All Payer Database

Introduction

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?

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, and leverage that success to promote similar activities;
  • Evaluate reform efforts to identify and duplicate successful initiatives, and identify opportunities for reform
Health Plans
  • Measure and collect data related to safety, quality, utilization, health outcomes, and cost;
  • Evaluate programs, implement new innovations and expand upon successful programs;
  • Promote or incentivize higher quality and lower cost treatments or refine reimbursement models;
  • 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 reporting access to information to enable better negotiations.
Providers
  • Reduce recording burden due to transition to a coordinated data set;
  • Improve treatment quality through a coordinated feedback loop and performance benchmarking;
  • Strengthen quality measurement, and provide tools that help providers better manage their entire panel of patients.
Researchers
  • Evaluate costs, quality, efficiency, patient satisfaction indicators across different models, settings, geographic areas and patient populations;
  • Analyze treatment options across a broader cross-section of patients- spread across age, gender, ethnicity, exploring what subgroups of patients respond best to each treatment;
  • Generate reports to inform clinical policies, training and legislation;
  • Identify gaps in existing treatment methodologies and the needs of clinical practice
  • Determine variations in costs of health care services across regions and influence policy to promote equity.
Consumers
  • Empower consumers to make informed decisions on health plans and providers through access to valuable information about their health care treatment options and to compare quality, cost, and efficiency among potential insurers.

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.

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), 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

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.


ADP Strategy

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 Intake Solution

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. Information is available under the Grants/Funding Opportunities portion of the DOH public website at http://www.health.ny.gov/funding/.

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).

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