All Payer Database
New York State enacted legislation in 2011 that allowed for the creation of an All Payer Database (APD). The complexities of the health care system and the lack of comparative information about how services are accessed, provided, and paid for were the driving force behind this legislation. The state recognized the need for an APD to provide a more complete and accurate picture of the health care delivery system. Planning and development of the system began in 2012, and continues aggressively, with full implementation envisioned by late 2017. The APD is being developed and administered through a new bureau within the New York State Department of Health (DOH) Office of Quality and Patient Safety, and will support a broad spectrum of health care finance policy, population health and health care system comparisons and improvements.
What is an All Payer Database?
Many other states have developed All Payer Claims Databases (also known as APCDs). These are secure databases, often created by state mandate, that typically include medical, pharmacy, and dental claims data received from both private and public payers. States are using APCDs for a variety of analysis including transparency reporting, cost comparisons, disease prevalence reporting, and total cost of care analysis.
New York’s All Payer Database (APD) will contain public and private health care claims and encounter data from insurance carriers, health plans, third-party administrators, pharmacy benefit managers, Medicaid and Medicare that can be synthesized to support the management, evaluation, and analysis of the NYS health care system. Payers will provide information about insured individuals, their diagnoses, services received, costs of care, and plan benefits. As time progresses, the APD may also strive to integrate other data sources including lab, pharmacy and clinical data from electronic health records and data contained within public health registries such as the New York State Cancer Registry. This is the primary reason New York has decided to use the term All Payer Database.
What the APD Will Do
The APD will provide information about how and where health care dollars are being spent, and will help answer important questions for various stakeholders, including but not limited to, consumers, business owners and policy makers. It will collect and integrate information to help the state understand the evolving needs of the health care system.
Examples of Questions an APD Can Help Answer
- What parts of the state have better access to specialists?
- How and where are health care dollars being spent?
- What is the prevalence of diabetes?
|State Policy Makers/Public Health||
Strategy & Initial Development Steps
The initial focus of the APD will be on claims and encounter data from health plans. As the APD evolves over time other types of information will be incorporated. The following figure represents the potential APD Data Domains.
Integrating data from Medicare, Statewide Planning and Research Cooperative System (SPARCS), public health repositories, and the clinical and laboratory information from the Statewide Health Information Network for New York (SHIN-NY), will make it possible for the APD to provide a more complete information integration for all participants in the health care system, from policy makers to clinicians to consumers.
Input from the full spectrum of APD stakeholders is critical to building a system that receives the necessary support and buy-in to be successful. DOH continues to work closely with external stakeholders to gather input on the development of the APD. Representatives from health plans, provider organizations, researchers, and other interest groups participate on an APD Advisory Committee and DOH informs stakeholders of progress through this site and the APD listserv.
DOH's approach to APD development focuses on three core solutions. The Data Intake Solution collects and edits claims data from numerous health plans. The Data Warehousing Solution will aggregate, link, de-identify and store the data that are received from all of the different sources. The Data Analytics Solution will include two components: the APD Business Intelligence and Analytics solution, which will facilitate data analysis and reporting; and the APD Data Delivery solution, which will produce extracts and de-identified data sets for researchers and other stakeholders approved through a Data Governance process. The graphic below illustrates the three interrelated solutions to form the APD.
Progress toward Goals and Current Status
Status of the Data Intake Solution
The initial focus of the APD has been development of the intake solution to collect encounter data. Collection of data from public and private payers is occurring in phases. In October 2014, 23 New York State of Health Exchange Qualified Health Plans (QHPs) began submitting test data to the Encounter Intake System. In January 2015, these plans began submitting live medical and pharmacy data. Production for the intake system for Medicaid and Child Health Plus Managed Care Plans followed in September 2015. Collection of production data from large commercial payers will begin in late 2016.
Status of the Data Warehousing Solution & Data Analytics Solutions
DOH released an RFP on 4/7/15 to secure a vendor for the Data Warehousing and Data Analytics solutions of the APD. The Department released an amended version, along with a questions and answers document, on 7/3/15, with a proposal due date of 9/3/15. Evaluation of submitted proposals was completed and announcement of Optum Government Solutions was made in late December as the selected vendor. The APD Data Warehousing and Data Analytics contract is currently pending approvals. All RFP and procurement materials are available on the Department's website at http://www.health.ny.gov/funding/rfp/15809/index.htm.
Status of the Regulatory & Governance Process
DOH developed a draft regulation in 2014, and shared it with both the APD Advisory Group and health care industry leaders. Finalization of regulatory language was completed and the package was submitted for agency review and processing on 12/23/2015. The regulatory adoption process will include a public comment period and review by the DOH Public Health and Health Planning Council (PHHPC).
Work has also begun on development of supporting policy documents, including an operations manual, submission specifications, and data release policies and procedures with a fee structure for data users.
After consultation with multiple other states that currently run APCDs utilizing Medicare data, DOH prepared and submitted an application for a Data Use Agreement (DUA) with the Centers for Medicare and Medicaid Services (CMS) to acquire historical extracts of Medicare claims data for all enrollees in New York State. This will add another payer to the APD to enhance the longitudinal analysis of health care provision in the State.
DOH’s development and implementation of the APD also benefits from a study recently completed that was sponsored by the NYS Health Foundation and conducted through the national APCD Council. Using targeted stakeholder interviews and research of other state APCDs, the study provided insight and analysis of challenges and barriers specific to the NYS APD environment, and recommendations for ensuring a quality system that achieves goals and meets stakeholder needs and expectations.
On 12/9/15, DOH held an APD Stakeholder Forum in Albany, NY to provide stakeholders with an update on the progress and status of the system, and to solicit feedback on key issues in design, development and implementation. The APCD Council participated and provided a synopsis of their recently issued report. Copies of the presentation slides from the meeting and a summary of the question and answer sessions can be accessed below.