142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

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

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 10:30 AM - 10:50 AM

Tanya Bernstein, MPH , Freedman HealthCare, Newton, MA
Alison Glastein, MEd , Freedman Healthcare, Newton, MA
John Freedman, MD, MBA , Freedman HealthCare, Newton, MA

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.

Learning Areas:

Chronic disease management and prevention
Communication and informatics
Program planning
Provision of health care to the public
Public health or related public policy
Public health or related research

Learning Objectives:
Describe All-Payer Claims Databases and how they provide valuable public health information to policymakers. Discuss how APCDs can be used to address public health issues and disparities. Identify the analytic enhancements and methodologies which APCDs can provide.

Keyword(s): Data Collection and Surveillance, Performance Measurement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have served as the project manager on two state All-Payer Claims Database initiatives. In my current role as the project manager of the Rhode Island APCD, I am responsible for managing data collection and vendors; drafting all public-facing documents; and leading sustainability and strategic planning efforts. In addition to working on APCD's, I have a decades' worth of experience overseeing the day-to-day operations of clinical, business, and health services research projects.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.