What is an APCD?
An All-Payer Claims Database (APCD) is a centralized statewide repository of claims data from public payers (Medicare, Medicaid, state employees and retiree benefit plans) and private payers (group and individual commercial or employer-sponsored commercial health plans). An APCD also includes eligibility and other publicly available data to create a comprehensive, longitudinal multi-payer dataset in order to provide the greatest opportunities for improving the health care delivery system. Most states mandate that payers submit data to their APCD to the extent allowed by law. Many states also encourage voluntary submissions of data. Eighteen states currently have established APCDs to provide transparency of healthcare costs and variability in utilization and services, and to identify wasteful healthcare spending on care that is not supported by evidence-based guidelines. Another eight states are in the process of implementing APCDs (including Georgia).
Some states have established public websites to illuminate price variations for procedures and other services across provider organizations within the state. Some state APCDs also combine clinical quality measurement data with claims data to inform value-based healthcare purchasing by consumers, employers, state Medicaid agencies, and other payers.
About the Georgia APCD
Senate Bill 482, passed in 2020, called on OHSC to create and implement an All-Payer Claims Database in Georgia, to be administered by the Georgia Tech Research Institute Center for Health Analytics and Informatics (GTRI-CHAI). Funding was provided for OHSC in the FY 2022 Appropriations Act, and Director Grant Thomas was appointed in June, 2021.
When the legislature passed SB482, a set of key goals were identified for the program:
- Establishing baseline health care cost information;
- Monitoring and analyzing health care costs;
- Assessing population health;
- Measuring utilization of health care services;
- Identifying health disparities;
- Informing consumers of cost and quality of health care;
- Supporting the planning and evaluation of health care operations and care;
- Improving coordination of care;
- Enabling oversight of health insurance premium medical loss ratios; and
- Conducting waste, fraud, and abuse studies.
In alignment with these goals, Georgia’s APCD will allow public and private health care purchasers and consumers to identify and compare: health plans, health insurers, health care facilities, and health care practitioners which provide safe, value-based, cost-effective, high quality healthcare services. It will promote cost and quality transparency, assess geographic variations in price and utilization, track healthcare spending drivers and trends, and promote public health.
What the APCD is Not
There are common misconceptions about what an APCD is and is not, so it is important to clarify that an APCD is not:
- an electronic health record
- another system that providers have to input data into
- a repository of identifiable individuals
- a repository of people that have consumed specific services, such as behavioral/mental health or substance abuse services
