Creation of All Payer Claims Database considered
3 February 2012
Del. John O’Bannon, M.D. is championing a bill to establish an All Payer Claims Database (APCD) system in the commonwealth. The APCD is intended to: facilitate data-driven, evidence-based improvements in access, quality and cost of health care through understanding of health care expenditure patterns and operation and performance of the health care system.
The Medical Society of Virginia (MSV) has been actively involved in the drafting of the legislation, HB 343, to ensure that physicians’ concerns about the system’s infrastructure, data submission process, and costs are addressed. Other key stakeholders include the Virginia Hospital and Healthcare Association, the Virginia Association of Health Plans and Virginia Health Information (VHI), a nonprofit organization the commonwealth of Virginia and businesses go to for consumer and business health information.
Under the bill, claims data would be provided by insurers (private, public and third party administrators) for all covered benefits. The VHI Board will provide overall governance of the APCD. MSV currently holds a seat on the VHI Board and would continue to do so. An advisory committee composed of a balanced representation of all stakeholders serving on the governing board would be formed to assist with the formation and operation of the APCD. Under the legislation MSV would appoint an advisory committee member and an alternate.
Development of the APCD would occur in three phases:
- Data reporting related to public health surveillance and population health
- Data reporting for the purpose of cost comparison of specific services and quality of care
- Data reporting for the purpose of design and evaluation of alternative delivery and payment models
The legislation specifies that no provider-specific, facility-specific or carrier-specific reimbursement shall be disclosed or reported. An additional protection MSV achieved for its physicians is that health care providers cannot be assessed any fees to fund the APCD though there would be fees if physicians were to subscribe to or request information from the database.
The Health, Welfare, and Institutions Committee approved the bill unanimously and then referred it to the Appropriations Committee. Negotiations are on-going among stakeholders about how data reporting will work. All committee action on bills must be completed by next week. A similar measure in the Senate, SB 135, introduced by Sen. Toddy Puller, also awaits consideration.
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