All Payor Claims Data Base Program

All Payor Data Bases (APCDs) are large, statewide databases that systematically collect health care claims data from both private and public payers. Under a Rhode IslandI law enacted in 2008, the Rhode Island Department of Health was directed to establish and maintain an All Payer Claims Database. The law directs private and public payors to submit claims for health services paid on behalf of enrollees. States with All Payer Claims Databases are in a stronger position to make informed decisions regarding the implementation of the Affordable Care Act.

Mission

To inform statewide health care policy and state health care purchasing decisions.

What the APCD Will Do

The purpose of the APCD will be to provide information about health care use, quality and costs, which will inform statewide health care discussions and decisions. The APCD will improve our understanding of the quality, efficiency and costs of health care in Rhode Island, including:

• Use of health care services by Rhode Island’s insured population;
• Performance of RI’s health care delivery system;
• Efficiency of Rhode Island’s health care system and providers;
• Major drivers of RI’s health care cost trends;
• The impact of new programs and initiatives, such as Patient-Centered Medical Home initiatives like the Rhode Island Chronic Care Sustainability Initiative and the Beacon Community Program;
• Rhode Island’s health care delivery system performance compared to other states, and
• Successes, opportunities, and challenges in Rhode Island’s health care system.

How the APCD will work

Private health insurers will provide all claims paid on behalf of their members, including fully insured and self-funded commercial enrollees; the individual market; Medicaid managed care enrollees; and Medicare managed care enrollees. Medicare and Medicaid will provide claims paid on behalf of their Fee for Service enrollees. The database will also include information for members enrolled in health insurance through the state’s Health Insurance Exchange.

The database will not collect information about health services received by uninsured individuals. The All Payer Claims Database will not collect personal identifiers, although individual enrollees may be linked across payors and tracked over time through a consistent but non-identifiable ID.

Funding

From January through August 2011,Rhode Island Quality Institute provided support for a technical assistance contract with Freedman Healthcare, for the initial planning and development of the All Payor Database Program with funding from their federal Beacon grant. Rhode Island Quality Institute's Beacon Program will have access to the public APCD data to meet reporting requirement of the Beacon grant.

Since August 2011, the APCD development and implementation has been supported by a combination of federal grants, as part of the Affordable Care Act . Rhode Island is first in the nation to receive APCD funding under this project. A long term plan to sustain ongoing operations of the APCD is in development, and may include support from user agencies.

How will Rhode Islands’s APCD be Implemented?

Rhode Island began the planning and design of the APCD early in 2011. The APCD will be implemented in four steps, with opportunities for input from the community along the way.

Step One: Make a decision on the technology infrastructure

• Consider various data flow and architectural models
• Consider strengths of vendor community, state assets, and goals

Step Two: Solicit input and Advice from Community Stakeholders

• write and issue draft regulations, including data submission requirements and data release policy
• contract for and define technology implementation

Step Three: Collaborate and Build

• work with payors regarding submission requirements
• begin to accept, test, and edit data from payors
• organize data and prepare for analysis

Step Four: Issue and Release Reports

• release public reports on various topics as data comes in
• consider applications for research