The concept of All-Payer Claims Databases (APCD) has been catching on in 2009.[1] Tennessee and Oregon passed legislation to enact APCDs and Minnesota and Utah worked to implement databases that were authorized in 2008. These states joined at least 6 other states that already have some form of an APCD. In addition, 2009 was an important year for a somewhat unique claims database in Wisconsin, led by the Wisconsin Health Information Organization (WHIO).
The WHIO was incorporated in late 2006 by ten founding members[2] that included payers, purchasers, and providers. All the founding members paid dues to get the initiative started. The organization developed by-laws and added two state agencies as members in 2007. They conducted business planning and settled on a technology partner in 2008, and in 2009 they began testing with an initial set of data. In August of 2009, they were able to issue the first complete data set to WHIO members and in October they announced that subscriptions were available to other organizations that would like access to the information.
Looking ahead, the WHIO will work with providers in 2010 to test the reliability of the data and its ability to enable them to respond to existing variations in quality and resource utilization between providers. The WHICH also has a contract with the state of Wisconsin to begin consumer level reporting in 2011. The goal is to create a public value metric that reflects the cross-section of cost and quality for specific episode treatment groups for each provider. The metric will be designed in order to be useful to both consumers and providers.
The WHIO Health Analytics Exchange is a unique APCD in that it is located in, and driven by, the private sector. This has forced them to work effectively with stakeholders and to find a financial model that makes the organization sustainable. Participation is voluntary, and WHIO currently has 29 percent of the health care claims in the state. They have commitments for submission of Medicaid program and other provider-sponsored health plan data that will bring that total to over 50 percent of the population in 2010.
[1] The State Coverage Initiatives Program hosted an all-day conference on APCDs in partnership with the National Association of Health Data Organizations (NAHDO) in October, 2009. An agenda for the meeting along with the slides of the presenters can be found at: http://www.statecoverage.org/node/1986.
[2] The founding members of WHIO are: Anthem Blue Cross and Blue Shield of Wisconsin, Greater Milwaukee Business Foundation on Health, Humana, The Alliance, United Healthcare of Wisconsin, WEA Insurance Trust, WPS Health Insurance, Wisconsin Collaborative for Healthcare Quality, Wisconsin Medical Society, and Wisconsin Hospital Association. They were soon joined by the Wisconsin Department of Health Services and the Wisconsin Department of Employee Trust Funds.
