Achieving States’ Goals for All-Payer Claims Databases

June 2018
Full report

All-payer claims databases (APCDs) have value but they also pose challenges with data collection and use, such as privacy concerns, potential disclosure of proprietary data, and unknown validity of the data collected. Greater collaboration between states and plans can help support states’ goals for APCDs.

Many states are establishing APCDs to collect data from private and public payers and make it available to third parties for a variety of research and data transparency activities. In some states, payers are required to submit data, while in other states submission is voluntary.

States’ goals for APCDs vary and include: informing health policy decisions, supporting delivery and payment reforms, and increasing transparency of healthcare data. However, realization of these goals is hampered by a number of challenges that result in incomplete data collection (e.g., not all payers submit data), variation in state reporting requirements, and misalignment with other data collection programs and efforts.

Topics

  • Current state of APCD activity
  • Goals of state APCDs
  • Privacy issues
  • Exclusion of data from ERISA plans
  • Anticompetitive concerns
  • Data standardization and data submission issues
  • Recommendations to improve APCDs

Related Public Policy Research

Best Practices in Using Medicare Advantage Encounter Data for Healthcare Research
September 2020
Experts have raised concerns that encounter data, made available by CMS, may not be appropriate for measuring healthcare utilization or making comparisons between MA and traditional Medicare.

Please wait while loading...

loader