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 RI 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.

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, when it is implemented in 2014.

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.

After August 2011, the APCD development and implementation will be supported by a combination of federal grants. Ongoing operations of the APCD will be supported by the agencies who will use the All Payor Database including Medicaid, the Health Insurance Exchange (a new program being developed under the Affordable Care Act requirements), and the Office of the Health Insurance Commissioner (to support new requirements under the Affordable Care Act   to conduct health plan rate review and commercial market risk adjustment.

When 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: May - September 2011

A decision will be made on the technology infrastructure. There are two basic options being evaluated for consideration:

• Issue a Request for Proposals for an information technology (IT) vendor to operate Rhode Island’s APCD. There are national vendors which already operate and house APCDs for several states. In some cases, the vendor’s APCD IT system and architecture is shared by several states with existing APCDs, with some state-specific additions if needed, allowing new states to leverage existing IT architecture and APCD experience.;
• Create an APCD within an existing state database infrastructure: Office of Health and Human Services (OHHS) existing Data Warehouse infrastructure could be leveraged to host the APCD, with the potential for federal Medicaid matching funds.

Step Two: September - November 2011

• Solicit input and advice from community stakeholders;
• Write and issue draft regulations, including data submission requirements and a data release policy;
• Contract for and define technology implementation.

Step Three: December – September 2012

• Work with payors regarding submission requirements;
• Begin to accept, test, and edit data from payors;
• Organize data into a format conducive for analysis.

Step Four: October 2012 - January 2013

• Make the APCD public database available in appropriate formats for analysis;
• The state will contract with an analytic vendor to conduct analyses, as well as write and disseminate reports.