If you haven’t heard of an APCD, it’s one of those acronyms you need to know. All-Payer Claims Databases are simply databases that consist of claims data from all health care payers in a given state. This includes private payers such as Blue Cross Blue Shield, and public payers such as Medicaid or Medicare. As you can imagine, it’s a lot of data, and it certainly fits the mold of “big data.” Moreover, APCDs are setting the stage for data-driven healthcare and big analytics.
Colorado’s APCD website recently went live and I spent some time playing around with the maps and report generation tools. It’s great to see population health and health metrics visually, and Colorado is to be commended for its APCD’s public interface. Giving the public access to this information will empower Colorado’s citizens to make better decisions about their health care.
All that’s been done with APCDs to-date is great, but on my team of analytics-obsessives, we like to continuously ask the question “so what?” What does that mean to the policy maker, the end user, and ultimately to the recipient of services? Now that we have all of this information in one place, how are we maximizing its use to essentially transform a system? With the data in the APCD there are certainly a lot of decisions on the payer, provider, and patient level that can be made. For instance, payers can identify what they’re spending the most on, providers can modify their treatments to be more effective, and patients can be empowered to make better choices. But, what does this mean to really enhancing quality and reaching our ultimate goal of improving health? This where the opportunity to leverage analytics comes into play. Not just any analytics, but advanced analytics. Predictive analytics.
APCDs offer us the ability to be predictive, proactive, preventive and personalized, or what I like to call the 4 P’s of quality care. The first ‘P’ is critical because when we can use the data in our APCDs to predict, we can increase their value tenfold and it becomes a tool in transforming care. While states have a road ahead of them to reach this point, and the dissemination of this data will require more engagement from providers, payers, and patients, big analytics is the direction APCDs are headed. And states can start now by using predictive analysis alongside their current reporting methods.
For example, we can utilize the data to forecast developing health trends and project their costs to the system one, three or five years down the road. Or, we can predict which groups of patients are at-risk for a chronic illness, like high blood pressure or arthritis. As APCDs are expanded to integrate clinical and financial data through linkages with health information exchanges (HIE) and health insurance exchanges (HIX), they will facilitate big analytics to support personalized care, improve health outcomes and reduce costs to our system.