All Payer Database

Introduction

New York State enacted legislation in the spring of 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. The APD will support 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 (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 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.

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 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.

Questions an APD Can Help Answer

  • Which hospitals have the highest prices?
  • What parts of the state have better access to specialists?
  • What is the total cost of care?
  • What is the prevalence of diabetes?

Stakeholder Benefits

STAKEHOLDER BENEFIT
State Policy Makers/Public Health
  • Enable targeted public health initiatives and interventions based on strategic assessment of health care disparities;
  • Identify high-performing communities that provide cost-effective care, leverage that success to promote similar activities;
  • Evaluate reform efforts to identify and duplicate successful initiatives, identify opportunities for reform.
Health Plans
  • Evaluate programs and implement new programs or expand upon successful programs;
  • Promote or incentivize higher quality and lower cost treatments or refine reimbursement models;
  • Measure and collect data related to safety, quality, utilization, health outcomes, and cost;
  • Modify contracts with providers in a geographic location based on the health needs of that area;
  • Compare health care facilities and providers, quality, and cost.
Employers
  • Empower businesses to design insurance products and select providers based on quality, cost, and efficiency;
  • Benchmark performance compared to peers-comparing cost and covered services of health insurance policies;
  • Provide access to information to enable better negotiations.
Providers
  • Reduce burden due to transition to a coordinated data set;
  • Improve treatment quality improvement due to a coordinated feedback loop and performance benchmarking;
  • Strengthen quality measurement, and provide tools so that providers can better manage their entire panel of patients.

The initial focus 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.

ADP 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), in the long term it will be possible for the APD to provide a more complete repository of information for all participants in the health care system from policy makers to clinicians to consumers.

Strategy

DOH has been working 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 the APD Steering Committee and DOH continues to inform stakeholders of progress through this site and the APD listserv.

The Department's approach to the development of the APD focuses on three solutions. The Data Intake Solution will collect and edit claims data from numerous health plans. The Data Warehousing Solution will store the data that is 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.

ADP Strategy

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