All-Payers Claims Database Workgroup
Meeting Summary
August 5, 2014, OLF Building B144, 2:00-5:00PM
APCD Workgroup Members Present: Thompson Aderinkoni, RetraceHealth; Laurie BreyerKropuenske, Minnesota Department of Administration; John Chandler, Hennepin County
Medical Center; Kathryn Correia, HealthEast Healthcare System; Bryan Dowd, University of
Minnesota School of Public Health; Roger Kathol, Cartesian Solutions, Inc.; Sara Knudson,
Health Partners; Larry Lee, Blue Cross Blue Shield of Minnesota; Nathan Moracco, Minnesota
Department of Human Services; Jim Naessens, Mayo Clinic College of Medicine; Michael
Oakes, University of Minnesota School of Public Health; Britta Orr, Local Public Health
Association; Diane Rydrych, Minnesota Department of Health, Health Policy Division; Michael
Scandrett, LPaC Alliance; Mark Sonneborn, Minnesota Health Association Not present: Justin
Bell, American Heart Association
Minnesota Department of Health staff: Stefan Gildemeister, Kevan Edwards, Chelsea
Georgesen
Facilitators: Linda Green, Freedman Healthcare; Kris Van Amber, Management Analysis and
Development (MAD)
Welcome and Introductions
Kris Van Amber from MAD asked each workgroup member to introduce themselves and, if
they were not the last meeting, to speak about the perspective they bring to the workgroup.
Kris reviewed the meeting agenda and asked members of the public who would like to
comment during the comment period to sign in. Linda Green from Freedman HealthCare
reviewed the meeting goals and timeframe.
Kris indicated that members were brought here because they have a unique perspective, so and
urged members to share their ideas. Member perspective is crucial.
Review of first APCD Workgroup meeting
Group Purpose & Ground rules
Kris reviewed purpose of the workgroup from statute and the workgroup ground rules. This
meeting’s focus was on data use parameters and to discuss a fee structure that would help
support, mechanisms of release or assessment, appropriate privacy and security protections and
additional resources.
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Recap of first meeting
Linda Green from Freedman HealthCare reviewed the first workgroup meeting. The purpose of
the last meeting was to help set context for the work ahead, including what the legislature has
asked the workgroup to do, what the APCD is, what other states have done, and build an
understanding of the workgroup’s perspectives. The top-of-mind feedback the workgroup
provided in the last meeting was very valuable to MDH and the facilitators. Linda reviewed the
interests identified in the first APCD Workgroup meeting and the focus of this meeting (see
PowerPoint presentation).
Building Data Use Parameters for the MN APCD
Linda gave an overview of evolving APCD data uses (see PowerPoint presentation), including:
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What do we mean by “Data Use”?
Inventory of data use (categories) and examples
Other States’ APCD data use concepts
The overview informed the APCD Workgroup’s answer to the legislative question regarding
“parameters for allowable uses.” This group is charged with finding the right balance in
language and parameters that fits the needs of Minnesota.
Discussion:
States have approached reselling of the data cautiously. States are not yet comfortable with that
type of data transfer.
At this point, other states have not utilized public/ private partnerships or worked with private
entities to financially facilitate the release of data. There is great interest in moving beyond that,
but states have not yet gotten that far. Currently, the majority of the users in other states are
academic researchers.
Virginia and Wisconsin have voluntary APCDs. Colorado is using the data to model bundled
payment. Wisconsin is using episodic data.
Various state approaches have emerged at the legislative level, where fairly general language is
created inside statute. Typically, a stakeholder group convened by the legislature to provide
further guidance on how to move data sharing parameters forward. Depending on the state, the
legislature has not necessarily consulted all parties prior to drafting the statute. Those states that
have broader reporting programs seem to have stronger stakeholder input.
There is a huge amount of interest in connecting APCD data to other types of data, such as
clinical data or registry data. Exploration of possible connections is still in progress. Maine
analyzed how many APCD members could be linked to the statewide exchange. Because
Maine’s APCD does not include identifying information, they resorted to probable matches,
which resulted in a low match rate with the state exchange. Arkansas plans to collect identified
data, so they can align member data with clinical data with much more certainty.
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The role of the state in interpreting the data is something the workgroup needs to decide. Some
states contract with trusted analytic organizations, while other states conduct the analysis
themselves. Each state that releases data is issuing a data dictionary. States are still developing
possible uses.
Data checking when the files are submitted looks at data gathered and determines whether
fields are completed, the information is what was expected, and whether it is similar to other
data.
About three years into data collection, states look at how coding is going and whether the
information they collect aligns with expectations and quality test results. States use that
information to have a continuing conversation about improvement. Data arrives six to nine
months after the rule takes effect. Infrastructure is populated in another six to nine months. In
twelve to eighteen months, states get an idea of what they have and whether the data is getting
stronger. The data can then be evaluated for appropriateness for use in more granular or
“segmented” studies.
Most states begin with summary-level analyses while they continually improve and refine their
data quality efforts. In some cases, lack of individually-identifiable data makes certain types of
analyses difficult, although some states do take in double-encrypted patient identifiers.
Ongoing conversations with data submitters allow for data validation and alignment to take
place, especially when states move towards public reporting.
Key data use concepts
Kris asked the group what use intentions would look like. The goal is to frame a statement
around parameters, rather than a word-smithing exercise. What is resonating with you? What
seems appropriate? What was missing?
Individuals were asked to write what they thought the parameters and the value or intent of
data use should be and share their thoughts in small groups.
Pre-activity discussion:
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Members should look both at parameters for present data and into the future as the
database develops.
A frequently asked questions document is available on the MDH website that gives a
high-level view of the database, such as the number of payers, process for collection,
aggregation processes, and process assuring data quality.
Consider what needs to be understood about the data.
Acknowledge the limitations and build a consideration of the limitations, rather than
articulating the best types of uses for the data.
After discussion, the groups offered diverse points of view on data use parameters:
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Purposes for with the data may be used included “Triple Aim,” “promoting the public
good,” and “broad uses.”
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Types of users noted included “anyone,” organizations not required to report to the
public, and the general public.
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Specific uses, including public-facing reports on a website, phased-in or tiered reports,
or subject to a review body that would set standards for types of allowed reports.
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Ability to link the APCD with other datasets.
The workgroups also listed data quality and transparency, as well as allowing providers to
review and correct the data.
Discussion
The workgroup discussed the data use parameter concepts and points developed by the small
groups.
The workgroup discussed limitations on access to the data. Comments included:
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If the data are open to some people, then it should be available to everyone and the
market would decide what analyses need to be conducted.
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If data accuracy and transparency could be ensured, it should be available to everyone.
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Rather than issuing a blanket statement or rule for access depending on data quality, the
focus should be on what portions of the data are high quality and/or can be validated for
use.
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Abuse and misuse of the data could create disadvantages for certain providers and
insurers, so providers and insurers would need a way to dispute or rebut unfair results.
A member said that transparency and data linkages may be challenging using de-identified or
encrypted data, but possibilities exist to link data using geocoding or death certificates. Another
member said that for data linkage, there would need to be process, controls and considerations
for situations, such as what benefits were available at the time data was collected.
While the onus of data accuracy may be on the user, one member said that at least initially,
there needs to be more confidence in the quality of the data. One member said the state could
provide a seal of approval of sorts, stating that the data is accurate. Another member said that
even high-quality data and research often does not yield high quality research findings. Rather,
there should be suggestions for how the data could be used.
A member said that establishing parameters for use requires a stronger understanding the type
or quality of existing data. A member suggested forming an off-site subgroup to examine data
and MDH processes for compiling data and report on quality for workgroup purposes.
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MDH would like to keep the conversation going and proposed sending items for the
workgroup to react to between this meeting and the next. Where consensus is unlikely, the
group can establish common themes and discuss areas of disagreement. Kris reminded the
group that the process is fluid, and themes will take shape as the group progresses.
Opportunity for Public Comment
Comments submitted by email:
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A member of the public commented that they agreed that there should not be any
restrictions on data access. While member concerns are valid, they would be mitigated
by requiring all analyses (including statistical programs etc. used to do the analysis)
available to public as part of the data use agreement. This would allow affected parties
to independently vet controversial claims based on APCD data.
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APCD claims database will include data feeds from variety of health plans. Will APCD
collect specifics about these health plans? For example, utilization of health care is
influenced by the type of health plan a person has. Thus, any outcome of interest needs
to be adjusted for individual, plan-specific characteristics.
Next Steps
Next meeting will be September 2, 2:00–5:00, OLF Building, B144
Please refer to the MDH website, http://www.health.state.mn.us/healthreform/allpayer/ for
meeting dates and materials.
Public comments may be submitted to Lisa Hermanson at [email protected].
Adjourn
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