Mountains of information

A giant database of claims payment information scheduled for rollout this spring is expected to offer a more complete view of how the Virginia health-care marketplace operates.
The Virginia Department of Health (VDH) is developing the state’s first All Payer Claims Database (APCD). The database will collect payment information from every insured health-care encounter in Virginia — from primary care checkups to dentist appointments.

While protecting the privacy of patients, the APCD data is expected to be valuable to anyone involved in buying or selling health care.

“Virginia’s APCD will provide a more comprehensive view of how health care is delivered today,” says Michael Lundberg, the executive director of Virginia Health Information (VHI), the Richmond-based nonprofit that the VDH asked to spearhead the state APDC effort.

“The APCD will allow employers to compare their employees’ health, quality and costs of health care to Virginia, regional and national benchmarks … Once programs are implemented, the APCD can be used to measure the extent to which health-care delivery has improved.” 

Eileen Ciccotelli, vice president of the Virginia Beach-based Virginia Business Coalition on Health (a nonprofit employer group), expects the APCD will give her members a new tool to design health plans and develop employee wellness programs.

“Employers believe in value-based purchasing,” says Ciccotelli. “If you can’t accurately measure the costs of health care, you can’t determine with any real confidence what value it has … The APCD will use data to put a better value on health care.”

On its website, Ciccotelli’s organization outlines the importance of APCDs and their potential value to company owners: “Every health encounter creates a claim for payment. Both public and private insurance plans routinely aggregate these claims data into their own administrative databases. APCDs combine data from all payers in a state, providing statewide information on costs, quality and utilization patterns. As with all data sets, there are limitations with the APCD data, however, capturing information from most — if not all — of the insured encounters in a state can create a powerful information source.”

In addition to aiding employers’ health-care decisions, APCDs will allow hospitals and walk-in clinics to see for the first time how the quality and cost of the care they provide compares with competitors, according to Lundberg. They also will be able to pinpoint, evaluate and monitor any quality improvement initiative they implement, he says.

Meanwhile, health insurance companies will be able to compare their payments to providers with those of their competitors, helping them run their businesses more efficiently and more profitably, Lundberg says.

The APCD’s ongoing collection of so much data also will permit government public health practitioners, lawmakers and health-care activists to map and track illness clusters, monitor trends in disease prevention, diagnosis and treatment, evaluate public health programs, and identify gaps in health-care delivery.

Individual consumers who visit the VHI website — www.vhi.org — can see updated prices for health-care procedures, comparison shop and “make better informed health-care decisions,” Lundberg says.
At press time, fully operational APCDs were active in Maine, New Hampshire, Maryland, Vermont, Oregon, Colorado, Massachusetts, Wisconsin, Utah, Kansas, Minnesota, Tennessee and Washington state, according to Denise Love, executive director of the National Association of Health Data Organizations and a co-leader of the APCD Council, based in Durham, N.H.
In addition to Virginia, five states — Kentucky, Rhode Island, New York, West Virginia and Connecticut — are close to launching  their APCDs, and 16 other states have begun to study their possible development, Love says.
Authorized by the 2012 General Assembly, Virginia’s APCD will cost a little more than $3.2 million to build and develop through its first phase, which will end in June 2015, Lundberg says. The Virginia Hospital and Healthcare Association and the Virginia Association of Health Plans will evenly split 80 percent of the bill, or $2.56 million, while VHI will cover the remaining $640,000.
Beyond 2015, in addition to some ongoing financial support from VDH, a significant portion of the money needed to sustain and develop the APCD will come from the sales of individual reports and ongoing corporate subscriptions. Lundberg says the prices of those services have not yet been determined.

The work of compiling health insurance claims filed in Virginia since January 2011 began in October. The first version of the APCD will be ready for public release in “late spring,” according to Lundberg, who says APCD data will be refreshed quarterly. The database eventually will contain an estimated “4.5 billion lines of claims data,” Lundberg says.

Like Wisconsin and Washington state, data contributions from insurance companies operating in Virginia will be voluntary.  The insurers now participating in the project include Aetna, Anthem Blue Cross and Blue Shield, Carefirst (Group Hospitalization and Medical Services Inc.), Cigna, InTotal Health, Kaiser Permanente, Optima Health, United Healthcare and Virginia Premier.

Lundberg says the state’s Department of Medical Assistance Services, which processes Medicaid payments for low-income Virginians, is contributing its claims information to the APCD.

He adds that “ongoing conversations” are taking place with the federal government to include claims information from Medicare and TriCare, the program that helps the Department of Defense provide civilian health benefits for active U.S. military personnel, military retirees and their dependents.

Also ongoing is an effort by VHI and the VBHC to get companies that self-insure to authorize their third-party administrators to contribute payments information to the APCD.

Laurens Sartoris, president of the Virginia Hospital and Healthcare Association, says the APCD’s usefulness will grow over time. “I think the principal value will be all the added transparency, but this is not going to happen overnight,” he says. “As the amount of data builds, as all the stakeholders begin to participate more, the value to everyone will be more and more apparent.”