All-Payer Claims Databases
PBGH has been a pioneer in the development of multi-payer claims databases, which can provide essential insights for quality improvement and cost management. Only when claims data is aggregated across large populations can systemwide trends, patterns and comparisons emerge.
Gathering All-Payer Information
California recently created an all-payer claims database (APCD) to collect both public and private health claims data across the state. The Healthcare Payments Data Program (HPD) is designed to increase transparency for stakeholders and inform policymakers by building out an accurate and holistic view of health care services provided in California.
An estimated 4-to-5 million Californians are covered by ERISA self-funded employers and purchasers. These purchasers are not required to submit data to the HPD. However, their voluntary contributions will go a long way toward creating the most comprehensive picture possible of California’s population and health care system.
Participating in the all-payer claims database can help self-funded employers and purchasers illuminate new cost-saving and quality improvement opportunities, furthering the goal of more transparency in health care pricing. Key insights and capabilities will include:
- Medicare Reference Pricing: Compare the rates you’re paying in the commercial market to Medicare rates for the same services.
- Price Variation: Compare price differentials for outpatient surgical procedures in hospital-based settings versus free-standing facilities.
- Low-Value Care: Isolate instances of care that is medically unnecessary, duplicative or provides no health benefits to patients.
- Prescription Drug Pricing: Assess pricing for prescription drugs across the most common therapeutic classes.
- Outcomes Benchmarking: Benchmark performance to reveal provider variation and resulting implications for quality, cost and patient experience.
- Health Equity: Understand differences across populations in access, quality of care and health outcomes.
Seizing the Moment
PBGH has long been an advocate for the development of all-payer claims databases – information viewed in isolation is of limited value for understanding care variation and cost shift to private payers. With new transparency rules mandating price disclosures by providers and other health care vendors, it is essential that purchasers develop tools to maximize the value of this information. California’s HPD is creating an ever-expanding and increasingly accurate picture of health care services in the state. We urge all PBGH members to contribute to this database to support improvements in health care value, quality, access and equity.
To learn more about how you can participate in this effort, visit the California HPD website.