Building a Citywide, All-Payer, Hospital Claims Database to Improve Health Care Delivery in a Low-Income, Urban Community

Abstract

Developing data-driven local solutions to address rising health care costs requires valid and reliable local data. Traditionally, local public health agencies have relied on birth, death, and specific disease registry data to guide health care planning, but these data sets provide neither health information across the lifespan nor information on local health care utilization patterns and costs. Insurance claims data collected by local hospitals for administrative purposes can be used to create valuable population health data sets. The Camden Coalition of Healthcare Providers partnered with the 3 health systems providing emergency and inpatient care within Camden, New Jersey, to create a local population all-payer hospital claims data set. The combined claims data provide unique insights into the health status, health care utilization patterns, and hospital costs on the population level. The cross-systems data set allows for a better understanding of the impact of high utilizers on a community-level health care system. This article presents an introduction to the methods used to develop Camden's hospital claims data set, as well as results showing the population health insights obtained from this unique data set.

Collaborative Evaluation for the Utah All Payer Claims Database Capacity Enhancement

“…In accordance with the collaborative evaluation model, we worked with internal stakeholders, including Cycle III collaborators, UDOH staff, and external stakeholders, to develop the model to evaluate the overall project and the vision for evaluation [3]. We engaged stakeholders by sharing information about how our program evaluation plan follows the six major precepts of the collaborative model mentioned previously.…”

“…APCDs provide transparency in pricing across healthcare providers [7]. This transparency, which is reasoned, will allow market forces, instigated by the payers and the public, to drive down cost and J. H. Garvin et al increase quality [3] [4] [5]. Transparency, however, involves more than listing prices for services.…”

“…For example, providing the cost to consumers for a maternity episode should include all costs for all providers and all care settings from the first prenatal visit to the last postnatal visit. However, developing actionable information requires stakeholder participation to determine the use cases that should be addressed in a given location to provide value to consumers for useful decision-making and the costs to be included [3] [4].…”

“…All are influential drivers in cost reduction [5]. Public health researchers at universities and the Utah Department of Health (UDOH), and policy makers are also interested in quality of care and in optimal use of APCDs [3]. Gathering and engaging a stakeholder pool with diverse interests is important to develop a useful APCD [1] [6].…”

Is a Strategy Focused on Super-Utilizers Equal to the Task of Health Care System Transformation? Yes

“…2 Although super-utilizers represent 5% of the population, they account for 50% of health care expenditures. 3 The SU strategy focuses on reducing these expenditures by reducing preventable hospital visits, employing a strategy based on data, 6 stakeholder engagement, and clinical redesign. It is clear that system transformation requires fundamental changes to produce high value care or improved outcomes at lower cost.…”