Initial All Payer, All Claims Data Reveals a Lot of Unknowns
June 29, 2012—More work needs to be done on Oregon’s all payer, all claims database before state officials have a better grasp of healthcare costs and an idea of which services are being used more than others, according to a recent report given to the Health Policy Board.
Such a system, which was given the go-ahead by the Legislature in 2009, collects a wide variety of data from health insurers, third party administrators, Medicaid, Medicare and pharmacy benefit managers.
The data, which is largely financially-oriented, includes information on claims, plan payments, a member’s cost sharing responsibilities for co-payments, coinsurance and deductibles, diagnoses and procedures performed, a member’s age, gender, race/ethnicity data, and whether the treatment they received was inpatient, outpatient, or from an emergency department.
Oregon began collecting data in the fall of 2010. Since then, approximately 153 million claims have been submitted by 37 payers, according to Gretchen Morley, the Oregon Health Authority’s director of health analytics. During those two years, a “back of the envelope” estimate of those costs are roughly $27 billion.
Currently, the all payer, all claims system is not collecting data for Medicare fee for service, uninsured and self-pay, and stand alone dental and vision coverage, but eventually that will happen, Morley said.
It is unclear when that will occur. Neither Morley nor spokespeople from the Oregon Health Authority returned a call for comment.
But Morley did tell the Policy Board that her agency is working to improve the data’s quality so it can be more informational. “There's a lot of work to be done,” she said.
Much of the discussion during the Policy Board’s meeting focused on what the data revealed in terms of a person’s race and ethnicity, which is considered a major factor influencing access to healthcare.
Analyzing the data from the commercial insurers, Morley found that more than 90 percent of the claims did not reveal anything about a person’s race and ethnicity is unknown. The data for Medicare was slightly better, while the Medicaid data showed that roughly 60 percent of people were white, while 30 percent of the time that information was unknown.
The Medicaid data is more informative, according to Tina Edlund, the authority’s policy chief, because anyone contracting with that agency must collect information on race and ethnicity, which is not true for commercial insurers.
“We’re hoping to see this improve,” Morley said.
The state is also asking the Centers for Medicare and Medicaid Services, as part of its waiver application to proceed with coordinated care organizations, to allow the people to give people the option of refusing to identify their race and ethnicity on their enrollment forms, rather than skip that question.
Morley also said the Oregon Health Authority exerts tight control over who has access to the claims data to protect the privacy of the member information.
“Because of the identifiable data, there is virtually no one who has access to the full data,” she said.