The Future of State All-Payer Claims Databases

Abstract

State policy makers are under increasing pressure to address the prohibitive cost of health care given the lack of action at the federal level. In 2020, the U.S. spent more on health care than any other country in the world—$4.1 trillion, representing 19.7% of the Gross Domestic Product (GDP). States are trying to better understand their role in health care spending and to think creatively about strategies to address health care cost growth. One way they are doing this is through the development and use of state-based all-payer claims databases (APCDs). APCDs are health data organizations that hold transactional information from public (Medicare and Medicaid) and private health insurers (commercial plans and some self-insured employers) and transform this data to useful information on health care costs and trends. This paper describes the use of APCDs by states and recent efforts that have provided opportunities and challenges for states interested in this unique opportunity to inform health policy. While challenges exist, there is new funding for state APCD improvements in the No Surprises Act and potential new federal interest will help states enhance their APCD capacity to better understand their markets, educate consumers and create actionable market information.

Inpatient Admissions and Re-Admissions in Medicare Beneficiaries Initiating Umeclidinium/Vilanterol or Tiotropium Therapy

“… 6 This study had several strengths, including the use of APCD data, which allows for easy comparisons of healthcare costs and utilization between treatments, and provides detailed data on patients’ sociodemographic characteristics. 21 The database repository is nationally representative of the US and includes patients from all geographic regions, including over 300 million unique patients. The APCD is also updated daily, providing near-real-time data.…”

Deductible imputation in administrative medical claims datasets

“…The first type includes detailed information about plan structure but often has poor externality validity as it is typically sourced from a single health insurer or small subset of enrollees 19 . The second type has improved external validity by pooling across insurers but does not usually include plan‐structure variables necessary to distinguish between HDHPs and plans with lower deductibles, or interpret what binary “HDHP” variables represent 20 . Several research groups have used claim‐level deductible spending to impute deductibles, but different methods have been used and none has been validated against a full distribution of true deductible levels 13,21 .…”

Combining legal epidemiology and implementation science to improve global access to medicines: challenges and opportunities

“…The ongoing expansion of universal health coverage can help overcome this barrier ( 45 ), because insurance claim databases, where available, aggregate claims from public and private sector providers. These payor claims databases can include claims data from a single public insurance plan or can be structured as all payor claims databases that aggregate claims data across multiple public and private insurers ( 46 ). Ideally, we would also be able to assess the effects of medicines access-related law reforms on health outcomes, but integrating medicine access data with health outcomes data has been challenging in the absence of integrated record systems.…”