Thursday, June 30, 2011

New York State’s Proposed All-Payer Database: APD

The New York State Department of Health (DOH) is developing an all-payer database (APD) for New York State. The database will serve as a repository of claims data drawn from all major public and private payers which may also be combined with clinical and public health data sources. APDs support state-level health care reform efforts by providing powerful tools to evaluate critical issues such as regional variations in utilization, quality, and cost. In addition, APDs are used to examine the impact of reimbursement methodologies, public health interventions, and health care resources on utilization, quality, outcomes, and/or costs. When this data is publicly available, consumers will have the tools they need to compare price and quality for important health care decisions. APDs may be a valuable tool in assessing the impact of various delivery system reforms and payment innovations encouraged by federal health care reform.

To date, nine states have created APDs: Kansas, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, Tennessee, Vermont, and Utah. Three additional states are in the process of implementation, and fourteen states have either taken initial steps toward creating an APD, or established a voluntary system.

Recently, New York enacted legislation for the creation of an APD. New York’s APD legislation builds on the existing Statewide Planning and Research Cooperative System (SPARCS), which collects clinical and demographic data concerning hospital discharges, emergency department visits, and certain ambulatory surgery and clinic visits. The new APD system may be developed within SPARCS or as a separate entity. It will include claims data related to inpatient, outpatient, emergency department, laboratory, pharmacy, and other health care services. The legislation authorizes New York to participate in a similar system operated by a regional or national entity or another jurisdiction. The bill is widely supported by members in both houses of the legislature and has been included in the 2011-2012 New York State Budget.

Currently, the project is in the initial planning phase. On Tuesday, June 7, 2011, the New York State Health Foundation, in collaboration with Commissioner Nirav Shah and the New York State Department of Health, hosted a working discussion regarding the establishment of the database. Various healthcare stakeholders throughout the state participated and provided valuable ideas about how to proceed. The Office for Health IT Transformation prepared an inventory of the existing data resources in New York that utilize payer data which was discussed at the meeting as well. These databases include SPARCS, FAIR Health, New York Quality Alliance (NYQA), and a state funded project in the Adirondacks.

The group began to discuss the governance, policies, and technical requirements of the system. Based on their input, DOH will reach out to a larger group of stakeholders to create a roadmap for implementation and potential funding sources and requirements, as well as a framework for an overall architecture model. In addition, a cross-cutting group within DOH will begin work on the regulations described in the legislation which will address the collection and use of the data as well as provisions to protect patient privacy.

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