All-Payers Claims Database Workgroup
Meeting Summary
July 8, 2014, OLF Building B144, 1:00-4:00PM
APCD Workgroup members present: Thompson Aderinkoni, RetraceHealth; Justin Bell,
American Heart Association; Laurie Breyer-Kropuenske, Minnesota Department of
Administration; Kathryn Correia, HealthEast Healthcare System; Brian Dowd, University of
Minnesota School of Public Health (by phone); Roger Kathol, Cartesian Solutions, Inc; Susan
Knudson, Health Partners; Larry Lee, Blue Cross Blue Shield; Michael Oakes, University of
Minnesota School of Public Health (by phone); Diane Rydrych, Minnesota Department of
Health, Health Policy Division; Michael Scandrett, LPaC Alliance Not present: John Chandler,
Hennepin County Medical Center; Nathan Moracco, Minnesota Department of Human
Services; Britta Orr, Local Public Health Association of Minnesota; Mark Sonneborn, Minnesota
Hospital Association
Minnesota Department of Health Staff: Stefan Gildemeister, Kevan Edwards, Chelsea
Georgesen
Facilitators: Linda Green, Freeman Healthcare; Kris Van Amber, Management Analysis and
Development (MAD)
Welcome and Introductions
Kris Van Amber from Management Analysis and Development (MAD) welcomed the first AllPayers Claims Database (APCD) workgroup and introduced Deputy Commissioner Koppel.
Deputy Commissioner Koppel thanked the workgroup and audience for joining and
participating. Mr. Koppel also discussed the purpose of the workgroup, which is to show the
legislature different ways that data from the APCD could be used. Koppel encouraged the
workgroup to think of the big picture.
There will be six total meetings, and progress with every meeting is important as is reflecting on
what other states have done.
Kris led the workgroup in introductions and read bios of workgroup members who were not
present.
Ground rules
Kris reviewed universal ground rules to build expectations of mindset, conduct, and process.
Mindset
 Minds for ideas
 Voices to share your ideas
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Ears to listen
All in an atmosphere of respect
Conduct and process
 All “at table” are equal
 One person speaking at a time
 Raise hands to talk
 Meetings are open to public to observe
 Documentation: meeting notes
 Distribute documents to work group 5 days prior to meeting
 Meetings begin and end on time
 Other ground rules
The group approved ground rules with two additions:
1. Meeting notes and other documentation will be distributed before the next meeting with time
for workgroup participants to check in with their constituencies.
2. All distributed material goes out electronically and will be posted to the APCD page on the
MDH website.
It is important that everyone can express their ideas in an honest, open manner.
Workgroup Charter
Kris reviewed Workgroup Charter. The charter outlines questions that the legislature would
like the APCD workgroup to answer (see Workgroup Purpose section of the charter).
Initially, the workgroup will have to talk in general terms about visions for the database. The
workgroup will be forming that understanding throughout the process. The guiding values and
answers to questions will take shape as the group continues on.
This will take introspection on the part of the workgroup members, asking themselves what
they wish they knew, and will inform possibilities for the APCD and ways to move forward.
The group should also discuss ongoing opportunities as there may be opportunities for work
beyond the scope or timeline of this workgroup.
While consensus is ideal and will be sought, there are situations where consensus will not be
possible. In those cases, each side will have the opportunity to voice its perspectives, and the
varying perspectives will be documented.
The focus of this workgroup is on the big picture surrounding the APCD. Thus, it will be
important for the group to avoid spending a great deal of time on details that distract from the
big picture.
The language that was passed by the 2014 legislature includes a number of specific types of
studies that MDH has authority to work on through fiscal year 2016. The charge of this group is
to say separately from that, if the state were to expand the use of APCD more broadly, what
would that framework look like?
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APCD 101
Kris introduced Linda Green, who gave an overview of APCDs, how Minnesota uses its APCD,
how other states use their APCDs, and other issues. Freeman Healthcare is currently working
with 13 states in various stages of developing APCDs.
Discussion
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Chapter 178 has passed and includes the language that created this workgroup and set
four of the five authorized uses.
The scope of the workgroup is not to focus only on specific authorized uses but
determining the framework that the state should use to decide on future authorized uses
and manage use going forward. The legislature is looking for overall principles.
How the database connects patients that are paid for by one payer for behavioral health
and another for medical care will be addressed at a later time.
Matching cost and resource data and clinical data requires technical resources. There is
not always a repository for data to match to the APCD.
While uses for the APCD can contribute to policy, APCD data is primarily retrospective
and dated once it gets to the database.
Interest Identification
Workgroup members were asked to brainstorm, then convene in small groups and finally come
together as one group and share what they thought were key factors to consider when
expanding the use of the Minnesota APCD. The workgroup identified key factors that can be
categorized into Governance of the APCD, Data quality and inclusion, and Use of APCD data.
Governance of the APCD
 Accessibility of data to the public, providers and consumers
 Ongoing stakeholder governance
 A flexible approach; a nimble framework with the right controls in place
 Ensuring future use compliments Minnesota-based initiatives already underway
Data quality and inclusion
 Incorporating missing data, such as pre-hospitalization and behavioral health data
 Quality of input data and ensuring providers are inputting data appropriately
 Harmonization of data among providers while using the simplest variable
 Ensure the appropriate measures are in the dataset
Use of APCD data:
 Understanding use case in terms of clarity of use case questions: Who is asking for data,
and how does APCD data answer the question?
 Quality of care: How is it measured?
 Use of risk adjustment for other purposes;
 Use data to identify disparities and variation in healthcare and outcomes;
 Use data to establish price transparency
 Consider how use of APCD data affects the public.
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Discussion
Workgroup questions and comments included:
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Is the workgroup building the infrastructure to address uses as they come forward, or
informing how the infrastructure is built?
Common among members was that the concern for quality overlaps the need for
deliberate and intentional use of the database. Additionally, timeliness has to do with
quality of data and stakeholder involvement to determine good use.
MDH emphasized the need for a phased approach. The group can examine and set a
framework for how and when to transition to the next phase, recommend who should
be the APCD gatekeeper, and how rigorously potential uses should be vetted.
MDH will submit a report to the 2015 legislature reflecting the discussion or
recommendations of the workgroup. If there was consensus or discussion of tradeoffs,
that would be reflected in the report as well. What that looks like will partially be
determined by the way the workgroup progresses. The other consideration is that the
legislature has the option to use or not use the information provided in the report.
It is too early at this point to determine how the timing of the report fits with the
governor’s budget proposal.
Workgroup members expressed interest in hearing MDH representatives’ perspectives
from time to time. MDH agreed that while it is important that the workgroup hears from
the other members, the state’s representatives will participate in discussion as well.
Data quality is concerning in relation to how well variables measure what actually
occurred, quality of inputs and motivating providers to input high quality data, and
know who contributes data and who does not.
Researchers are often interested in choice sets and actual choices, such as the number of
providers or health plans from which a person can choose.
Opportunity for Public Comment
Comments:
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From a provider’s perspective, price transparency can be a good thing, but we need to
consider that purchasing healthcare is not like purchasing other goods. There are other
things that need to be considered. Prices fluctuate based on an individual’s need.
Next Steps
Next meeting will be August 5, 1:00–4:00, location TBD
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
Member Comments Received After Meeting
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Another workgroup member expressed written concern that reports using APCD data
have been published with verifiably inaccurate results. These were either caused by
research methodologies of those who used the data or the reliability of the data itself.
Processes need to be in place to ensure the accuracy of the data, and MDH or its vender
need a mechanism to measure the efficacy of those processes.
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