All Payer Claims Data

About the All Payer Claims Data

Healthcare reform advocates at the state and national level are calling for increased transparency in our healthcare system. Numerous states including Utah have collected hospital discharge data for several years. While data derived from hospital discharge records remains valuable, an increasing number of states began collecting medical and pharmacy claims data across healthcare insurance carriers (payers) in what are commonly called All Payer Claims Databases (APCD).

Utah’s APCD contains data from health insurance carriers, Medicaid, and third party administrators in Utah.  These data consist of medical, pharmacy, and dental claims as well as insurance enrollment and health care provider data. During processing these files are cleaned, standardized, and enhanced with analytics software that produces data on risk and burden of illness.

Utah’s APCD is a rich source of health care data capable of answering questions such as:

  • What was the patient’s diagnosis and treatment?
  • When was the patient diagnosed with a certain condition and who made the diagnosis?
  • Where did the patient receive treatment?
  • What medications were prescribed as part of treatment?
  • How much did the patient’s care cost?
  • How much of the cost is the insurance company’s responsibility and how much is the patient’s responsibility?
  • Did the patient receive treatment expected by the standard of care?
  • What is a patient or cohort’s risk profile?

 

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