All-Payer Claims Databases - Health Cost Containment
Updated March 2013
Collecting Health Data: All-Payer Claims Databases - Download PDF File
Colorado Supplement: Collecting Health Data: All-Payer Claims Databases - PDF File
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Cost Containment Strategy and Logic
In recent years, several states have established databases that collect health insurance claims information from all health care payers into a statewide information repository. Known as “all-payer claims databases” or “all-payer, all claims databases,” they are designed to inform cost containment and quality improvement efforts. Payers include private health insurers, Medicaid, children’s health insurance and state employee health benefit programs, prescription drug plans, dental insurers, self-insured employer plans and Medicare (where it is available to a state). The databases contain eligibility and claims data (medical, pharmacy and dental) and are used to report cost, use and quality information. The data consist of “service-level” information based on valid claims processed by health payers. Service-level information includes charges and payments, the provider(s) receiving payment, clinical diagnosis and procedure codes, and patient demographics. To mask the identity of patients and ensure privacy, states usually encrypt, aggregate and suppress patient identifiers.
Summary of Health Cost Containment and Efficiency Strategies- Collecting Health Data: All-Payer Claims Databases
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State/Private Sector Examples |
Strategy Description |
Target of Cost Containment |
Evidence of Effect on Costs |
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Colorado, Kansas, Minnesota, Tennessee, Maine, Maryland, Massachusetts, New Hampshire, Utah and Vermont all have existing All-payer Claims Databases |
A statewide repository of health insurance claims information from all health care payers, including health insurers, government programs and self-insured employer plans. |
Inability to identify and reward high quality/lowcost providers.
Lack of data to enable consumers to compare
provider prices and care quality. |
It is too early to determine whether all-payer claims databases can help states control costs. |
States that are currently implementing APCDs include Connecticut, New York, Rhode Island, Virginia and West Virginia.
States that have had existing voluntary efforts to maintain an APCD include Washington and Wisconsin.
Recent Information and Resources
Reports
Meetings
Accountable Care Organizations and "all payer databases" have been touted by both publically funded programs and the private insurance market as effective tools to contain health costs and improve quality. Meeting Materials include:
Denise Love, executive director, National Association of Health Data Organizations (NAHDO), Utah: Presentation: All-Payer Databases - slides
Barbara Yondorf, CEO, Yondorf & Associates, Colorado - lead researcher, NCSL Cost Containment Project, Colorado: Presentation: Accountable Care Organizations (ACOs) - slides
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About this NCSL project
NCSL’s Health Cost Containment and Efficiency Series will describe two dozen alternative policy approaches, with an emphasis on documented and fiscally calculated results. The project is housed at the NCSL Health Program in Denver, Colorado. It is led by Richard Cauchi (Program Director) and Martha King (Group Director) with Barbara Yondorf as lead researcher.
NCSL gratefully acknowledges the financial support for this publication series from The Colorado Health Foundation and Rose Community Foundation of Denver, Colorado.
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For additional information, please contact Richard Cauchi, Health Program Director or Kara Nett Hinkley, Policy Associate. |