How Claims Data Expand Health Equity
This article was written by Jenn Whinnem, digital media manager at the Connecticut Health Foundation.
One of the key components of the Connecticut Health Foundation (CT Health)’s approach to expanding health equity is helping ensure that the system is providing the type of care we all want to receive – care that is affordable, comprehensive, and accountable.
An All Payer Claims Database (APCD) is a valuable new tool that can provide large data sets about affordability, comprehensiveness, and accountability.
The Connection between Better Care and Claims Data
Access Health Analytics (the name of the APCD in CT) will be a database containing information from medical claims filed with all health care payers (“payers”), both commercial and public, in the state. Data will be scrubbed of all personally identified health information to protect consumer privacy. Data will also only be available to certain people.
The real boon of pulling all these claims together is comparison. Ideally, when we compare these claims against each other we can answer these questions:
- What is the real cost of an MRI at Hospital X?
- Which is less expensive, an MRI at Hospital X or Hospital Y?
- How many MRIs are being ordered at Hospital X, and are they medically necessary?
The complexity of this effort can’t be overstated. An advisory group is still working out the details. Data collection and claims systems are not uniform or harmonized across payers. This leads to two questions, 1) which data are included, and 2) how can the database talk to the different claims systems?
Let’s examine this through the lens of health equity.
What Access Health Analytics Means for Health Equity
Race and ethnicity data are not collected uniformly across payers. In some cases, it’s not collected at all.
Multiple pieces are at play here:
- When consumers enroll in a health insurance plan, they have the option of filling out their race and ethnicity data. But that is by law voluntary, and no payer faces a penalty if they don’t collect those data. The industry average for receiving this data at the point of enrollment in a commercial plan is five percent.
- Payers don’t need race and ethnicity data to pay claims. While that information may be in a member’s profile, that information is not readily available to the people paying the claims. Ostensibly this means that a member’s race and ethnicity do not factor in to whether or not a claim gets paid.
Having that data, however small, would allow those of us interested in health equity to benchmark the care and health outcomes of people of color.
Are consumers of color receiving the same care as white consumers? And what are the outcomes? We’ve known for a long time that African Americans with diabetes are more likely to have a limb amputation than their white counterparts. Access Health Analytics may not be able to answer these questions, but the data can surface patterns that we can explore through other forms of inquiry.
It’s not just diabetes. Disparities in health and care cross the chronic condition spectrum. Diabetes, renal disease, cardiac disease, asthma, are all examples of where people of color suffer worse health outcomes.
Access Health Analytics data can let us compare the health care that accompanies those outcomes.
Timeline for Access Health Analytics
Access Health Analytics will collect race and ethnicity data. But as noted previously, the availability of these data are expected to be low.
At the time of writing, AHCT was in the final stages of selecting a data manager through a competitive bidding process.
The first products geared toward consumers are expected toward the beginning of calendar year 2015.
CT Health made a grant to the Connecticut Health Policy Project and the Connecticut Center for Patient Safety to make comprehensive policy recommendations about the design, development, and usefulness of the APCD. You can read their report, The Power of Data: Consumer Involvement and Accountability for Connecticut’s All Payer Claim Database (APCD), here.
If you’re interested in following the advisory group’s progress, their meetings are open to the public. This website contains details of their meetings.
 The security of protected health and personally identifiable information is a genuine concern, but it is not within the scope of this article to discuss. If you’re interested, contact me at firstname.lastname@example.org and we can plan an article or blog post.