This document discusses the uses of all-payer claims databases (APCDs) for health care reform evaluation. APCDs contain claims data from multiple payers and can be used to monitor health care costs, identify cost drivers, foster price transparency, and track quality measures. The document outlines several state case studies that demonstrate how APCDs have been used to monitor statewide spending, evaluate transformation efforts, and promote price transparency. It concludes by discussing future directions for APCDs, including data linkages and payment reform evaluation.

1. MAKING USE OF ALL-PAYER CLAIMS
DATABASES FOR HEALTH CARE
REFORM EVALUATION
Jennifer Ricards, MS
Minnesota Health Services Research (HSR) Conference, March 3, 2015

2. Acknowledgements
• Funded by the Department of Health and Human
Services, Office of the Assistant Secretary for
Planning and Evaluation
• Co-author: Lynn Blewett, PhD
• Other contributors: Amy Potthoff-Anderson, BA;
Kelsey Avery, MPH; and Mary Cobb, MPH; Karen
Turner, BA

3. Objectives
• Provide an update on state all-payer claims
database (APCD) uses
• Describe analytic uses and capabilities for state
health care reform efforts:
• Monitor health care costs trends over time
• Identify drivers of high spending
• Foster price transparency
• Track key quality measures
• Develop and monitor payment reform initiatives

4. Methods
• Secondary data collection
• Peer-reviewed studies
• Formal reports
• Documentation
• Web-content
• Primary data collection
• Phone and email communications with state staff
• Semi-structured interviews
• January through June 2014

5. What are State Operated APCDs?
• Repositories of health care claims from multiple
payers for the purposes of analyzing and monitoring
state-level cost and quality of health care
• Significant resources are devoted to planning,
implementing, and maintaining state-operated
APCDs

6. Source: http://www.apcdcouncil.org/state/map

7. APCD established
APCD legislation passed, but not yet fully established

8. State has established data release structures and processes
to allow researchers and stakeholders access to the data
?

9. Minnesota’s APCD
• Represents 85% of the state's population
• Claims dating back to 2008
• Truly “all payer”
• Medicare (fee-for-service and advantage)
• Medicaid (fee-for-service and managed care)
• Commercial
• Self-insured

10. State Case Studies
Monitor Statewide
Spending
Evaluate
Transformation
EffortsIncrease Care
Quality
Promote Price
Transparency

11. Statewide Spending: Massachusetts
Develop “High
Cost” Patient
Profiles
Analysis of
Patient
Characteristics
Source: http://www.mass.gov/anf/docs/hpc/2013-cost-trends-report-final.pdf

12. Source: http://www.mass.gov/anf/docs/hpc/2013-cost-trends-report-final.pdf

13. PriceTransparency
• Price transparency refers to the degree to which
health care cost information is readily available to
consumers
• Both federal and state officials are looking to
increased price transparency as a means of reducing
health care costs
• When coupled with information on care quality,
consumers can use price information to make
informed decisions about their care

14. PriceTransparency: Colorado
Source: http://www.comedpriceshowcase.org/
Can click through
by topic to explore
ways in which the
APCD data are
being used; e.g.:
• Pricing of
emergency room
services
• Combining
medical claims
data with EMR
data for
Medicaid

15. Source: http://www.comedpriceshowcase.org/

16. PriceTransparency: Colorado
Source: https://www.comedprice.org/

17. Source: https://www.comedprice.org/

20. EvaluateTransformation Efforts
• Impact of reform on health care costs, utilization,
and quality
• To what extent reforms have impacted processes vs.
patient outcomes; and the differences in impacts of
reforms across population subgroups

21. EvaluateTransformation Efforts:Vermont
• Vermont Health Care Uniform Reporting and
Evaluation System (VHCURES)
• VHCURES data are used to evaluate Blueprint for
Health initiative
• Identify participating patients
• Define the comparison group
• Assess patient utilization, cost, and quality metrics

24. What’s Next for APCDs?
• “Administrative Simplification”
• Data Linkages
• ACO Measurement
• Payment Reform Evaluation

25. Resources
Analytic Approaches to Health ReformWhite Papers (SHADAC)
• http://www.shadac.org/content/analytic-approaches-monitoring-and-evaluating-
health-reform-topic-papers
APCD Council
• http://www.apcdcouncil.org/
APCD Development Manual
• http://apcdcouncil.org/all-payer-claims-database-development-manual
Colorado’sAPCD
• http://www.civhc.org/All-Payer-Claims-Database.aspx/
Minnesota’s APCD
• http://www.health.state.mn.us/healthreform/allpayer/
Massachusetts’ ACPD
• http://chiamass.gov/ma-apcd/

26. Resources (cont.)
National Association of Health Data Organizations
• https://www.nahdo.org/
Vermont’s APCD
• http://gmcboard.vermont.gov/vhcures

27. THANKYOU!
Jennifer Ricards, MS
Senior Research Fellow
State Health Access Data Assistance Center (SHADAC)
University of Minnesota
Email: ricar010@umn.edu
Phone: 612-625-4835