Minnesota's All Payer Claims Database (APCD) Frequently Asked Questions
What is an All-Payer Claims Database or APCD?
The APCD Council is a learning collaborative that focuses on improving the development of APCDs. They define All-Payer Claims Databases as large-scale databases that systematically collect medical claims, pharmacy claims, and eligibility and provider files from private andpublic payers. APCDs include data from all settings of care and permit the systemic analysis of health care delivery.
How many APCDs are operated, nationwide?
Currently, ten other states are collecting and releasing APCD data or reports, including Massachusetts, Tennessee, Utah, Colorado, Kansas, Maryland, Oregon, Vermont, New Hampshire, and Maine. Four states are starting up APCDs: Virginia, Connecticut, Rhode Island, and Arkansas. Fourteen more states have expressed strong interest in further exploring options to start an APCD or expand statewide from a regional project.
With data from Medicaid and Medicare as well as from commercial payers, Minnesota’s APCD is one of a few in the nation that is truly an “All Payer” claims database.
Who is required to submit data to the MN APCD?
According to state regulations, a health plan company or a third-party administrator (TPA) must submit data to the APCD if total claims for MN residents exceed $3 million per year. Pharmacy benefit managers are also required to submit data if total claims for MN residents exceeds $300,000 per year.
Who runs the MN APCD?
The Minnesota Department of Health is legislatively directed to collect data for the APCD. MDH issues regulations describing requirements for data submission. Legislative authority to conduct this work can be found in Minnesota Statutes, Section 62U.04.
How many payers submit data into the MN APCD?
Currently, over 100 different sources submit medical, pharmacy and enrollment data to the APCD. The number of organizations submitting data into the APCD has been increasing over time, as MDH has worked with health plan companies and TPAs to understand and comply with submission requirements.
Six payers alone submit about 80% of the claims volume (HealthPartners, Medica, Blue Cross Blue Shield of Minnesota, UCare, The Centers for Medicare & Medicaid Services, and the Department of Human Services).
Note: 2014 is part-year estimate
What types of data are included in the MN APCD?
APCD data for MN’s residents with health insurance includes:
- All medical and health services insurance claims paid by a health plan company or TPA, including
- Commercial products and
- Managed care data for Medicaid and Medicare
- Medicare fee for service data
- Medicaid and other state fee for service claims
Are there types of health insurance not included in the MN APCD?
The following types of health insurance policies or sources of coverage are excluded by administrative Rule:
- Hearing, dental, vision, or disability-only;
- Auto medical or accident-only;
- Insurance supplemental to liability;
- Long term care or Workers Compensation;
- Medicare Supplemental and Medigap;
- Veterans Affairs, Indian Health Service, Tricare;
- Carriers with less than $3 million in annual medical and/or $300,000 in annual pharmacy claims
- Non-Minnesota residents
The APCD also does not include information about people without health insurance.
How much information does the MN APCD contain?
Minnesota’s APCD captures enrollment and claims for approximately 85% of the state. Minnesota’s APCD has grown larger and become more inclusive every year. MDH continues to work with health plan companies and pharmacy benefit managers to increase the completeness of the data.
The MN APCD collects de-identified member information; the number of covered lives is equal to or less than the number of Unique Member IDs.
What types of information are included in the data?
Records in the APCD include information about diagnoses, procedures, and duration of treatment, as well as de-identified demographic information (age, gender, geography) and high-level health plan product information. Information about prices paid for services is also included. The APCD does not include direct patient identifiers, such as social security number, name, or address.
Does the MN APCD contain patient names or identifying information?
The APCD does not collect patient identifiers such as social security number, name, or address. All data are encrypted using up-to-date industry standard encryption algorithms. The encryption of identifying information happens before the data are submitted, ensuring only encrypted values reach the database. Since the encryption is a one way process (performed by the health plan submitting the data) it cannot be decrypted by data users. For example, after encryption, the name Jane R Doe might look something like this: z3x@K57#.
How is the information in the MN APCD protected?
Data in the MN APCD is protected physically, technically and administratively. Data are housed on secure servers that are not accessible through the internet. Access controls to the data are strictly limited to staff with appropriate training and clearance. Analysts are prevented from intentionally or unintentionally removing detailed information from the storage environment. State of the art software and hardware solutions are in place to further protect the data.
Notably, the MN APCD has been certified as a Qualified Entity by the Centers for Medicare & Medicaid Services (CMS). To achieve this certification, CMS conducts an on-site audit to verify that the organization adheres to strict data management and security standards.
How does MDH ensure that data in the MN APCD are of high quality? MDH contracts with a vendor to perform data collection, processing, quality assurance, and aggregation. The vendor produces regular data extracts of cleaned data for MDH and performs basic services that ensure consistency of the data. As part of this work, the vendor conducts over 500 quality assurance checks that include, among others, the following:
- Accuracy of dates of service spans;
- Validity of data identifying submitters and providers;
- Consistency of record layout and counts;
- Consistency with MN-established health care claims threshold levels;
- Degree of duplicate records; and
- Variation in claim volume trends and payment patterns.
MDH conducts additional benchmarking and validation activities once the vendor completes its rounds of quality analysis and is working to identify provider and stakeholder organizations interested in performing specific validation tasks. In addition, MDH is taking the following tangible steps to publicly report on the status of quality of the MN APCD:
- MDH is currently implementing a requirement in its contract with the new data aggregation vendor to produce a biannual data quality report. This report would be specific to each data update. It will be public. We aim to receive the first update by November, 2014.
- MDH is currently negotiating a contract with a vendor to independently assess the quality of data along a number of metrics. This report, which will also include recommendations for improvement and increased compliance, will be public. It will be available by the end of 2014.
- MDH is currently in the process of procuring a vendor to conduct legislatively required work on assessing the feasibility of using the APCD for state-based risk adjustment of the individual and small group market. This contract includes funding to perform spot audits of the data. The results of this work will be communicated in a report to the Legislature that will be public.
- MDH has applied for grant funding to hire dedicated staff in MDH to perform additional quality assessment, enhance quality reporting, and further improve quality.
Is MDH’s goal to establish perfection of data before putting it to use?
No. There is no data set that would meet a standard of perfection, even one such as claims data that is used for financial transactions. The volume of the data; the consistency of its submission by health plans, including carriers in Minnesota; and the increased compliance by payers over time make the data highly comprehensive for the Minnesota health care market and representative of providers. The richness of data far surpasses statistical samples that are often used for claims research and provide a more complete picture than data from one payer (e.g., Medicare), one market space (e.g., state public programs), or one part of the state (e.g., the Twin Cities metro). This makes the data useful to many applications.
That said, it is important to note that there are inherent limitations to claims data, including the MN APCD: (1) data are not fully identified, making validation complex; (2) data, while comprehensive, are limited by statutory intent; (3) data may reflect variations among providers in coding and differences among payers in retention of data elements; (4) data may lack unique identification of providers; and (5) they lack some granularity that might be available in medical records.
How is the information currently being used?
At this point the MN APCD can only be used for limited applications defined by the Minnesota Legislature. They include:
- Evaluating the state’s Health Care Home program and the State Innovation Model grant initiatives.
- Studying service provision for chronic pain management.
- Assessing the feasibility of using the data for state-based risk adjustment in the individual and small group market.
- Conducting research in the variation of health care costs, quality, utilization and illness burden, including by considering demographic and geographic factors.
What have other states done with APCD data?
Each state with an APCD uses the information in ways unique to its own population and needs. These states benefit from knowing more about the care system, how often and where residents access care, and population health.
Initial uses of APCDs have been to publish results allowing the public to compare variation in disease burden and health care quality and to allow consumers a better understanding of statewide variations in the amounts paid for health care. For example, states have used these data to report on chronic disease burden and geographic variations. Others are considering use of the data for rate review and risk adjustment. A few states are looking for ways to use the data to help consumers make informed choices about health care, including about provider-specific prices. Several states with existing APCDs are exploring opportunities to broaden the user community to include state human services agencies; insurance departments; health policy and planning; and health insurance exchanges as well as academic researchers. Some examples of use cases by other states are available online: APCD Showcase Website.
Can users other than MDH access the data in the MN APCD?
As of July 2014 only staff at MDH or organizations under contract with MDH to conduct research on its behalf can access the data. The 2013 legislature has directed MDH to convene a work group in the summer of 2014 to weigh in on the question of expanded use of the data. This work group will make recommendations to the 2015 legislature on the guiding principles of who may use the data and for what purpose beyond MDH.
Where can I find out more information about the MN APCD?
MDH maintains a website with information about the MN APCD. It contains basic background information, this document, detail about a workgroup that is considering recommendations on a framework for potential future use, as well as information about the data collection requirements. The website can be accessed here: Minnesota APCD Homepage.