All-Payer Claims Databases Measurement of Care: Systematic Review and Environmental Scan of Current Practices and Evidence

References

1. Porter J, Love D, Peters A, et al. The basics of all-payer claims databases: a primer for states. Robert Wood Johnson Foundation;.January 2014. http://www.rwjf.org/en/library/research/2014/01/the-basics-of-all-payer-claims-databases--a-primer-for-states.html. Accessed February 3, 2017.

2. Bridges JFP, Berger Z, Austin M, et al. Public reporting of cost measures in health: an environmental scan of current practices and assessment of consumer centeredness. Technical Brief No. 19 (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No.290-2012-00007-I). Rockville, MD: Agency for Healthcare Research and Quality; March 2015. AHRQ Publication No. 15-EHC009-EF. http://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=2053. Accessed February 3, 2017.

3. Peters A, Sachs J, Porter J, et al. The value of all-payer claims databases to states. N C Med J 2014;75(3):211-3. https://www.ncbi.nlm.nih.gov/pubmed/24830498. Accessed February 3, 2017.

4. Price transparency: an essential building block for a high-value, sustainable health care system. Berkeley, CA: Catalyst for Payment Reform; 2013. http://www.nbch.org/nbch/files/ccLibraryFiles/Filename/000000002494/PriceTransparency%20Action%20Brief%20-%20FINAL%2011%201%2012.pdf. Accessed June 20, 2017.

5. Colla CH, Schpero WL, Gottlieb DJ, et al. Tracking spending among commercially insured beneficiaries using a distributed data model. Am J Manag Care 2014;20(8):650-7. https://www.ncbi.nlm.nih.gov/pubmed/25295679. Accessed February 3, 2017.

6. Newhouse JP, Garber AM, Graham RP, et al., eds. Variation in health care spending: target decision making, not geography. Washington, DC: Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care, Board on Health Care Services, Institute of Medicine; 2013. https://www.nap.edu/catalog/18393/variation-in-health-care-spending-targ.... Accessed February 3, 2017.

7. Chernew ME, Sabik LM, Chandra A, et al. Geographic correlation between large-firm commercial spending and Medicare spending. Am J Manage Care 2010;16(2):131-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322373/. Accessed February 3, 2017.

8. Miller PB, Love D, Sullivan E, et al. All-payer claims databases: an overview for policymakers. Washington, DC: State Coverage Initiatives, AcademyHealth, and Robert Wood Johnson Foundation; May 2010. http://www.statecoverage.org/node/2380.html. Accessed February 3, 2017.

9. Pollack CE, Hussey PS, Rudin RS, et al. Measuring care continuity: a comparison of claims-based methods. Med Care 2016 May;54(5):e30-4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4101051/. Accessed February 3, 2017.

10. Aligning Forces for Quality. Glossary. Defining the problem: cost and price transparency. Princeton, NJ: Robert Wood Johnson Foundation; November 2011. http://forces4quality.org/node/4376.html. Accessed February 3, 2017.

11. Baker L, Bundorf MK, Royalty A. Private insurers' payments for routine physician office visits vary substantially across the United States. Health Aff (Millwood) 2013;32(9):1583-90. http://content.healthaffairs.org/content/32/9/1583. Accessed February 3, 2017.

12. Fisher ES, Weiss K. Measurement framework: evaluating efficiency across patient-focused episodes of care. Washington, DC: National Quality Forum; 2010. http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=25912. Accessed February 3, 2017.

13. Hornbrook MC, Hurtado AV, Johnson RE. Health care episodes: definition, measurement and use. Med Care Rev 1985;42(2):163-218.

14. Romano P, Hussey P, Ritley D. Selecting quality and resource use measures: a decision guide for community quality collaboratives. (Prepared under Contract No./Assignment No. 08003967.) Rockville, MD: Agency for Healthcare Research and Quality; May 2010. AHRQ Publication No. 09(10)-0073. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/perfmeasguide/index.html. Accessed February 3, 2017.

15. AAPC. What is CPT®? https://www.aapc.com/resources/medical-coding/cpt.aspx. Accessed February 3, 2017.

16. Wharton, University of Pennsylvania. Glossary: Health Care Purchaser. http://kwhs.wharton.upenn.edu/term/health-care-purchaser/. Accessed February 3, 2017.

17. Boodman SG. "Facility fees" are surprise cost for many patients. Kaiser Health News 2009 Oct 6. http://kaiserhealthnews.org/news/fees/. Accessed February 3, 2017.

18. Ross JS, Siu AL. The importance of population-based performance measures. Health Serv Res 2007;42(1 Pt 1):1-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955236/. Accessed February 3, 2017.

19. Goodman RA, Posner SF, Huang ES, et al. Defining and measuring chronic conditions: imperatives for research, policy, program, and practice. Prev Chronic Dis 2013 Apr 25;10:E66. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3652713/. Accessed February 3, 2017.

20. Ginsburg PB. Shopping for price in medical care. Health Aff (Millwood) 2007;26(2):w208-16. http://content.healthaffairs.org/content/26/2/w208.long. Accessed February 3, 2017.

21. Gross K, Brenner JC, Truchil A, et al. Building a citywide, all-payer, hospital claims database to improve health care delivery in a low-income, urban community. Popul Health Manage 2013;16 Suppl 1:S20-5. https://www.ncbi.nlm.nih.gov/pubmed/24070246. Accessed February 3, 2017.

22. Dalal AA, Liu F, Riedel AA. Cost trends among commercially insured and Medicare Advantage-insured patients with chronic obstructive pulmonary disease: 2006 through 2009. Int J Chron Obstruct Pulmon Dis 2011;6:533-42. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206770/. Accessed February 3, 2017.

23. Mehrotra A, Liu H, Adams JL, et al. Comparing costs and quality of care at retail clinics with that of other medical settings for 3 common illnesses. Ann Intern Med 2009;151(5):321-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805258/. Accessed February 3, 2017.

24. Kullgren JT, Duey KA, Werner RM. A census of state health care price transparency websites. JAMA 2013;309(23):2437-8. https://www.ncbi.nlm.nih.gov/pubmed/23780454. Accessed February 3, 2017.

25. Rosenthal JA, Lu X, Cram P. Availability of consumer prices from US hospitals for a common surgical procedure. JAMA Intern Med 2013;173(6):427-32. https://www.ncbi.nlm.nih.gov/pubmed/23400757. Accessed February 3, 2017.

26. Sinaiko AD, Eastman D, Rosenthal MB. How report cards on physicians, physician groups, and hospitals can have greater impact on consumer choices. Health Aff (Millwood) 2012;31(3):602-11. http://content.healthaffairs.org/content/31/3/602.long. Accessed February 3, 2017.

27. Love D, Custer W, Miller P. All-payer claims databases: state initiatives to improve health care transparency. Issue Brief (Commonw Fund). 2010 Sep;99:1-14. PMID:20830868. http://www.commonwealthfund.org/publications/issue-briefs/2010/sep/all-payer-claims-databases. Accessed February 3, 2017.

28. Health Policy Snapshot: Health Care Costs. Issue Brief. What’s the price of health care? Princeton, NJ: Robert Wood Johnson Foundation; August 2012. http://www.rwjf.org/en/library/research/2012/08/what-s-the-price-of-health-care-.html. February 3, 2017.

29. . Massachusetts payment reform. the role of a robust Massachusetts all-payer claims database: recommendations for policymakers. Burlington, MA: Massachusetts Hospital Association; October 2011. http://www.mhalink.org/AM/Template.cfm?Section=Newsroom&Template=/CM/ContentDisplay.cfm&ContentID=17268. Accessed February 3, 2017.

30. 2007-2011 Vermont Health Care Cost and Utilization Report. Washington, DC: Health Care Cost Institute; December 2014. http://www.healthcostinstitute.org/report/2007-2011-vermont-health-care-cost-utilization-report/. Accessed February 3, 2017.

31. A commercial insurance study of vaginal delivery and cesarean section rates at New Hampshire hospitals. Concord: New Hampshire Insurance Department; April 1, 2011. http://www.nh.gov/insurance/reports/documents/commins_stdy_delivery.pdf. Accessed February 3, 2017.

32. Report on patient contributions to medical expenses. Concord: New Hampshire Insurance Department; May 19, 2008. http://www.nh.gov/insurance/media/bulletins/2008/documents/nhid-memliab_rpt.pdf. Accessed February 3, 2017.

33. Tu H, Gourevitch R. Moving markets: lessons from New Hampshire’s health care price transparency experiment. Oakland: California Health Care Foundation; 2014. http://www.chcf.org/publications/2014/04/moving-markets-new-hampshire. Accessed February 3, 2017.

34. Health care price transparency: meaningful price information is difficult for consumers to obtain prior to receiving care. Washington, DC: U.S. Government Accountability Office; September 2011. http://www.gao.gov/assets/590/585400.pdf. Accessed February 3, 2017.

35. PBGH Policy Brief: Price transparency. San Francisco: Pacific Business Group on Health; August 2013. http://www.pbgh.org/storage/documents/Policy_brief_transparency_2013.pdf. Accessed February 3, 2017.

36. TrendWatch. Price transparency efforts accelerate: what hospitals and other stakeholders are doing to support consumers. Washington, DC: American Hospital Association; July 2014. http://www.aha.org/research/reports/tw/14july-tw-transparency.pdf. Accessed February 3, 2017.

37. Painter MW, Chernew ME. Counting change: measuring health care prices, costs, and spending. Princeton, NJ: Robert Wood Johnson Foundation; March 2012. http://www.rwjf.org/en/library/research/2012/03/counting-change.html. Accessed February 3, 2017.

38. Lasser KE, Hanchate AD, McCormick D, et al. The effect of Massachusetts health reform on 30 day hospital readmissions: retrospective analysis of hospital episode statistics. BMJ 2014 Mar 31;348:g2329. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970763/. Accessed February 3, 2017.

39. Yegian JM, Dardess P, Shannon M, et al. Engaged patients will need comparative physician-level quality data and information about their out-of-pocket costs. Health Aff (Millwood) 2013;32(2):328-37. http://content.healthaffairs.org/content/32/2/328.long. Accessed February 3, 2017.

40. Sinaiko AD, Rosenthal MB. Increased price transparency in health care—challenges and potential effects. New Engl J Med 2011;364(10):891-4. http://www.nejm.org/doi/full/10.1056/NEJMp1100041. Accessed February 3, 2017.

41. Hibbard JH, Greene J, Sofaer S, et al. An experiment shows that a well-designed report on costs and quality can help consumers choose high-value health care. Health Aff (Millwood) 2012;31(3):560-8. http://content.healthaffairs.org/content/31/3/560.long. Accessed February 3, 2017.

42. Lence CT. Health care price transparency for consumers: a review of original and prior research on best practices for the development of state-based web resources. (developed under the Grants to States to Support Health Insurance Rate Review and Increase Transparency in Health Care Pricing - Cycle III, Federal Grant Number 1 PRPPR140059-01-00.) Salt Lake City, UT: HealthInsight; July 2014. http://healthinsight.org/Internal/docs/upv/pt_consumers.pdf. Accessed February 3, 2017.

43. Bringing data to life: issues in empowering consumers to choose higher value health care. Denver, CO: Center for Improving Value in Health Care; August 2012.

44. Hollingsworth JM, Saigal CS, Lai JC, et al. Medicare payments for outpatient urological surgery by location of care. J Urol 2012;188(6):2323-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008316/. Accessed February 3, 2017.

45. Hollingsworth JM, Saigal CS, Lai JC, et al. Surgical quality among Medicare beneficiaries undergoing outpatient urological surgery. J Urol 2012;188(4):1274-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3697119/. Accessed February 3, 2017.

46. Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q 1966;44(3):Suppl:166-206.

47. Green L, Lischko A, Bernstein T. Realizing the potential of all-payer claims databases: creating the reporting plan. Princeton, NJ: Robert Wood Johnson Foundation; January 2014. http://statenetwork.org/wp-content/uploads/2014/11/RWJF_SHVS_RealizingPotentialAllPayerClaimsDatabases1.pdf. Accessed February 3, 2017.

48. Mehrotra A, Hussey PS, Milstein A, et al. Consumers’ and providers’ responses to public cost reports, and how to raise the likelihood of achieving desired results. Health Aff (Millwood) 2012;31(4):843-51. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726186/. Accessed February 3, 2017.

49. Hoy T, Singhal PK, Willey VJ, et al. Assessing incidence and economic burden of genital warts with data from a US commercially insured population. Curr Med Res Opin 2009;25(10):2343-51. https://www.ncbi.nlm.nih.gov/pubmed/19650749. Accessed February 3, 2017.

50. Maine Department of Health and Human Services. Using an APCD to inform healthcare policy, strategy, and consumer choice: Maine’s experience.Medicaid Enterprise Systems Conference; Boston, MA; 22 Aug 2012. http://mesconference.org/wp-content/uploads/2012/08/wednesday_cms-data-analytics_leonard.pdf. Accessed February 3, 2017.

51. Brannen T. New Hampshire acute care hospital comparison: a commercial insurance relative cost comparison. Concord: New Hampshire Insurance Department; August 27, 2008. http://www.nh.gov/insurance/consumers/documents/nh_ac_hosp_comp.pdf. Accessed February 3, 2017.

52. Jacobson DM, Teutsch S. An environmental scan of integrated approaches for defining and measuring total population health by the clinical care system, the government public health system and stakeholder organizations. Commissioned Paper. Washington, DC: National Quality Forum; June 2012. http://www.qualityforum.org/Publications/2012/06/An_Environmental_Scan_of_Integrated_Approaches_for_Defining_and_Measuring_Total_Population_Health.aspx. Accessed February 6, 2017.

53. All-payer claims database developmental manual: establishing a foundation for health care transparency and informed decision making. Durham, NH: APCD Council; February 2015; https://www.apcdcouncil.org/manual. Accessed February 6, 2017.

54. McDowell I, Spasoff RA, Kristjansson B. On the classification of population health measurements. Am J Public Health 2004;94(3):388-93. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448263/. Accessed February 6, 2017.

55. Hibbard JH. What can we say about the impact of public reporting? Inconsistent execution yields variable results. Ann Intern Med 2008;148(2):160-1. http://annals.org/aim/article/739013/what-can-we-say-about-impact-public-reporting-inconsistent-execution [abstract]. Accessed February 6, 2017.

56. Anderson KM, Cacchione J. Evaluating episode groupers: a report from the National Quality Forum. Washington DC: National Quality Forum; September 2014. http://www.qualityforum.org/Publications/2014/09/Evaluating_Episode_Groupers__A_Report_from_the_National_Quality_Forum.aspx. Accessed February 6, 2017.

57. Vera-Llonch M, Weycker D, Glass A, et al. Healthcare costs in women with metastatic breast cancer receiving chemotherapy as their principal treatment modality. BMC Cancer 2011;11:250. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3141771/. Accessed February 6, 2017.

58. Agency for Healthcare Research and Quality. National Quality Measures Clearinghouse. http://www.qualitymeasures.ahrq.gov/. Accessed February 6, 2017.

59. HEDIS Quality Measures. Summary of Measures, Product Lines and Changes. Washington, DC: National Committee for Quality Assurance; 2015. http://www.ncqa.org/Portals/0/HEDISQM/Hedis2015/List_of_HEDIS_2015_Measures.pdf. Accessed February 6, 2017.

60. National Committee for Quality Assurance. Relative Resource Use. http://www.ncqa.org/HEDISQualityMeasurement/HEDISandQualityMeasureImprovement/HEDISandRelativeResourceUseRRU.aspx. Accessed February 6, 2017.

61. How NCQA Calculates the RRU Quality Index. Washington, DC: National Committee for Quality Assurance; 2014. http://www.ncqa.org/Portals/0/HEDISQM/RRU/2014/HowNCQAcalculatesQualityIndicesforRRU_HEDIS2015_Final.pdf. Accessed February 6, 2017.

62. Cost-of-care measurement development. Washington, DC: Quality Alliance Steering Committee; 2011.

63. HealthPartners. Total Cost of Care. https://www.healthpartners.com/public/tcoc/. Accessed February 6, 2017.

64. Collecting Health Data: All-Payer Claims Databases. Health Cost Containment and Efficiencies. NCSL Briefs for State Legislators. Washington, DC: National Conference of State Legislatures; May 2010. http://www.ncsl.org/portals/1/documents/health/ALL-PAYER_CLAIMS_DB-2010.pdf. Accessed February 6, 2017.

65. Recommendations for Collecting Payer Information on Plan Benefit Design and Payments to Providers for Non-Claims based services. Report to the Maryland Health Commission. Durham, NH: APCD Council, University of New Hampshire, NAHDO; September 2014. https://www.apcdcouncil.org/publication/recommendations-collecting-payer-information-plan-benefit-design-and-payments-providers. Accessed February 6, 2017.

66. Rexford J, Andrews E, Shipley B. The power of data: consumer involvement and accountability for Connecticut’s all payer claim database (APCD). Report of recommendations. Hartford: Connecticut Health Foundation; 2013. http://www.cthealth.org/news-publications/news/the-front-lines-of-health-reform/paving-the-road-from-uninsured-to-insured-with-health-equity/report-the-power-of-data-consumer-involvement-and-accountability-for-connecticuts-all-payer-claim-database-apcd/. Accessed February 6, 2017.

67. Ricards J, Blewett L. Making use of all-payer claims databases for health care reform evaluation. (Prepared under Contract No. HHSP23320100024WI to the Office of Assistant Secretary for Planning and Evaluation.) Minneapolis, MN: State Health Access Data Assistance Center, University of Minnesota; July 2014. http://www.shadac.org/publications/making-use-all-payer-claims-databases-health-care-reform-evaluation. Accessed February 6, 2017.

68. McHugh C, Cutler J. Report of the LD 1818 Work Group to evaluate options and actions available to improve the availability of and access to health care data and to examine the all-payor claims database system in Maine. Augusta, ME: LD 1818 Work Group; February 23, 2013. http://www.maine.gov/hit/ld_1818/documents/ld1818workinggroupfinalreport2242013.pdf. Accessed February 6, 2017.

69. APCD Analytic Workgroup. Efforts to enhance data quality assurance. Boston, MA: Center for Health Information and Analysis; October 18, 2011.

70. History of APCD Council harmonization efforts. Durham, NH: APCD Council; October 2011. https://www.apcdcouncil.org/publication/history-apcd-council-harmonization-efforts. Accessed February 6, 2017.

71. Luft HS. Advancing public reporting through a new “‘aggregator”‘ to standardize data collection on providers’ cost and quality. Health Aff (Millwood) 2012;31(3):619-26. http://content.healthaffairs.org/content/31/3/619.long. Accessed February 6, 2017.

72. Higgins A, Zeddies T, Pearson SD. Measuring the performance of individual physicians by collecting data from multiple health plans: the results of a two-state test. Health Aff (Millwood) 2011;30(4):673-81. http://content.healthaffairs.org/content/30/4/673.long. Accessed February 6, 2017.

73. Overview of the Massachusetts all payer claims database. Boston, MA: Center for Health Information and Analytics; September 2016. Publication Number: 16-258- CHIA. http://www.chiamass.gov/assets/docs/p/apcd/APCD-White-Paper-2016.pdf. Accessed February 6, 2017.

74. Institute of Medicine; Roundtable on Value and Science-Driven Health Care; Alper J, Sanders J, Saunders R. Core Measurement Needs for Better Care, Better Health, and Lower Costs: Counting What Counts: Workshop Summary. Washington DC: National Academies Press; August 2013. https://www.nap.edu/catalog/18333/core-measurement-needs-for-better-care-better-health-and-lower-costs. Accessed February 6, 2017.

75. Christianson JB, Volmar KM, Alexander J, et al. A report card on provider report cards: current status of the health care transparency movement. J Gen Intern Med 2010;25(11):1235-41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2947645/. Accessed February 6, 2017.

76. Levit KR, Friedman B, Wong HS. Estimating inpatient hospital prices from state administrative data and hospital financial reports. Health Serv Res 2013;48(5):1779-97. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3796114/. Accessed February 6, 2017.

77. Speir AM, Kasirajan V, Barnett SD, et al. Additive costs of postoperative complications for isolated coronary artery bypass grafting patients in Virginia. Ann Thorac Surg 2009;88(1):40-6. http://www.annalsthoracicsurgery.org/article/S0003-4975(09)00576-1/abstract. Accessed February 6, 2017.

78. Ash AS, Ellis RP. Risk-adjusted payment and performance assessment for primary care. Med Care 2012;50(8):643-53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394905/. Accessed February 6, 2017.

79. Risk adjustment definitions and methodology: key information for the Colorado APCD. Denver, CO: Center for Improving Value in Health Care; 2013. https://www.comedprice.org/view/about/content/RiskAdjustment.pdf. Accessed February 6, 2017.

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Internet Citation: References. Content last reviewed June 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/apcd/envscan/references.html