As some states implement laws requiring health insurers and providers to disclose estimated costs of care to patients, a workshop for developing state all-payer claims databases (APCDs) will draw lawmakers, health insurers, and data analysts to Minneapolis, Minnesota.
The final day of the 31st annual meeting, held October 26–28, of the National Association of Health Data Organizations (NAHDO) is devoted to discussing and promoting APCDs. State APCDs rely on health insurers, third-party administrators, and pharmacy benefit managers to collect and forward data about health care providers, charges, claims, and facilities to a hub overseen by the state.
In July, Delaware became the 18th state to approve legislation establishing an APCD requiring some or all third-party payers to submit data. Five other states are implementing APCDs with reporting mandates, and 12 states have already implemented them, according to an interactive map published by the APCD Council, which provides technical assistance to states implementing APCDs.
Twenty states have “strong interest” in establishing APCDs, the map’s creators state.
Josephine Porter, NAHDO executive director and APCD Council co-chair, says APCD laws with voluntary reporting requirements have had mixed results.
“Virginia has a legislatively mandated system with voluntary submission that sets a threshold for voluntary participation [that becomes] mandatory if the threshold hasn’t been met,” Porter said. “They have experienced some voluntary participation by insurers. On the other hand, Arkansas started with voluntary submission of data, and after experiencing little success, it moved to a mandated system.”
Delaware’s law mandates reporting of claims data only for state-sponsored health insurance programs and plans offered on the state’s Obamacare exchange.
Insurers, the primary data sources for most APCDs, have cited concerns about the costs and security of data submission, Porter says.
“At the end of the day, it is a mandate they haven’t budgeted for, and they want to ensure the state has clear intentions for the use of data and safeguards in place for security,” Porter said. “In addition, some also express concerns [about disclosing] proprietary rates and negotiated rates.”
Porter says the point at which many “stakeholders”—a term one APCD Council manual uses to describe patients, payers, providers, employers, and state agencies—start favoring APCDs is “when you start to understand what you don’t already know about the health of your community and your state.”
Christina Thielst ([email protected]) writes from Santa Barbara, California.