: Describe the uses and benefits of state-level APCDs as well as challenges to realizing their value, including data limitations and antitrust concerns.
- Methods: Interviews with staff and stakeholders of eight diverse state-level APCDs, supplemented by a review of documentary evidence.
- Key Findings and Conclusions: APCDs are used to: 1) report on health system spending, utilization, and performance; 2) enhance state policy and regulatory analysis; 3) inform the public about health care prices and quality; 4) enable value-based purchasing and health care improvement; 5) support public health monitoring and improvement; and 6) provide reliable data for health care research and evaluation. The benefits of state APCDs include raising awareness of the need for change; fueling data-informed policymaking; and generating knowledge for improvement. Fulfilling the purposes of an APCD requires cultivating relationships with stakeholders and learning how to effectively use data to meet their needs.
Introduction
States and health care stakeholders that wish to take effective action to control health care spending and ensure its value require systemic information on costs, utilization, and quality of services. To support this objective, 21 states have created or are implementing all-payer claims databases (APCDs). These aggregate health care payment data for state residents from commercial health insurers, some employee benefit plans, and the Medicaid and Medicare programs (Exhibit 1). Eleven other states have indicated strong interest in establishing APCDs, while voluntary efforts serve specific geographic areas or purposes in at least five states.1
This report, the second in a two-part series, synthesizes the experiences of eight state-level APCDs. The purpose is to inform states about what to consider when creating an APCD and to help them realize the potential of their APCD. Study sites were selected to exemplify diverse approaches and contexts for implementing an APCD as well as to highlight relatively advanced uses of data (see the section, “How This Study Was Conducted” in the full report). The first report describes how the states established their APCDs. This report describes the uses of APCDs, their benefits as perceived by stakeholders (Exhibit 2), and challenges that must be overcome to realize their value. It concludes with lessons learned, which could be useful for other states.
