All-Payer Claims Data

One of the challenges of studying import issues in health economics is that the patients often come in and out of your data file.  For instance, beneficiaries often switch their private health insurance plan, or can become eligible for public insurance (e.g., Medicare or Medicaid) or the individual may lose their insurace coverage.  In each of these cases, it is difficult to track these patients over time.

One effort to solve this problem is AHRQ’s All-Payer Claims Databases (APCD).  AHRQ does not create the APCDs themselves but facilitates States efforts to create them.  According to a 2010 fact sheet:

Payers include insurance carriers, third party administrators (TPAs), pharmacy benefit managers (PBMs), dental benefit administrators,state Medicaid agencies, CMS (Medicare), Federal EmployeesHealth Benefit (FEHB) and TRICARE administrators.APCD systems collect data from existing claims transaction systemsused by health care providers (facility and practitioners) andpayers.

The information typically collected in an APCD includes patient demographics, provider demographics, clinical, financial,and utilization data. Because of the difficulties involved with thecollection of certain information, most states implementing APCD systems have typically excluded a number of data sources, such asdenied claims, workers compensation claims, and, because claimsdo not exist, services provided to the uninsured.

One concern with these data is that the APCD must maintain beneficiary confidentiality. On the one hand, one of the key benefits of APCD is that it allows researchers to examine patterns in the cost and quality of care for beneficiaries who change insurers.  The institution administering the APCD, however, must institute a strong institutional review board (IRB) or data use agreement (DUA) policy.

Also, the APCD must determine whether or not the claims files are updated.  Oftentimes, claims payment amounts can change or the claims can be later denied.  The APCD must determine a policy for updating the data files over time.

Although there are a number of challenges, some states are making progress.  “Oregon and Tennessee willhave live systems in 2010. Hawaii and Colorado havecurrently submitted legislation for their 2010 session toauthorize development.”

Hopefully, the APCD will be a high-quality, useful data resource that can be used to answer a variety of research questions.

1 Comment

  1. Technology, paired with the APCD, it has to be assumed will likely be able to manage the difficult information now attempting to be managed. As technology improves, or as current technology is updated it’s clear that management of long term care patients, or patients with constantly changing coverage will be much more simply to track and assist.

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