Computers interconnectedAll-payer claims databases can capture large sample sizes,geographic representation, and capture of longitudinal informationon a wide range of individual patients. (Image:Shutterstock)

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A new report by the California Health Care Foundation (CHCF) willassist state regulators in establishing a new All Payer ClaimsDatabase (APCD) in that state. The new database is one of manybeing considered by states as part of a nationwide movement toimprove price transparency in health care.

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California, home to several large insurers and health systems,is one of the largest states in the process of creating an APCD.These systems allow the collection of more complete insurance claimdata sets, and many states are creating web sites to share some ofthat data with the public.

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According to the Agency for Healthcare Research and Quality(AHRQ), APCDs have several advantages over former systems of claimsreporting:

  • They include information on private insurance not found inother datasets.
  • They include data from most or all insurance companiesoperating in any particular state, unlike some earlier proprietarydatasets.
  • They include information on care for patients across caresites, rather than just hospitalizations and emergency departmentvisits. These older data sets reported primarily discharge data andwere maintained by state governments or hospital associations.
  • AHRQ said the new systems also include large sample sizes,geographic representation, and capture of longitudinal informationon a wide range of individual patients.

State data collection vs. trade secrets

The California state legislature passed a bill to establish anAPCD in 2018, and the final report on recommendations is due onJuly 1, 2020. The latest report reviews legal questions aroundwhether prices negotiated by health insurers constitute tradesecrets. California's laws in this area are broader than federallaw, providing more protection of information in some cases.

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Overall, the study said the state should be able to establish anAPCD without damaging competition. "APCD reports would be unlikelyto cause anticompetitive harms that outweigh procompetitivebenefits unless 'competitor recipients of the reports used theinformation to enter into price fixing agreements,'" the reportsaid.

Drug prices were another focus

According to an analysis by Laura Burns in the State of Reform, the California report lookedspecifically at drug pricing, and said that such drug price datashould be made public.

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In analyzing APCD efforts in other states, the CHCF researchersfound that common payment data collected on drug claims included:paid amount, capitation/prepaid amount, charge amount, cost sharing(co-pay, coinsurance, deductible), dispensing fee amount andingredient cost/list price. Some states in the study collectallowed amount as well.

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The CHCF study notes that dissemination of the data varies fromstate to state. "For example, in Washington State, data requestorshave to assert a public benefit justification in their request. AllAPDCs also incorporate Data Use Agreements to protect thesensitivity of the information and limit its use," the report said.In addition, the report recommended adopting Washington's tieredsystem of releasing data.

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"Tier 1 would comprise data releases to the public, includingprice reports and other consumer- or policy-relevant findings, on apublicly available website," the report said. "Tier 2 would includedata releases to government or academic researchers. While thesedata releases should be reviewed, they should be presumed to beprocompetitive. Tier 3 would include data releases to privateentities or industry participants."

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The study also calls for the state to share clear informationand policies with all submitters prior to data collection, create adata release committee to oversee the process, and said that theAPCD data system should be monitored for anticompetitivebehavior.

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