All-Payer Claims Databases

Overview of All-Payer Claims Databases

All-payer claims databases (APCDs) are large State databases that include medical claims, pharmacy claims, dental claims, and eligibility and provider files collected from private and public payers.ⁱ

APCD data are reported directly by insurers to States, usually as part of a State mandate. In terms of their capacity to produce price, resource use, and quality information for consumers, APCD data have three potential advantages over other datasets:

• They include information on private insurance that many other datasets do not.
• They include data from most or all insurance companies operating in any particular State, in contrast to some proprietary datasets.
• They include information on care for patients across care sites, rather than just hospitalizations and emergency department visits reported as part of discharge data systems maintained by most States through State governments or hospital associations. They also include large sample sizes, geographic representation, and capture of longitudinal information on a wide range of individual patients.

There is national and local momentum to establish and implement APCDs. To date, 18 States have legislation mandating the creation and use of APCDs or are actively establishing APCDs, and more than 30 States maintain, are developing, or have a strong interest in developing an APCD. These efforts vary, with a handful of States, such as New Hampshire, Maine, and Massachusetts, using APCD data to launch public Web sites with price and cost information for consumers while other States are not as far along in the process.ⁱⁱ

Purpose of the APCD Project

AHRQ is undertaking activities to develop an effective and feasible approach for using APCDs to advance the goal of improving health care affordability, efficiency, and cost transparency. The project was undertaken to advance the use of APCD data for transparency efforts within and among States. For States to use their APCD data to compare price and performance of providers within their States and across States, measures for use with these data need to be developed and refined, and the data themselves need to be standardized.

A first step toward developing and refining measures for use with APCD data is the development of an inventory of price, utilization, and potentially, quality and episode of care measures. This project builds on previous work funded by AHRQ in November 2011 through a small conference grant, "Expanding and Enhancing All-Payer Claims Database System Capacity in States." A conference report is available online.

The specific objectives of this project were to:

• Conduct a review of published literature and grey literature and conduct an environmental scan (e.g., review of Web sites) to better understand the use of APCDs and the state of measurement and reporting using APCDs.
• Develop an inventory and assemble initial specifications for specific APCD-based measures.
• Outline the steps that need to be taken to encourage use of APCDs for the reporting of these measures.
• Obtain and evaluate APCD data from at least three States to ensure that the fields in the APCD data received are correct, document any anomalies, note differences over time and across the State, and gauge whether the data can be used to calculate useful and accurate quality measures.

ⁱ Go to The Basics of All-Payer Claims Databases: A Primer for States.
ⁱⁱ Go to The Basics of All-Payer Claims Databases; APCD Council Interactive State Report Map; CompareMaine; Massachusetts' Center for Health Information and Analysis site; and Realizing the Potential of APCDs: Creating the Reporting Plan.