Massachusetts
Title or Name of APCD System:
Massachusetts All-Payer Claims Database
Category:
Existing
Who Maintains the System:
Massachusetts Center for Health Information and Analysis
Website:
First Year APCD Collected Data:
2009
APCD Snapshot:
The Health Care Quality and Cost Council was established to design a consumer-friendly website that would provide transparency about healthcare costs and quality for the public. The desire to improve health care quality, reduce racial and ethnic disparities and contain health care costs was expressed in their statute. The authority to collect claims data was established under the same legislation that established the Council. Since then, the Division was given authority, under a separate bill, to examine cost containment. Massachusetts began collecting claims in 2008, retro to July 2006. The Division adopted new regulations in July 2010 and includes the collection of medical, pharmacy, and dental claims, and information from member eligibility, provider, and product files encompassing fully-insured, self-insured, Medicare, and Medicaid data.
Number of Commercial Sources of Claims Data:
100
Sources and Status of APCD Data Collection
| Payers | Currently Collected | Planned Collection |
|---|---|---|
| Commercial Payers | Yes | -- |
| Third Party Administrators/Self-Funded | Yes | -- |
| Medicaid | Yes | -- |
| Medicare | Yes | -- |
| Types of Data Collected | Currently Collected | Planned Collection |
|---|---|---|
| Medical Claims | Yes | -- |
| Eligibility | Yes | -- |
| Dental | Yes | -- |
| Pharmacy | Yes | -- |
| Other | Collection of Product and Provider files | |
Primary Users/Uses:
1) Cost analysis and 2) Facilitation of administrative simplification by serving as the central repository of health care claims data for Massachusetts state government agencies
Future Plans:
Anticipating an expansion of the original regulation to include collection of Medicaid claims and require self-funded to submit. Studies of cost, patterns/episodes, global payments, modeling, behavioral health, co-morbidity, leading indicators; maybe quality, system utilization
State Specific Resources:
CHIA, Overview of the Massachusetts APCD, 2016
How employer participation in the MA APCD can curb health care costs, June 2016
July 2015 Enrollment Trends Publications, July 2015
Massachusetts Payment Reform: The Role of a Robust Massachusetts All-Payer Claims Database; Recommendations for Policymakers, October 2011
AGO Examination of Health Care Cost Trends and Cost Drivers, MA Attorney General Office, June 2011
Contact Information:
For more information please contact Kathy Hines at Kathy.Hines@state.ma.us