The ABCs of APCDs: how states are using claims data to understand and improve care
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Issue brief (California HealthCare Foundation)
- Author(s):
- Porter, Josephine, author Love, Denise, author
- Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, Calif.] : California Health Care Foundation, November 2018
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Databases as Topic Health Expenditures -- statistics & numerical data Insurance Claim Review Chronic Disease -- economics Cost of Illness Drug Costs Health Care Costs Inappropriate Prescribing -- prevention & control Opioid-Related Disorders -- economics Opioid-Related Disorders -- epidemiology State Government Humans California United States
- Genre(s):
- Technical Report
- Abstract:
- All-payer claims databases (APCDs) systematically 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 receives 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. In capitated systems like Kaiser Permanente, these data are generated when a patient has an encounter with the care system. Data are submitted directly from health insurers, third-party administrators, and pharmacy benefit managers to a central point, often a state agency or its vendor. Fourteen states currently have functioning APCDs, and another 10 are in various stages of development. In June 2018, Governor Jerry Brown signed AB 1810, which set aside $60 million in state funds for the creation of an APCD in California. States have a long history of collecting, analyzing, and reporting health care data for assessing quality and system performance. Hospital discharge and financial databases, such as those maintained by the California Office of Statewide Health Planning and Development, have provided systemwide information on hospitals for decades. A statewide APCD could provide more broad information on the use and price of care across different settings. This information could be used by policymakers, health care providers, plans, employers, and academic researchers to understand regional variation in care delivery and price, monitor population health trends, and ensure patients have adequate access to care. Several states have created transparency tools for consumers using APCD data. This issue brief 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. More information on these issues and other use cases for APCDs can be found at www.apcdshowcase.org.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (6 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101744622 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101744622