1-2-3 Did you know that having access to an APCD has the potential to make data analytics as easy as A-B-C? You may have heard of an APCD before – it stands for All Payer Claims Database. APCDs collect data from private health insurers, Medicaid, prescription drug plans, and self-insured employer plans, among other sources. APCDs are widely considered to be superior data sources because they include actual paid amounts—not charged amounts—which often are significantly lower due to contracted or negotiated rates from providers. So, what can one do with access to an APCD and all the data it contains? Turns out, there are many exciting ways claims data can be put to good use; here are some cool examples:
- You can create a powerful consumer price transparency tool: In Altarum and CPR’s newly combined 2017 Price Transparency & Physician Quality Report Card, only two outstanding states got an “A grade.” Maine and New Hampshire went above and beyond with their APCDs and provided their citizens with websites offering consumers comprehensive health care price information. For instance, check out the New Hampshire Insurance Department’s pioneering site NH HealthCost.
- You can track referral practice patterns: Amino, a health care transparency vendor, uses claims data to analyze a range of topics in health care. We love their blog post on referral practices across providers, which features a beautiful visualization allowing you to compare which specialties send and receive the most referrals. Understanding referral practice patterns offers key insights when thinking about limited networks in health plan offerings, a trend that CPR will measure in our upcoming Scorecard on Payment Reform 2.0.
- You can reveal fraudulent practices: The Center of Public Integrity, with the help of Palantir Technologies, extensively analyzed Medicare claims data to reveal “upcoding” fraud practices that cost taxpayers an estimated $11 billion. Their investigative reporting series “Cracking the Codes” created quite a stir.
- And that’s not all! Palantir technologies leverages claims databases to do much more than just identify fraud: other applications include driving policy recommendations and helping health plans and their in-network providers make data-driven medical decisions, features they showcased at the 2013 GovCon conference.
As APCDs and accompanying data analytics tools become more commonplace, it’s important to think about the various, and expanding, ways these resources can be used to maximize their impact. To that end, be sure to check out CPR’s newly updated Toolkit for Selecting and Evaluating a Price Transparency Tool. We also recommend the APCD Council Issue Brief focusing on APCDs from an employer’s perspective available here.