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 development and implementation envisioned by 2017. The APD has been developed and administered through a new bureau within the NYSDOH 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 health care claims 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 and costs of care. 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 major 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 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. The New York State Department of Health (DOH) continues to work closely with external stakeholders to gather input on the establishment 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 will collect and edit claims data from numerous health plans. The Data Warehousing Solution will 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 will occur in phases. Since October 2014, 23 New York State of Health Exchange Qualified Health Plans (QHPs) have been submitting test data to the Encounter Intake System. In January 2015, these plans began submitting live medical and pharmacy data. Development is underway for the intake system for Medicaid Managed Care Plans, with live data to be collected by the fall 2015. Collection of production data from large commercial payers will begin in early 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. All RFP materials are available on the Department's website at http://www.health.ny.gov/funding/rfp/15809/index.htm. Potential bidders should thoroughly review all materials before developing any proposals.
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. Steps are now underway to further refine the document and to move through the regulatory process, which will include a public comment period. Work has also begun on development of a framework for data release policies and procedures and a fee structure for data users.
Status of Other Project Components
After consultation with multiple other states that currently run APCDs utilizing Medicare data, DOH is actively preparing an application for a Data Use Agreement (DUA) with the Centers for Medicare and Medicaid Services (CMS).