Producing comparable cost and quality results from all-payer claims databases

Area of Science:

• Health Services Research
• Health Informatics
• Comparative Effectiveness Research

Background:

• All-payer claims databases (APCDs) are valuable for healthcare analysis but often lack standardization across states.
• Developing comparable cost and quality metrics across different state APCDs presents a significant challenge.
• This study addresses the need for standardized data to understand healthcare costs and quality across delivery organizations.

Purpose of the Study:

• To evaluate the feasibility of using APCDs for multistate analysis.
• To overcome data standardization barriers for comparable cost and quality results across four states.
• To inform state, regional, and organizational healthcare policy through standardized performance measures.

Main Methods:

• A descriptive account of the process for producing healthcare quality and cost measures from regional APCDs.
• Standardization of calculations for cost and quality measures using 2014 commercial claims data from Colorado, Massachusetts, Oregon, and Utah.
• Development of standardized rules for payer inclusion, data elements, measure specifications, SAS code, and population adjustments.

Main Results:

• A Uniform Data Structure file format was developed.
• This format is scalable across populations, measures, and research dimensions.
• The study successfully produced comparable healthcare cost and quality findings across four states.

Conclusions:

• Multistate analysis using APCDs is feasible with standardized processes.
• Standardized state-based claims data can yield comparable healthcare performance measures.
• The findings support evidence-based healthcare policy at various levels.