Introduction to All Payer Claims Databases
Presentation to the Minnesota APCD Workgroup
Linda Green
Vice President, Freedman Healthcare
July 8, 2014
Agenda
Overview and History
Minnesota’s APCD
How Other States Oversee APCD Operations
Discussion
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About Freedman HealthCare
Since 2010, FHC has worked with 13 States on APCDs
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What is an APCD?
APCD Council’s Definition:
• “All Payer Claims Databases are large-scale databases that
systematically collect medical claims, pharmacy claims, dental
claims (typically, but not always), and eligibility and provider
files from private and public payers.¹”
Data from all settings of care
Permits systemic analysis of health care delivery
Builds on the example of Medicare data analysis
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Is there a “typical APCD?”
If you’ve seen one APCD…..
Each one reflects that state’s perspective, needs and
priorities
Common themes:
“We cannot manage what we cannot measure”
Deep concern about health care value
Interest in making thoughtful policy decisions
Initial uses expand as database matures
ACA is an important driver
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Claims Databases
Statewide APCDs
11 collecting data and issuing reports
4 getting underway with data collection
3 just starting
21 states considering legislation
Private and voluntary efforts
Fair Health
Health Care Cost Institute
Pacific Business Group on Health
Commercial Databases
CMS Comparative Effectiveness Database
Qualified Entity Program
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APCD Roll Out Template
Development
• Stakeholder engagement
• Legislative action
• Initial funding
Data Collection
• Establish data collection rules and data release process
• Build technical infrastructure
• Collect data from payers
Construct Datasets
• Conduct ongoing data quality tasks
• Build data warehouse
• Run “value add” tools, e.g. condition categories
Reporting
Review and Revise – meet new needs
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Common Features of Data Collection
Stated purpose of using the data in the public interest
Ongoing stakeholder participation
Data derived primarily from claims system
Data are submitted by carriers on a monthly or
quarterly basis
Statutory authority to use the data for the public
good (improve health, monitor cost trends, increase
value
Regulatory language establishing collection and
release provisions
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Ins and Outs of APCDs
What’s Typically Collected
Diagnosis codes
Procedure/treatment codes
Dates of service
Site of care
Provider name
Provider-submitted billing and
payment data (similar to an
EOB)
City, State, Zip code
What’s Typically Not Collected
Most PHI data elements
Uninsured
VA, Tricare, Champus
Lab results
Clinical notes
Electronic medical record
information
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How are states using APCD data?
Public facing data
Reports: Utah, Vermont, Maryland
Websites: Colorado, New Hampshire
Academic researchers
Oregon, Massachusetts, New Hampshire, Vermont, Colorado
State Agencies
Modeling health policy
ACA Rate Reviews
Price variation
Medicaid policy development
Population health
Cutting Edge
Alignment with Health Information Exchanges
Risk Adjustment for Exchange-based plans
Custom reports at appropriate levels of detail
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Source: https://www.cohealthdata.org/#/map
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Source::http://hcqcc.hcf.state.ma.us/Reports/ProviderComparison.aspx?sCity=&sCounty=&sName=&sPTypeId=1&sId=628&sZip=02461&sCId=511&sPNo=1&sPCoun
t=15&sType=AdvancedSearch&sLType=Zip_Code&sSort=Distance&sRange=Ten_Miles&rPS=11392~11388~11124&rPId=0&rPTypeId=1&rId=628&rCId=511&rTC=Fals
e&rIP=False&
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Northern New England Tri-State CT Variation in CT Scan Utilization
Source: http://apcdcouncil.org/sites/apcdcouncil.org/files/OnPoint%20Act49-Tri-StateCommercial-Variation.pdf
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APCD Management Themes
Operate under HIPAA and any other state privacy law
Maintain options for public input
Transparency: two way street
Consideration for level of effort needed to comply with
state requirements
Formal data release process and structure
Sustainability considerations
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Differences among APCDs
Types of data collected
File contents
Required data submitters
Public payers
Data Management Arrangements
Permitted uses
Narrow
Broad
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APCD Data Use Authority
Statutory Data Release Authority
Overarching purpose
Permit fee collection
HIPAA compliance
May mandate certain reports
May allow state agencies access to data
May list member representation on Data Release Committee
Regulatory Activity
Timelines
Fee schedule
Data Release Committee members, if not in statute
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How Other APCDs Structure Data Release
Operations
Formal written application process
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User qualifications
Purpose and use of the study
Funding source
Prior experience with similar data
Data management plan (security)
IRB approval
Staff review of application
Data Release Committee formally considers the application
If approved, user pays fee
• Data transmission
• Access to data enclave
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Sample of Data Release Purposes
Colorado: Improve health care or public health outcomes
Connecticut: Provide health care consumers in the state with
information concerning the cost and quality of health care services
that will allow consumers to make economically sound and informed
health care decisions.
New Hampshire: Resource for insurers, employers, providers,
purchasers of health care, and state agencies to continuously
review health care utilization, expenditures, and
performance...and to enhance the ability of New Hampshire
consumers and employers to make informed and cost-effective
health care choices
Oregon: Will approve study requests that serve the public interest
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Learning in Progress:
Starting/Revisiting an APCD
Set out a vision for reporting with stakeholders
Phased approach to reporting
Transparency
Two way street
Know the audience
Keep up with health care policy and data changes
Explore new data use opportunities
Access models
Enhance existing data
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MINNESOTA’S APCD
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History of MN APCD
Established in 2008 as part of bipartisan health reform
effort
Use initially limited for establishing transparency in
provider value (Provider Peer Grouping)
Data collection began mid-2009
• De-identified
• Significant investment in:
• Developing data system
• Developing risk adjustment methodologies and outlier adjustments
and mechanisms to remove add-on payments
• Building provider directories
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What’s in the MN APCD
Analytic database includes data for 2009 through 2013
• 4.2 million records of Minnesota covered lives
• 52 million medical claims
• 58 million prescription drug claims
Information about diagnoses, procedures, duration of
treatment, as well as de-identified demographic
information (age, gender, geography) and high-level
health plan product information
Actual payment information
Direct identifiers are encrypted using a standardized,
one-way process that does not allow re-identification
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MN APCD at the Cutting Edge
Built a “true” all-payer database, including Medicare
First and only state agency to achieve Medicare QECP
certification
National leader in developing innovative approaches to
analyzing payment transparency and construct a metric
for provider value
Extensive, ongoing data quality processes
Leadership roles on boards of national data organizations
Successful collection and management of data from 62
payers representing public, commercial and self-insured
markets
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Current Authority to Use MN APCD
Chapter 178 of 2014 – amended section 62U to add the
following uses:
• Evaluate the Health Care Home program
• Study hospital readmission trends and rates in partnership with
stakeholder collaborative
• Analyze variations in health care costs, quality, utilization and
illness burden based on geographical areas or populations
• Evaluate the SIM testing grant
• Conduct pain management provider study
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Looking Ahead
MN has a scarce resource in hand
Strong intake management
Robust quality activity
Investment in “value adds” that strengthen analysis
APCD Workgroup Going Forward
Diverse perspectives
Depth of knowledge
Range of experience
Lessons learned about using data
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