Case Studies

Resource	Category	Carriers	Purpose
Fragmented Financing in Emergency Department Use Among US Veterans This study found that emergency care for U.S. veterans is often fragmented because many veterans receive emergency department services that are paid… State: New York	Insurance Department, Population Health, Researchers	Commercial, Medicaid, Medicare	Cost, Utilization
Curbing the Growing Fragmentation of Veterans' Health Care This article discusses how healthcare for U.S. veterans is becoming increasingly fragmented as more care is delivered outside the Veterans Health… State: New York	Health Reform, Population Health	Commercial, Medicaid, Medicare	Cost, Quality, Utilization
Gender-Affirming Chest Masculinization and Nipple–Areolar Complex Reconstruction: An All-Payer Claims Database Analysis This study analyzed 912 gender-affirming chest masculinization surgeries performed in Massachusetts between 2016 and 2020 and found that 70% included… State: Massachusetts	Population Health, Researchers	Commercial, Medicaid	Cost, Utilization
Rural–Urban Differences in Use of Diabetes Self-Management Education and Support in Arkansas, 2015–2019 This study found that adults with diabetes living in rural areas were less likely to participate in Diabetes Self-Management Education and Support (… State: Arkansas	Population Health, Researchers	Commercial, Medicaid	Utilization
Poverty and Mortality Risk in Patients With Colorectal Cancer This study found that colorectal cancer patients living in areas of persistent poverty had a significantly higher risk of death than those living in… State: Arkansas	Population Health, Researchers	Commercial, Medicaid, Medicare	Quality, Utilization
Rising Health Care Costs in Wisconsin: The Case for Price Transparency The report highlights growing financial and operational challenges facing healthcare organizations in 2026, including policy uncertainty, increasing… State: Wisconsin	Health Reform, Researchers	Commercial	Cost
Incidence of pediatric chronic tic disorders and feasibility of using the Massachusetts All-Payer Claims Database, 2012-2016 This study found that the Massachusetts All-Payer Claims Database can be used to identify new cases of chronic tic disorders, such as Tourette… State: Massachusetts	Researchers	Commercial, Medicaid, Medicare	Utilization
Health Insurance Claim Denials The article explains that health insurance claim denials are becoming increasingly common in the U.S., affecting everything from preventive care to… State: Massachusetts	Consumers, Insurance Department, Researchers	Commercial, Medicare	Cost, Quality, Utilization
Leveraging Population-Level and Multipayer Claims Data to Estimate Changes in Prostate Cancer Screening at the Small-Area Level This case study uses the Colorado's All-Payer Claims Database (CO APCD) to measure prostate screening procedures in men ages 55-69, finding that… State: Colorado	Population Health, Researchers	Commercial, Medicaid, Medicare	Utilization
Physical therapy utilization among firearm injury survivors: an analysis of linked trauma database and medical claims data This case study uses the Washington State All-Payer Claims Database (APCD) linked with a trauma registry to analyze the utilization of physical… State: Washington	Population Health, Researchers	Commercial, Medicaid, Medicare	Utilization
Kidney Screening Care Coverage Analysis The report supports preventive kidney screening coverage as a cost-effective public health strategy that could improve early diagnosis, reduce severe… State: Colorado	Health Reform, Insurance Department, Population Health	Commercial	Cost, Utilization
Maryland Medical Assistance Program and Health Insurance – Required Coverage for Menopause-Related Treatment, Care, and Training of Clinicians This report evaluates the use, cost, and insurance impact of menopause-related treatments—especially prescription drugs—within Maryland’s healthcare… State: Maryland	Health Reform, Insurance Department	Commercial	Utilization
Using prescription medication utilization trends to evaluate health system resilience and inform future emergency preparedness The study examines how changes in prescription medication use during the COVID-19 pandemic can reveal strengths and weaknesses in the healthcare… State: Colorado	Population Health	Commercial, Medicaid, Medicare	Utilization
Evaluating the impact of health equity zones to mitigate disparities in cancer screening: study of colorectal cancer screening in Rhode Island This case study uses Rhode Island's all-payer claims database (HealthFacts RI) to evaluate whether the state's Health Equity Zones… State: Rhode Island	Population Health	Commercial, Medicaid	Utilization
Maryland Medical Assistance Program and Health Insurance – Required Coverage for Aesthetic Services and Restorative Care for Victims of Domestic Violence This mandate study uses Maryland's All-Payer Claims Database (APCD) to estimate the fiscal impact of requiring Medicaid and commercial insurers… State: Maryland	Consumers, Health Reform, Insurance Department	Commercial, Medicaid	Cost, Utilization
Corporate Moral Hazard In U.S. Health Insurance: Churn And Denial Rates This dissertation uses the New Hampshire APCD to examine whether commercial insurers increase claim denial rates ahead of the predictable transition… State: New Hampshire	Health Reform, Insurance Department, Researchers	Commercial, Medicaid, Medicare	Cost, Utilization
Novel approaches in linkage of data sources to explore the associations between purchase of opioid prescriptions during pregnancy and adverse neonatal outcomes This case study links Arkansas APCD and PDMP data to assess prescribed opioid exposure during pregnancy, demonstrating that combining both data… State: Arkansas	Population Health, Researchers	Commercial, Medicaid	Utilization
County-level medical debt and treatment initiation among individuals newly diagnosed with cancer This case study examined the relationship between county-level medical debt and timely cancer treatment initiation, finding that patients in counties… State: Colorado	Health Reform, Population Health, Providers	Commercial, Medicaid, Medicare	Cost, Quality
Provider networks for pulmonary hypertension in Massachusetts: Implications for improving referrals to expert care This case study found significant gaps in connections to expert care, even among providers caring for patients at risk for pulmonary arterial… State: Massachusetts	Consumers, Medicaid, Population Health, Providers	Commercial, Medicaid, Medicare	Quality, Utilization
Reclassifying Primary Care: A Decision Tree Approach to Improving Workforce Estimates and Research Using Claims Data This case study uses Virginia APCD data to develop and validate a decision tree classifier for identifying primary care clinicians in claims data,… State: Virginia	Employers, Providers	Commercial	Utilization

Case Studies

APCD Showcase

APCD Council