Harnessing Claims Data to Address Today's Healthcare Challenges

Below is an edited excerpt from a recent report by The Leukemia and Lymphoma Society and Manatt Health. For more information on APCDs, register for our webinar on 12/16.

State All Payer Claims Databases (APCDs) can provide users with broad insights about the health of our populations and the performance of our health care system, across payers (insurers) and over time, and may be used to:

• Monitor health care coverage, service utilization, health needs, and cost trends across Medicaid, Medicare, and commercially-insured populations
• Identify inequities in health system access and use, as well as disparities in health
  condition prevalence and outcomes.
• Support regulatory oversight of payers and providers, from monitoring network adequacy
  and mental health parity to assessing the cost impact of industry consolidation.
• Identify health system failures – including coverage disruptions, excessive cost growth,
  service price variation, and preventable emergency department visits – to inform policy
  responses.
• Provide purchasers, payers, and consumers with health service cost and quality
  information to make informed health coverage purchasing and network design decisions.

State All Payer Claims Databases (APCDs) are powerful data resources that can help policymakers, regulators, researchers, consumer advocacy organizations, public and private purchasers, and other health care stakeholders answer critical questions about the performance of our health care system, including who it is serving, with what services, to what effect, and at what cost.

To date, at least twenty-one states have APCD programs at varying levels of maturity.

As other states begin to invest in APCDs, state policymakers and health data organization leaders should engage peer APCD states to identify and apply emerging best practices and engage local stakeholders to understand and address their health data needs.

As APCDs spread nationally, the federal government has the authority and
opportunity to enhance their utility and build state capacity for health care market oversight and transparency by:

• Establishing national APCD data standards;
• Procuring a national claims data clearinghouse and centralized analytic infrastructure;
• Providing structured financial support for State APCDs;
• Establishing APCDs in alignment with best practices; and
• Accelerating state APCD use for public health and population health purposes.

This brief offers a blueprint and recommendations for establishing, supporting and improving APCDs. Click here to read the full recommendations.

The paper was authored by The Leukemia and Lymphoma Society and Manatt Health with support from Arnold Ventures and the input of state APCD agency leaders.