Abstract
State policy makers are under increasing pressure to address the prohibitive cost of health care given the lack of action at the federal level. In 2020, the United States spent more on health care than any other country in the world—$4.1 trillion, representing 19.7% of the nation’s gross domestic product. States are trying to better understand their role in health care spending and to think creatively about strategies for addressing health care cost growth. One way they are doing this is through the development and use of state-based all-payer claims databases (APCDs). APCDs are health data organizations that hold transactional information from public (Medicare and Medicaid) and private health insurers (commercial plans and some self-insured employers). APCDs transform this data into useful information on health care costs and trends. This article describes states’ use of APCDs and recent efforts that have provided benefits and challenges for states interested in this unique opportunity to inform health policy. Although challenges exist, there is new funding for state APCD improvements in the No Surprises Act, and potential new federal interest will help states enhance their APCD capacity so they can better understand their markets, educate consumers, and create actionable market information.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 93-115 |
| Number of pages | 23 |
| Journal | Journal of health politics, policy and law |
| Volume | 48 |
| Issue number | 1 |
| DOIs | |
| State | Published - Feb 1 2023 |
Bibliographical note
Funding Information:The authors are grateful for the thoughtful comments from the reviewers and the editors that made this a much better article. We also would like to acknowledge the work of State Health and Value Strategies and their continued health policy work with the states and the funding from the Robert Wood Johnson Foundation that they provide to the State Health Access Data Assistance Center. The views presented are those of the authors only.
Funding Information:
The federal government has also played a significant role in financing state APCDs. Federal funds have flowed in a variety of ways, often without a cohesive plan or oversight. For example, states have used funds from the Affordable Care Act Rate Review Grant Program, funded by the Center for Consumer Information and Insurance Oversight (SHADAC 2014), and from the Center for Medicare and Medicaid Innovation State Innovation Model (RTI International n.d.) for APCD development. States have also funded a portion of their APCD activity through the Medicaid program, including using existing waiver authority (Klabunde 2019). Medicaid federal matching funds are allowable for costs associated with Medicaid’s functional business requirements (HHS 2016). Rhode Island used an enhanced Medicaid match (90% match in the first year and 75% match in the following four years) to establish its APCD as part of its Medicaid information technology system (Bernstein and Paulson 2018). Colorado’s APCD is partially financed by Medicaid (50% match) to support evaluation of Medicaid utilization, costs, and trends (Bernstein and Paulson 2018). A key point here is that historically there has been no
Publisher Copyright:
© 2023 by Duke University Press.
Keywords
- APCDs
- Medicaid
- Medicare
- health care costs
PubMed: MeSH publication types
- Journal Article
