States Are Increasingly Implementing All-Payer Claims Databases

June 19, 2014 in News

Many states are creating all-payer claims databases and using them to evaluate their health care systems and make policy decisions, particularly in the past three years, USA Today reports.

Details of Claims Databases

Such databases accumulate dental, medical, mental health and pharmacy claims from all providers in a given state, including Medicaid and Medicare claims. Large employers also are required to provide claims information in some states.

Codes are used in place of names and addresses to protect patient privacy, and the databases protect proprietary business information by listing only the median prices paid to providers.

Claims databases are used to:

  • Evaluate insurer, physician and hospital performance;
  • Track spending and price trends; and
  • Help insurers and employers design insurance plans.

Increasing Adoption of Databases

According to the APCD Council:

  • 11 states have implemented all-payer claims databases;
  • Five states are developing new databases;
  • Three states have voluntary databases created by insurers and employers; and
  • At least 21 states currently are considering laws to create claims databases.

The amount states have spent on their database varies. For example, Maine has spent about $5 million since 2002 on its all-payer claims database, while Massachusetts — which has had its database for over a decade — spends about $1 million annually.

Reaction

Most economists say the databases have the potential to reduce costs by increasing price transparency, according to USA Today. Consumer advocacy groups and large employers also largely support the implementation of claims databases.

However, some providers argue that the databases are unable to adequately measure value because they lack important context, such as patients’ clinical data.

Clare Krusing, spokesperson for America’s Health Insurance Plans, said the group supports the idea of claims databases but emphasized the need to protect patients’ privacy and collect data in a cost-effective manner.

David Newman — director the Health Care Cost Institute, which last month announced plans to create a website with national claims data from Aetna, Humana and United Healthcare, as well as Medicaid and Medicaid Advantage plans — said that there should be national standards to be able to compare data across different states. He added that currently “every state is using its own consultant to do it uniquely” (Vestal, USA Today, 6/17).

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