Understanding All-Payer Claims Databases: Unlocking Insights into Health Care

Kentucky is not known for being one of the country’s healthier states. When you look at the rate of adults with multiple chronic conditions- we have some of the worst statistics in the country. It’s a similar story for the rate of premature deaths. In order to tackle health issues in our state, we need thorough data. 

We can’t fix what we don’t know. The world of health care is complex, with multiple players involved in delivering and financing care. We need to know exactly what health care services Kentuckians are receiving and how much those services cost. What’s available now in that arena- only scratches the surface. Fortunately, an All-Payer Claims Database (APCD) is a tool that can help close that gap.

So, what is an APCD?

Every time someone receives medical care or gets a prescription- there is a cost. In many cases, that means an insurance company is going to get a claim from the health care provider or pharmacist. An APCD collects and stores that data. It can include information from health insurance companies, government programs, self-insured employers, and other payers, thus covering a wide range of healthcare services delivered to individuals.

We need to be able to see the whole picture to be able to make the right decisions. Having all that data in one place where it can be analyzed and compared- is necessary to achieve better health for Kentuckians. By collecting records from multiple payers and across the entire spectrum of care, an APCD provides policymakers, researchers, and healthcare organizations with valuable insights that can inform decision-making and improve the overall quality and affordability of health care. As a comprehensive and detailed database, an APCD allows us to create change based on evidence and not educated guesses or conventional wisdom.

What it’s not…

An APCD is not a way to pry into the personal details of someone’s health. APCDs have strict safeguards and regulations in place to protect patient privacy. The data is usually anonymized before being made available for analysis, ensuring confidentiality while still allowing for valuable insights.

Everyone benefits from an APCD.

Let’s use hospitals as an example. By providing comprehensive data on healthcare utilization and costs, an APCD can help hospitals to identify areas where they may be overutilizing resources or providing low-value care. This information can guide hospitals to find ways to operate more efficiently and reduce unnecessary costs. This information can also help hospitals develop targeted interventions to improve patient outcomes.

There are also many benefits to the payers themselves. An APCD allows payers to benchmark their own performance against competing commercial payers and against public programs. And in the long term – when we are able to use the data from an APCD to make advances in the health of the state – it will save the payers money because it costs less to take care of healthier people.

But most importantly… when hospitals, payers, policymakers, and other stakeholders are able to use the data provided from an APCD, Kentuckians win. With the complete picture provided by an APCD, people can make more informed choices and receive higher-quality care.  

Want to learn more about APCDs? Check our our Health for a Change webinar on the topic.