Got Questions About All-payer Claims Databases?

AAFP FAQ Aims to Educate FPs About Using Claims Data

September 06, 2019 03:25 pm News Staff

What family physician wouldn't like to see his or her state increase the amount of money spent on primary care? Well, one way to gain ground in that fight is to collect and share hard data as proof for the people who create state health care budgets.

[frequently asked questions concept]

One lucrative source of that data can be a state-based all-payer claims database. Unfortunately, fewer than half of all states have created one. In fact, as of 18 months ago, just 16 states had operational APCDs.

A new resource may help level the playing field.

The AAFP has created an FAQ(2 page PDF) to help members understand the importance of these databases. The two-page document, which is available online, also details how individuals can get involved in pushing their states to take action.

Members should know that the FAQ was developed in direct response to a resolution titled "Big Data and Family Medicine" that the Colorado AFP introduced during the AAFP's 2018 Congress of Delegates and that delegates adopted.

The resolution directed the AAFP to take a deeper dive into the topic of all-payer claims databases to identify how these resources could be used to, among other things,

  • assist family physicians in clinical practice,
  • demonstrate the value of family medicine in achieving higher-quality health care at lower costs,
  • help measure the effectiveness of existing primary care value-based payment pilots and
  • quantify the overall current spend on family medicine.

The FAQ first defines APCDs as statewide data repositories for health insurance claims.

"They are used to collect health insurance claims information from the vast majority of health care payers in a state," notes the FAQ.

"Once collected, the data may be released to organizations for projects to study and improve health care outcomes and decrease and/or contain health care costs."

The FAQ also explains how the claims data can be used in a variety of ways, including to

  • provide benchmarks for quality data for payer performance improvement programs, quality scorecards for consumers and mandatory quality improvement reporting for maintenance of certification;
  • demonstrate quality for contract negotiations;
  • benchmark systemwide costs of care that help communities assess their health care costs and address variations across populations; and
  • help states set policy by providing details of their entire health care delivery and payment system.

Specifically, the FAQ notes, building successful campaigns to measure and improve the percentage of a state's health care budget spent on primary care can be an important way for family physicians to use this data.

The FAQ also provides links that help family physicians determine whether their state has an APCD and, if not, how to work with their state legislature to create one.

Readers interested in pursuing the topic further will find contact information for the national APCD Council, the National Association of Health Data Organizations, the National Academy for State Health Policy and the National Conference of State Legislatures included in the FAQ.

Related AAFP News Coverage
Report Examines Benefits of Investing in Primary Care
Authors Parse State Spending Levels, Offer Road Map to Smart Asks

(8/15/2019)

AAFP Advocates for State Primary Care Spending Bills
Legislation in Several States Aims for Greater Investment

(4/24/2019)

2018 Congress of Delegates
FPs Act on Data, Credentialing, Other Hot Topics

(10/16/2018)