RD107 - All-Payer Claims Databases

Executive Summary:

A Joint Commission on Health Care report, Catastrophic Health Insurance – HD No. 3 (2011), included a policy option to review the idea of establishing an All-Payer Claims Database (APCD). APCDs, large-scale databases that manage systematically-collected health care claims data, can facilitate a better understanding of cost and utilization across institutions and populations.

The concepts involved in establishing an APCD were reviewed by the Joint Commission in 2011. The review revealed that APCD data analyses can provide useful information in such areas as health care costs, quality, and efficiency; geographic differences related to access and utilization; and overall system utilization.

Based on the study findings, JCHC members voted to introduce legislation to create an APCD specifying that the governance-structure should be housed within the nonprofit organization, Virginia Health Information; that data collection should adhere to national reporting standards for medical claims; and that health insurers be required to report health insurance claims data. House Bill 343 (Delegate O’Bannon) and Senate Bill 135 (Senator Puller) were introduced as companion bills during the 2012 General Assembly Session. During consideration by the General Assembly, the bills were amended to allow insurers to voluntarily report claims data. House Bill 343 and Senate Bill 135 were awaiting the Governor’s signature when this report was submitted.

Joint Commission members and staff would like to thank the numerous individuals who assisted in this study, including representatives from: Aetna, Anthem, APCD Council, Castlight Health, Centers for Medicaid and Medicare Services, Medical Society of Virginia, Mercer, National Association of Health Data Organizations, National Conference of State Legislatures, National Governors Association, Onpoint Health Data, Sentara, Virginia Hospital & Healthcare Association, Virginia Association of Health Plans, Virginia Department of Health, Virginia Health Information, Virginia Health Reform Initiative, and WellPoint.

Kim Snead
Executive Director
March 2012