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The Rise of All-Payer Claims Databases: An Update

In 2009, GovWin reported that we would see increased implementation of the All-Payer Claims Database (APCD) in states across the country. We predicted states would start to catch on to this initiative to improve health care delivery and facilitate reform, and I am proud to report that our forecast hit the mark.

The All-Payer Claims Database is a state-created database that collects and reports medical claims, pharmacy claims, eligibility files, provider files, and dental claims data. The data is collected from all health care payers, including health insurance companies and third party administrators. Typically, states have enacted legislation to mandate the use of an APCD; however, we've found voluntary reporting of data to be infrequent and less successful. The collected data is important for policymakers, consumers, researchers, and providers, and offers a breadth of information on health care cost, quality and access.

Currently, 11 states across the nation have an operational APCD and two more states are actively implementing based on enacted legislation. GovWin is tracking the following states actively implementing an APCD:

  • Oregon - The Oregon Office of Health Policy and Research is finalizing a contract with Milliman, Inc. for the All-Payer All-Claims Data Program. For more information, see GovWin Opportunity # 57970
  • Rhode Island - The Rhode Island Quality Institute is currently evaluating responses to a request for proposals (RFP), and anticipates a contract award early next year. For more information, see GovWin Opportunity # 65451

In a departure from the legislative model, former West Virginia Governor Joe Manchin issued an executive order for his state to join the trend and begin establishing an APCD. Though still in the early planning stages, a solicitation for the West Virginia APCD is expected early next year. For more information, see GovWin Opportunity # 59819.

Over the course of 2011, it is highly likely that more states will see the APCD as an integral component to health care reform and begin the development process. Legislation will likely be necessary to develop an APCD; however, six states have already begun the process through informal discussions. As these discussions intensify and funding becomes available for APCD development, GovWin will add new opportunities to our database and continue to update you on this exciting health care reform component.

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