Massachusetts
Category
Title or Name of APCD System
- Massachusetts All-Payer Claims Database
Who Maintains the System
- Massachusetts Center for Health Information and Analysis
Legal Authority
Submission Rules
Release Policy
First Year APCD Collected Data
- 2009
APCD Snapshot
- In 2009, the Division of Health Care Finance and Policy (CHIA’s predecessor agency) began to collect detailed claims data from payers following earlier preliminary efforts. The project charter established the goal of administrative simplification: making the database a central resource for all state agencies needing claims-level data to support their missions. This focus was important to secure the support of the insurance carriers who would be submitting data to the MA APCD. While implementation of the MA APCD would require significant resource investment by the carriers, it would also reduce the proliferating—and sometimes conflicting—requests for carriers to submit data to different state agencies. The charter also called for enhancing the data to facilitate analysis and making the database widely available: to the public to help inform policy, to consumers to support health care purchasing decisions, and to physicians to support care management and coordination. Responsibility for the MA APCD was transferred to CHIA in November 2012 following its creation earlier that year.
Number of Commercial Sources of Claims Data
- 52
Sources and Status of APCD Data Collection
Payers
Commercial Payers
- Currently Collected
Third Party Administrators/Self-Funded
- Currently Collected
Medicaid
- Currently Collected
Medicare
- Currently Collected
Other
- Collection of Product and Provider files
*Self-funded claims are Voluntary
Types of Data Collected
Medical Claims
- Currently Collected
Eligibility
- Currently Collected
Dental
- Currently Collected
Pharmacy
- Currently Collected
Primary Users/Uses
- 1. Cost analysis
2. Enrollment monitoring
3. Facilitation of administrative simplification by serving as the central repository of health care claims data for Massachusetts state government agencies
4. Academic research
State Specific Resources
Contact Information
- For more information, please contact apcd.data@chiamass.gov
Use Cases from the APCD Showcase
Displaying 11 - 15 of 27
| Use Cases | Category | Carriers | |
|---|---|---|---|
"In this report, required by Section 130 of Chapter 47 of the Acts of 2017, the Massachusetts Health Policy Commission (HPC) examines the prevalence and impact of health insurance payer policies that seek to reduce overall pharmaceutical spending by requiring alternative methods of distribution and payment for certain costly specialty drugs. The specific drugs subject to these policies are not those typically dispensed by a retail pharmacy directly to a patient, but instead are administered by a clinician to a patient through injection or infusion in the outpatient setting (e.g. chemotherapy injections). These clinician-administered drugs are typically high priced and represent a growing share of all pharmaceutical spending in Massachusetts and the U.S." |
Consumers, Health Reform, Insurance Department, Population Health, Providers, Researchers | Commercial, Medicare | |
The July 2015 edition of the Massachusetts Health Care Coverage: Enrollment Trends, offers new insights into changes in health insurance coverage through the second Affordable Care Act Open Enrollment period in Massachusetts. Coverage is defined by unique Massachusetts residents in primary, medical membership within the top 16 commercial payers and, to the extent data allow, within MassHealth (Medicaid) and Medicare. |
Consumers, Health Reform, Insurance Department, Medicaid, Population Health | Commercial, Medicaid, Medicare | |
Enrollment Trends monitors health insurance coverage in Massachusetts. Coverage is defined as primary, medical insurance administered by the top 14 commercial payers, MassHealth (Medicaid), or Medicare. This report relies on data from December 2013 through March 2016 from the Massachusetts All-Payer Claims Database (MA APCD) to analyze changes in enrollment trends among different insurance plans. |
Consumers, Employers, Health Reform, Insurance Department, Medicaid, Researchers | Commercial, Medicaid, Medicare | |
The Center for Health Information and Analysis' (CHIA) annual report on the Massachusetts healthcare system monitors quality and cost trends over time to inform policy making. Key findings are made in the areas of total health care expenditures, quality of care, and private commercial contract enrollment, among others. These findings inform the Health Policy Commission's (HPC) 2016 Health Care Cost Trends Hearing. |
Consumers, Employers, Health Reform, Insurance Department, Medicaid, Providers, Researchers | Commercial, Medicaid, Medicare | |
This report provides baseline information about MassHealth's eligibility and claims data. MassHealth is the Commonwealth's combined Medicaid and Children's Health Insurance Program (CHIP) insurance. The Center for Health Information and Analysis (CHIA) analyzed eligibility, enrollment, and claims data submitted to the Massachusetts All-Payer Claims Database (MA APCD) by MassHealth for state fiscal years (SFY) 2013 and 2014. |
Health Reform, Insurance Department, Medicaid, Providers, Researchers | Medicaid, Medicare |