Abstract
We present a process to evaluate the continuing development of All Payer Claims Databases (APCDs) using a collaborative evaluation process. Project teams enhanced the Utah APCD with improved analytic capacity to provide online pricing and cost-transparency reports to support health care reform in Utah. Our program evaluation efforts added key methods and tools, building on recommendations in the APCD Development Manual to provide evaluation data facilitating improvements [1]. These additions included a Collaborative Evaluation Model, logic models, and development and use of best practices as measures. Stakeholders found that the added use of best practices, logic models, and frequent feedback to practitioners facilitated the project’s success. Since the Collaborative Evaluation Model served a structural purpose, it was transparent to the project teams.
Highlights
All Payer Claims Databases (APCDs) currently operate in thirteen states, with five more being implemented [2]
We present a process to evaluate the continuing development of All Payer Claims Databases (APCDs) using a collaborative evaluation process
Since the Collaborative Evaluation Model served a structural purpose, it was transparent to the project teams
Summary
APCDs currently operate in thirteen states, with five more being implemented [2]. In broad terms, an APCD’s purpose is to facilitate curtailing the rising costs of healthcare [1] [3] [4] [5] [6] [7]. Developing actionable information requires stakeholder participation to determine the use cases that should be addressed in a given location to provide value to consumers for useful decision-making and the costs to be included [3] [4]. We present an evaluation process that stakeholders viewed favorably Stakeholders, such as employers, the public, insurers, and payers, all participate in healthcare decisions. Stakeholders external to UDOH’s Office of Healthcare Statistics (OHCS) participate in the governance structures These stakeholders include consumers, providers, policy makers, researchers, and payers, as well as organizations related to health information exchange and healthcare quality improvement [12]. The most recent funding resulted from the CMS Grants to States to Support Health Insurance Rate Review and Increase Transparency in Health Care Pricing, Cycle III (Cycle III grant) available through the UDOH. The Cycle III grant required an evaluation component for which we developed a novel APCD evaluation process that builds on recommendations found in the APCD Development Manual [1]
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