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Competing Priorities for an All-Payer Claims Database

October 21, 2010
by Jennifer Prestigiacomo
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Interview: Keely Cofrin Allen, Ph.D., Director, Office of Healthcare Statistics, Utah Department of Health

Utah started building its All-Payer Claims Database (APCD) three years ago to bring public transparency to the cost of healthcare. Last September the APCD started collecting claims data from four commercial payers, and is now analyzing episodes of care ranging from maternity to chronic disease management. Utah's APCD has more than 2.2 million unique Utahns identified, linked, and grouped, and more than $10.5 billion Utah healthcare claims charges represented. Keely Cofrin Allen, Ph.D, the director of the Office of Healthcare Statistics at the Utah Department of Health spoke with HCI Associate Editor Jennifer Prestigiacomo about the competing priorities she has to balance and what laid the foundation for her organization’s success.

Healthcare Informatics: Payer databases have generally been met with skepticism and resistance when they first hatch. How did you build consensus to support this project?

Keely Cofrin Allen, Ph.D.: Of course there was [resistance]. And we were very aware to lead with the security and the privacy issues related to the data. However, we did not struggle with it in Utah as much as some other states did. Minnesota had to make some significant changes to the way they ran their APCD because of those privacy concerns. Here in Utah—it’s surprising because it’s a very red state—we had enormous backing from the legislature because they asked us to do episodes of care analysis across an entire course of care, be it maternity, which would include prenatal through the birth and after care of the mom, or a knee replacement, which is more than just the surgery. And because we were asked initially to do episodes of care, we were able to go back to the legislature and say, ‘if you want a complete episode on people, you don’t want to lose people every time they change plans; we’re going to need identified data in order to link people.’ And we were given leave to do that. We have the highest encryption protocol there is available. We keep the data secure and encrypted on a separate server with no ties to the outside world. I think one of the things that was an advantage to us in Utah is that we have 20 years of history in my office [the Utah Health Data Committee within the Office of Health Care Statistics in the Utah Department of Health] collecting health information, and because of the two decades of trust we’ve built up, the APCD project fit nicely into that.

HCI: What’s Utah APCD’s relationship with the Utah Health Information Network (UHIN), the state HIE?

Allen: We actually get our claims through UHIN. UHIN has been a very important partner for us from the beginning. From a policy point of view, they’ve convened meetings on our behalf to get the payers together. Two years ago this fall, they were very helpful in setting up standards and helping us set up the 837 standard [the ANSI ASC X12 837 claim/encounter format], and the modified 837 that we use. We have plans to submit claims via UHIN, and we have a contract in place right now where we’re funding a UHIN employee to help us engage plans we haven’t engaged.

HCI: What are some of the Utah's goals with its payer database?

Allen: I think the public health benefits of a data set like this were very apparent to the Utah DOH [Department of Health] from the beginning. I said before we even had funding that to undertake a project of this magnitude that I wanted it to be of a public health benefit. Given the spending of $615,000 of the public’s money, the public health benefit needs to be there. We work very closely with the Department of Health in our building. We think once we get public health data, this will be very useful from a public health perspective to look at disease prevalence by area and by time. Obviously, our data aren’t real-time enough for surveillance of the really critical things like swine flu.

HCI: Besides maternity, what other episodes of care will you be analyzing?