Metro

R.I. introduces health care claims database

R.I. encourages health insurers to submit electronically stored claims for analysis

By
Staff Writer
Tuesday, April 22, 2014

The Rhode Island All-Payer Claims Database will require all private and public health insurers and administrators in the state to submit eligibility and medical and pharmacy claims data beginning next month. By analyzing this data for patterns and statistical significance, the program seeks to cut health costs and improve the quality of health care within the state.

Twelve other states have already implemented APCD programs.

The General Assembly passed legislation approving the APCD in 2008, but the law did not provide funding for the Rhode Island Department of Health to advance the project at the time. Funds from federal grants have been used to implement initial phases, and partnering agencies — Medicaid, the Health Insurance Exchange, the Office of the Health Insurance Commissioner and RIDOH — will contribute sources of funding for future operations, according to the APCD Council’s website.

Jennifer Wood ’81, chief of staff for Lt. Governor Elizabeth Roberts ’78, said the cost of the database stems more from security and accuracy maintenance than from the data collection process.

Health insurers electronically store the claims data, which they then submit to the database. But insurers will remove any personally identifiable information, such as names and addresses, to ensure anonymity among data sets. Rhode Islanders will also have the option to opt out of participating in the database. These measures were implemented in order to increase public confidence in the confidentiality and security of the system, Wood said.

“There are some people who are simply not comfortable having their claims data go anywhere outside their insurance company no matter how many layers of protection there are,” she added.

“I don’t think there are any good reasons” to opt out of the database, said Ira Wilson, professor and chair of the Department of Health Services, Policy and Practice. “The only reason would be … you don’t trust the state to be able to protect your confidentiality.”

No more than 1 to 2 percent of potential participants in national APCD programs request to opt out because of the privacy assured with the anonymous data, Wood said.

APCD implementation in Rhode Island arose from a lack of data about physician care and outpatient treatment, said Denise Love, executive director at the National Association of Health Data Organizations and co-chair of the APCD Council.

“The state started realizing we don’t have a clue what’s happening in the outpatient arena outside of Medicaid,” she added.

The APCD will give Rhode Island a source of data to manage its health care decisions, as well as provide context for cost comparison at the individual level, Love said. “When you don’t have the larger database, you don’t know the scope of everything.”

Wood said the APCD will begin to generate its first aggregate reports by next fall or early winter, adding that the reports will include information such as the overall costs of health care within the state, comparative costs of different categories of medical and disease treatments and unexpected costs that need to be addressed.

The APCD Council has met with researchers at the School of Public Health to discuss how the database can be most useful for academic researchers and government policymakers, Wood said.

“This isn’t simply a government database used to help us develop policies for health insurance regulation and Medicaid and so forth,” she said. “The aggregated reports will be available to the public, and most particularly, to academic researchers who want to use this powerful tool to understand the issues around the cause of certain kinds of medical treatment.”

 

A previous version of this article incorrectly stated that Denise Love, executive director at the National Association of Health Data Organizations and co-chair of the APCD Council, said a lack of data about malpractices was one factor behind APCD implementation. In fact, she did not say a lack of data about malpractices was a factor for APCDs. The Herald regrets the error.

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