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The Rise of the All-Payer Database

October 17, 2011
by David Raths
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APCDs have the potential to help policymakers evaluate regional variations in utilization, quality, and cost

A few weeks ago I conducted a wide-ranging interview with Rachel Block, the deputy commissioner for health IT transformation for the state of New York. Among other things she described how after an initial phase of grant funding, her state is developing regulations to govern the operation of regional health information organizations (RHIOs). Legislation passed in 2010 gives the commissioner of health broad regulatory and enforcement authority regarding health information exchange to ensure compliance with federal rules and policies. In addition, it is looking to develop recommendations for RHIO or HIE accreditation.

One thing Block said caught my attention: “Looking forward, we are going to deal with policies around data use involving medical homes,” she said. “We plan to build an all-payer claims database and then link that information to clinical data.”

I wasn’t too familiar with the concept of all-payer databases, but after a little research I found that many states have them in place or in development. As New York creates its all-payer database (APD), nine states have them in place: Kansas, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, Tennessee, Vermont, and Utah. Three more states are in the process of implementation, and 14 have taken initial steps toward creating an APD, according to the New York State Department of Health website. These databases will be repositories of claims data that may be combined with clinical and public health data sources. They have the potential to help policymakers evaluate regional variations in utilization, quality, and cost.

Writing about a recent Health Innovations Summit in Utah, that state’s epidemiologist, Robert Rolfs, noted that one recommendation that came out of the summit “was to use the All Payer Claims Database (APCD) to identify high-cost and high-variability conditions where there is potential to reduce costs by standardizing care around best practices.” It was suggested that clinical decision support could be developed for use in electronic medical record systems, and cost and care pattern data could be provided to clinicians to support efforts to adopt best practices to improve quality and reduce costs. Rolfs also reported that a health IT panel recommended using the APCD now and Utah’s statewide clinical health information exchange when data are available to provide cost and quality information to consumers and employers to improve the market for health care.

It’s too early to say whether all-payer claims databases can help states control costs, but they may become valuable tools used to assess the impact of system reforms and payment innovations.

According to a September 2010 report by the Commonwealth Fund, the National Association of Health Data Organizations and the Regional All Payer Healthcare Information Council are supporting the development of state reporting systems. Also efforts are under way to standardize data elements to improve the comparability of data from state to state.