All-Payer Claims Databases (APCDs) as New and Powerful Sources for Public Health Trends and Population Health

All Payer Claims Databases (APCDs) have emerged as powerful analytic tools that can address a state’s need for comprehensive information about health, healthcare, and total medical expenses across many populations and settings. By aggregating claims across commercial payers, Medicare, and Medicaid, APCDs provide policymakers with a more complete picture of what healthcare really costs, the quality and breadth of services offered, and existing variations in the treatment and reimbursement rates of similar conditions or medical events. While currently available databases provide limited snapshots on patient populations within a single healthcare environment (i.e. inpatient hospital stays) or from an individual source (i.e. administrative databases maintained by commercial carriers), APCDs give an unprecedented view of care as a continuum, looking not only at a particular episode of care, but also at what came before and after it. Moreover, by standardizing multi-payer claims data, APCDs provide important opportunities to overlay analytic enhancements such patient-level risk scores - a calibrated rate of an individual’s relative health compared to the general population, and geocoding - a process by which existing claims information is assigned to a particular geographic area in order to meaningfully impute otherwise unavailable information.

Looking ahead, the next generation of APCDs will become increasingly robust from the influx of individuals acquiring insurance under the Affordable Care Act; build even greater public health reporting capacity by aligning claims-based quality information with outcome results drawn from sources like Health Information Exchanges; and increasingly, be used to facilitate inter-payer comparisons on healthcare spending and value.