A new kind of statewide data system is emerging with great potential to provide policy makers, researchers, purchasers, and consumers with broader information than is available anywhere else today. The data sources of these databases are carriers, plans, third-party administrators, pharmacy benefit managers, state Medicaid agencies, and Medicare. The data reporting includes eligibility and claims data (medical, pharmacy, and dental) and are being used for cost, health care utilization, and quality reporting.
We are learning from three pioneering states that have established all claims reporting systems: Maine, Vermont, and New Hampshire. Implementation is underway in Utah, where legislation was enacted to establish claims reporting and Massachusetts has proposed reporting rules to govern health care claims reporting. Other states are actively planning for a payer-based system or evaluating the merits of such a system for their states. All of these states have established statewide all payer all patient hospital reporting systems and the all claims reporting from payers augments, but does not replace, the hospital discharge data.
The Regional All Payer Health Information Council (RAPHIC) is a federation of government, private, non-profit, and education organizations focused on improving the development and deployment of all payer claims databases that many states are undertaking. http://www.raphic.org/index.html. The first National All Payer Claims Databases conference was held in Beverly, MA April 17-18, 2008. The Massachusetts Health Data Consortium, the National Association of Health Data Organizations (NAHDO), and the Regional All Payer Healthcare Information Council (RAPHIC), and the New Hampshire Institute for Health Policy and Practice at the University of New Hampshire (NHIHPP) partnered to convene this meeting which drew 125 people representing 25 states and the District of Columbia. http://www.mahealthdata.org/forums/events/2008/SW_0417/AllPayerIssueBrief_20080511.pdf.