Using all-payer claims databases to reduce the growth of healthcare costs

By having better access to healthcare data, providers, payers, and individuals can stretch their healthcare dollars further and make the whole system more efficient and effective. Many states are using all-payer claims databases to gather the information necessary to initiate plans to bring bills down. The data collected will determine what tools are most useful to deliver high-quality care without exploding governmental and consumer budgets.

Defining an all-payer claims database

An all-payer claims database (APCD) is a large state database that systematically collects information on medical claims, pharmaceutical claims, and dental claims as well as eligibility information from both public and private payers. This is important because it includes granular data from private insurance companies not included in other datasets. An all-payer claims database also incorporates information from care sites instead of relying on discharge data from emergency room visits and hospitalizations.

This collective state database includes information on large geographic sample sizes as well as linear information on a range of individual patients. More than 30 states have expressed interest in establishing an all-payer claims database, but only half of them are making concrete progress toward that goal. A few states have used all-payer claims database information to launch public websites displaying price and cost information to consumers. While this is helpful, it may not make a significant impact on the growth of healthcare costs in the near term.

Rhode Island Initiative

Rhode Island has implemented targeted action aimed at reducing this growth. Researchers from Brown University are putting a $550,000 grant to work drilling down into the granular data contained in the state’s all-payer claims database. They are measuring healthcare performance in hopes of establishing a way to make the information more useful to consumers, payers and providers. The governor has also appointed a steering committee with one goal: a healthcare cost growth target.

Finding a plan in your state

Most states are not yet ready to launch a consumer-friendly all-payer claims database. Even if your state has implemented the database, each state has its own data release policies and processes. Every state has a point of contact responsible for helping people navigate the state’s claims data, but much more work still needs to be done to standardize the information collected.

How HCM can help

Healthcare Claims Management is a forward-thinking, analytical healthcare customer service company that seeks to increase patient engagement while simultaneously increasing revenue cycle performance. We encourage open dialogue with patients as a key part of the engagement continuum. With the goal of “rehumanizing” healthcare, open communication and reliable information support every customer touchpoint, we make.  This customer-focused reporting helps drive quality and efficiency by providing accurate information that helps overcome barriers to increase revenue and satisfy consumer demand.

Contact us today, to find out how we can help you understand your data.

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