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The all-payer claims database: Big name, big potential

WORCESTER, MA — OK, I’ll be the first to admit it: Until I heard self-described “data geek” Jo Porter speak about statewide all-payer claims databases (APCDs) as a research tool for many health care stakeholders, I’d skipped over the whole APCD concept entirely. Why? Confession time: Because the name sounded so brutally boring and technical.

Porter, the deputy director of the New Hampshire Institute for Health Policy and Practice and coauthor of a 2010 white paper that lays out “APCD 101” for the uninitiated, revealed the incredible potential of mining insurance claims data for attendees of Massachusetts governor Deval Patrick’s “Health Information Technology: Improving Healthcare and the Economy” conference. In her session, Porter showed how:

  • Massachusetts, Maine and New Hampshire patients can use data from APCDs to compare pricing data for health care services; officials, she said, plan to offer that data cross-referenced with quality-of-care data in the future.
  • In New Hampshire, public health researchers can track the frequency and location of disease incidence by tracking claims data — and can even track, for instance, asthma incidence among Medicaid patients versus commercially insured (the condition is known to affect underprivileged populations with much greater frequency).
  • Payers can test new payment models, or even research the validity of new ideas before launching pilot projects — and they also can see how their reimbursements compare to each other (including Medicaid vs. different commercial providers).
  • Providers can track how their quality of care stacks up to their peers, and track the efficacy of medical home pilot projects in which they’re participating or are considering trying themselves.
  • Employers can survey commercial insurers’ reimbursement data, to compare, contrast and analyze what they get for their premiums.

In one of her demos, Porter showed how her organization used 2005 New Hampshire data to show how much more the Medicaid population is using emergency rooms for care versus patients who have commercial health insurance. Health care observers know it to be true that underprivileged patients end up in the ER more often for a number of reasons — starting with an inability to afford routine care — but they struggle to quantify how often it happens. Knowing, of course, would give policymakers a handle on how much money they could save by preventive care/access-to-care programs, real numbers they could show lawmakers.

The data showed dramatic differences broken down by age group with the 21-24 year old age bracket having the biggest disparity: Medicaid patients end up in the ER almost 15 times more often than their counterparts on private plans do.

“It’s probably not a surprise to anybody that the Medicaid population is using the ER more than the commercial[ly insured] population,” Porter said. “This isn’t sort of groundbreaking, ‘Wow, we didn’t know that’ [findings]. Everybody sort of believed this to be true, but didn’t necessarily have the data to back that up, and that’s really what this provides.”

In an extended question-and-answers session, audience members and expressed concerns about patient privacy as well as the veracity of data that APCDs possess. The Cliff’s notes:

  • APCDs are mostly new (some states, such as Maine, have had them up running for nearly a decade, but that’s the exception) or in the planning stages — and states still are writing the rules of who can do what with claims data mining.
  • Connectivity to electronic health records will be very difficult, even though there are potentially valuable applications of making them interoperable (such as the above example of pricing data or quality outcomes data for a specialist service a family physician’s ordering for a patient, sorted by region).
  • ICD-10 implementation, scheduled to take place in 2013, will pose a financial and technical challenge to the administrators of statewide APCD admins.

Despite APCDs’ newness and the complications involved in administering them, health care CIOs should keep them in mind during planning meetings with clinical leaders. Mining the data within these new tools can help answer questions about who’s getting what care — and who’s paying for it — in your backyard.

That goes double for CIOs working at teaching/research hospitals; it’s a publicly available tool to seek information on potential studies at your facility. Not sure what’s happening in your state? Keep abreast of new developments at the APCD Council site, which offers state-by-state info.

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