How states are using claims data to understand and improve care
November 8, 2018
Josephine Porter, Institute for Health Policy and Practice
Denise Love, National Association of Health Data Organizations
All-payer claims databases (APCDs) systemically collect administrative data, including medical, pharmacy, and dental claims, eligibility files, and provider (physician and facility) files. These claims are created when an insured patient recieves care or fills a prescription, and include a record of what was provided, who provided it, how much was charged, and how much was paid. Data are submitted directly to a central point, often a state agency or its vendor. Fourteen states currently have functioning APCDs, and Governor Jerry Brown signed a bill in June 2018 that sets aside $60 million for California to plan for the creation of one of its own.
This issue brief, The ABCs of APCDs: How States Are Using Claims Data to Understand and Improve Care, provides examples of the ways APCDs are being used by selected states and illuminates issues of critical importance to California, including health care and prescription drug spending trends, opioid use and prescribing patterns, and the prevalence of chronic disease. It concludes with a short summary of key areas for consideration when developing a new APCD.
Key highlights include:
Rhode Island was able to use its APCD to identify $90 million in potential savings from a reduction in avoidable emergency room visits, and researchers were able to use Virginia’s APCD to identify $586 million in unnecessary spending on low-value services.
Analysts in Colorado used its APCD to track EpiPen prescription costs, highlighting an increase of $400 per prescription between 2009 and 2016.
Several states have been able to use APCD data to effectively track chronic disease rates and understand more about the costs behind their treatment.