Download the claims data survey summary here.

 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. 

A new wave of health care transparency has descended upon us.  States vary in their responses to the current push for consumer quality reports.  Keeping track of the proliferation of measures and the number of entities and coalitions producing quality reports is daunting.  Transparency legislation is being enacted across states and these are too often unfunded or under-funded, but with expectations of rapid implementation.  State health care reform efforts are embedding transparency as a way to promote consumer choice, reduce costs, and improve quality.  Nationally, the Department of Health and Human Services is rolling out the "Four Cornerstones Plan", that include price transparency, quality measurement, connectivity, and incentives and chartering regional "Value Exchanges" to advance these cornerstones (.http://www.hhs.gov/transparency/fourcornerstones/).  The Centers for Medicare and Medicaid Services (CMS) will standardize measures and policies, including the formation of "Better Quality Information to Improve Care for Medicare Beneficiaries" (BQIs).  In short, transparency is sprouting roots at various levels of our health care system.

Is your health data agency ready?  How will your agency respond to new demands for health information?  How will you position your agency to participate in this new transparency wave? 

Transparency in health care has been the core mission of NAHDO and its members, many of whom rode the first wave of transparency in the early 1990's.  Many of our state health data agencies were pioneers in making comparative hospital and physician quality and cost performance data public and raise awareness about the huge variation that existed then (and continues to exist today) in health care.  States can be proud of their data systems and their accomplishments, which will serve them well in this new transparency phase.  However, not all states are equal when it comes to public quality reporting.  Many states are developing consumer quality websites, but not every state.  The political climate and data infrastructure may not support quality reporting.

States are encouraged to assess their "transparency readiness" using the following indicators of minimum capacity for public reporting.  Does your agency have:

--the ability/authority to release hospital and physician-level information?

--the ability/authority to collect non-inpatient data and information?

--reasonable procedures for distributing analytic information, including de-identified data sets?

--plans to establish a consumer-friendly website, or collaborate with local partners to produce a consumer website?

--a source of stable and sufficient funding to produce quality reports?

The following reporting objectives are suggested for state health data agencies seeking to move to the next level of quality reporting.  Generating quality information from existing data and enhancing existing data will position agencies as a source of health care information for local stakeholders and consumers.  These all are reach of all state health data agencies today (or should be in the near future):

--The ability to calculate and publicly report all of the AHRQ Inpatient Quality Indicators and Prevention Quality Indicators.

--The ability to generate AHRQ Patient Safety Indicators for local collaborative quality improvement efforts. 

--Generating physician volume using the AHRQ IQIs for high volume procedures.

--The addition of Present on Admission, Race and Ethnicity to current reporting requirements. 

Several states are at the forefront of transparency and information.  Maine and New Hampshire are leading the way in creating essential data and information that is unique, moving beyond facility data and charges.  Other states are likely to follow their lead to capture outpatient data through all payer all claims data systems.  Payment data moves these states beyond charges, adding new dimensions to transparency in health care.  Additionally, over 30 states have had legislative activity related to the reporting of healthcare-acquired infections (HAI).  HAI reporting will pose huge implementation challenges but have emerged as a critical public health, purchasing, and consumer issue.

 In summary, consumers and purchasers are seeking information and states should be playing a key role in local and national transparency initiatives.  How can state health data agencies position themselves to respond?

--Use your legal authority, if you have it.

--Expand your data collection beyond inpatient and facility data.

--Enhance your inpatient and other data resources with clinical data elements.

NAHDO's Quality Reporting Workgroup will continue to help states advance their quality data and reporting agendas by convening monthly calls and supporting a Present on Admission and Quality Reporting web forums (http://www.nahdo.org/CS/forums/default.aspx).  NAHDO is actively engaged with the national agenda, including the National Quality Forum in the Consumer and Public Health Council.  We are promoting the use of existing data systems to measure quality and are working to dispel the myths of administrative data in quality reporting.  We ask all of you to join us.

Regards,

 Denise Love, Executive Director--NAHDO