Since November 2009, the health care market has seen change at a pace so dramatic and dizzying, it verges on unpredictable. However, one change that GovWin predicted early was the rise of the all-payer claims database (APCD) across all fifty states. In 2009, prior to the passage of the Affordable Care Act, and again in 2010, GovWin published these predictions. It will become clear in this in-depth analysis that the implementation of APCDs will continue as predicted over the next several years. The APCD is an integral tool for the achievement of true health care reform, especially in light of current and projected state budgetary deficits; increases in state Medicaid enrollment and spending; the implementation of health insurance exchanges; and the push for efficient, data-driven, outcome-based care.
From whence we came: A look back at APCD 1.0
In 2009, when we wrote our first piece on the APCD, only six states had an APCD in place. Today, the number has doubled to 12 states, with four actively implementing an APCD. Over those two years, we have seen state legislatures, policymakers, consumers, providers, and bureaucrats explore and implement an APCD. The increased transparency the database allows attracted them, and the promise for a deeper understanding of the drivers of health care spending across programs and providers further enticed them. Ultimately, the stakeholders in the 31 states that have deployed, or are seriously considering the deployment of an APCD, have been convinced by the promise for access to data to drive cost containment and increase efficiencies.
This is not to say that there are not legitimate, substantive concerns and roadblocks facing APCDs. Issues such as patient and consumer privacy, information security, and finding the funding for planning and implementation, not to mention the $1 million annual funding necessary to operate the database, have all been raised. Further, there are concerns about the practical complexity involved with the implementation of a database pulling data sets from many disparate sources. Finally, perhaps the most consistent obstacle is the political will required to mandate the data collection necessary to operate the database. In all but two states with active APCDs (Washington and Wisconsin), the legislatures enacted laws to mandate private health plan (including medical, dental, pharmacy) data be reported. In an anonymous, en-masse fashion, the data reported fills gaps in cost information previously only gathered from providers, facilities and state-run assistance programs. The concern for patient privacy and funding, combined with the often arduous legislative process, has led to fits and starts in states with legislation defeated or stalled in long-study processes. Without the mandated data collection for all insurers, providers, facilities, and government agencies, the data collected will inevitably be incomplete.
Figure 1 below provides a graphic representation of the current, though fluid, procurement landscape. The states shaded red have either contracted with vendors for technical infrastructure and support and/or have an operational APCD. States shaded gold have released a solicitation or plan to release a solicitation for implementation of and/or planning for an APCD. The blue states have active discussions at various levels of government and the stakeholder community, but no solid direction or legislation to signal procurements will occur. Finally, the states shaded gray have not publicly engaged in significant discussion about the development of an APCD.
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Source: Deltek's GovWinIQ Database, state legislative and health care department websites, Massachusetts Health Data Consortium, and the APCD Council, a collaboration between the University of New Hampshire and NAHDO.
APCD 2.0: opportunity abounding
A cursory glance at the map above yields the impression that a lot of states have yet to do anything concrete with the APCD. Indeed, the vast majority of states have yet to release an RFP or outline specific plans to implement the database. So, you might be wondering, how can we conclude that there is a rise of the APCD, or that it will continue? The question is easily answered by the following three words: math, feds, and outcomes. Sentence explaining what math, feds, and outcomes are.
The remainder of this section is subscriber only content. Subscribers have access to expanded analysis on upcoming opportunities, detailed data, and a case study on APCD’s, here.
Conclusions and recommendations
Next steps for vendors:
- Monitor GovWinIQ for updated information on state APCD efforts. As state plans begin to take shape, our expert team will add opportunities and update records in our database.
- Get involved. Many state agencies, private companies, and nonprofit groups within states are discussing the implementation of APCDs. With the legislation requirement, a vocal push for policy change has to come from all sectors of the health care market.
- Get more technical information. The APCD Council is a great resource for vendors. The council’s website includes vendors already involved in the market, information on technical components necessary for an APCD, and various other APCD-related information.
GovWin has been talking about the rise of the APCD for two years now, but at no time is it more true or exciting than right now. The federal mandates, increased cost of health care, increased enrollment in Medicaid, development of health insurance exchanges and health information exchanges, and a general desire to make health care delivery better for all people have combined to make this the moment of the APCD.
Subscribers have access to expanded analysis, data, and the full article, here.
