All-Payer Claims Databases (APCDs)

1/1/2018

As states strive to achieve the triple aim of better care, smarter spending and healthier people, many are increasingly using data to guide health care innovations and improve transparency.

Policymakers, health care providers and other stakeholders recognize all-payer claims databases (APCDs) as a promising tool that can help achieve this objective. Most APCDs gather claims and eligibility data from medical, pharmacy and dental payers to create a comprehensive collection of information on costs and quality of care, and patient demographics. APCD submission requirements vary by state, but often include either voluntary or mandatory submissions from Medicaid, state employee health programs, commercial insurers and self-insured employer plans.*

Policymakers, payers, providers and state agencies can access APCD data to inform their decisions on how they deliver and pay for health care. For example, a recent report from the Minnesota Department of Health provides information about state spending on chronic disease care, which was significantly higher than for those without chronic illnesses. The report gathered this information from the state’s APCD, which was created by the Minnesota Legislature in 2008.

State legislatures play instrumental roles in statewide APCDs through funding, oversight, reporting requirements and establishing the structure of the database system. Currently, 26 states have established APCDs and other states have introduced legislation to create an APCD or to study the feasibility of creating a database.

*In the recent case, Gobeille v. Liberty Mutual Insurance Co., the Supreme Court ruled that state reporting requirements cannot apply to self-insured employer plans because such requirements are preempted by the federal Employee Retirement Income Security Act (ERISA), which regulates multi-state, employer-based health benefit plans.

Resources: Collecting Health Data: All-Payer Claims Databases. NCSL, March 2016. APCD Council, All-Payer Claims Database, 2016.

 

United States map of All-Payer Claims Databases